{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T04:30:43Z","timestamp":1786681843636,"version":"build-2736575974"},"reference-count":58,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Coeliac disease (CD) is associated with neurological manifestations, including peripheral neuropathy. While sensorimotor neuropathy has been described, objective evidence for small-fibre neuropathy (SFN) in CD remains limited. We aimed to assess large- and small-fibre involvement in patients with CD with and without neuropathic symptoms using contemporary diagnostic standards.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this cross-sectional study, 36 adults with biopsy-proven CD were recruited nationwide and stratified by the Neuropathy Symptom Score into symptomatic (pwCD(NS+), NSS\u202f\u2265\u202f3) and asymptomatic (pwCD(NS\u2212), NSS\u202f&amp;lt;\u202f3) groups. All participants underwent neurological examination, sural nerve conduction studies (NCS), quantitative sensory testing (QST), distal leg skin biopsy for intraepidermal nerve fibre density (IENFD), and autonomic testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>pwCD(NS+) predominantly reported distal symmetric sensory complaints with neuropathic pain characteristics. NCS were normal in both groups, arguing against relevant sensorimotor neuropathy. Both groups showed a loss-of-function QST profile with impaired thermal detection. IENFD was lower in pwCD(NS+) than in pwCD(NS\u2212) and correlated with symptom severity. Autonomic testing was largely unremarkable. 50% of pwCD(NS+) fulfilled the diagnostic criteria for SFN, while all remaining patients showed abnormalities in at least one small fibre-related domain (clinical examination, IENFD or QST). In pwCD(NS\u2212), isolated abnormalities in QST or IENFD were frequently observed despite the absence of neuropathic symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In CD, neuropathic symptoms are associated with small-fibre pathology rather than sensorimotor neuropathy. SFN should be considered in the diagnostic work-up of neuropathic complaints in CD, and symptom-oriented treatment is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1858125","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T04:22:20Z","timestamp":1786681340000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Small-fibre neuropathy in coeliac disease: a cross-sectional study"],"prefix":"10.3389","volume":"17","author":[{"given":"Livia Sophie","family":"Lang","sequence":"first","affiliation":[{"name":"Department of Neurology, University Medical Center of the Johannes Gutenberg-University Mainz","place":["Mainz, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panoraia","family":"Baka","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Medical Center of the Johannes Gutenberg-University Mainz","place":["Mainz, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikola","family":"Hauke","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Medical Center of the Johannes Gutenberg-University Mainz","place":["Mainz, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H\u00fcseyin","family":"Uysal","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Medical Center of the Johannes Gutenberg-University Mainz","place":["Mainz, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Majd","family":"Abusaada","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Medical Center of the Johannes Gutenberg-University Mainz","place":["Mainz, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianne","family":"Hahn","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Medical Center of the Johannes Gutenberg-University Mainz","place":["Mainz, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cora","family":"Rebhorn","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Medical Center of the Johannes Gutenberg-University Mainz","place":["Mainz, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clemens","family":"Sommer","sequence":"additional","affiliation":[{"name":"Institute of Neuropathology, University Medical Center of the Johannes Gutenberg-University Mainz","place":["Mainz, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Birklein","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Medical Center of the Johannes Gutenberg-University Mainz","place":["Mainz, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Violeta","family":"Dimova","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Medical Center of the Johannes Gutenberg-University Mainz","place":["Mainz, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,14]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"830","DOI":"10.1053\/j.gastro.2016.11.043","article-title":"Prevalence and morbidity of undiagnosed celiac disease from a community-based study","volume":"152","author":"Choung","year":"2017","journal-title":"Gastroenterology"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1007\/s00281-012-0311-2","article-title":"Epidemiology and clinical presentations of celiac disease","volume":"34","author":"Reilly","year":"2012","journal-title":"Semin 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