Exploration of Digestive Diseases

Table 2. Neurological complications in celiac disease and malabsorption.

Mechanism/Deficiency	Pathophysiological features	Neurological consequences
Gluten ataxia [131]	Autoantibodies against TG6 target cerebellar neurons; independent of gastrointestinal symptoms.	Progressive ataxia; halted by early gluten-free diet
Peripheral neuropathy [132]	Immune-mediated axonal/demyelinating injury; deficiencies in B1, B6, B12, E.	Sensory loss, paresthesia, motor weakness
Cognitive impairment “brain fog” [133]	Chronic inflammation and micronutrient deficits impair neurotransmission and energy metabolism.	Memory deficits, poor concentration, fatigue
Wernicke’s encephalopathy [134]	Severe B1 deficiency from malabsorption or vomiting; astrocyte dysfunction.	Confusion, ophthalmoplegia, ataxia; medical emergency
Vitamin E deficiency [135]	Oxidative stress and neuronal degeneration in spinocerebellar tracts.	Ataxia, neuropathy, myopathy
Vitamin B12 deficiency [136]	Demyelination of dorsal columns and corticospinal tracts.	Subacute combined degeneration: ataxia, paresthesia, cognitive decline

Return to article view

Declarations

Author contributions

AB: Conceptualization, Writing—original draft. SS: Conceptualization, Writing—original draft. KH: Writing—original draft. VR: Conceptualization, Writing—original draft, Writing—review & editing, Supervision. All authors read and approved the submitted version.

Conflicts of interest

The authors declare that there are no conflicts of interest.

Ethical approval

Not applicable.

Consent to participate

Not applicable.

Consent to publication

Not applicable.

Availability of data and materials

Not applicable.

Funding

Not applicable.

Copyright

Publisher’s note

Open Exploration maintains a neutral stance on jurisdictional claims in published institutional affiliations and maps. All opinions expressed in this article are the personal views of the author(s) and do not represent the stance of the editorial team or the publisher.

References

Lee A, Lee JY, Jung SW, Shin SY, Ryu HS, Jang S, et al. Brain-Gut-Microbiota Axis. Korean J Gastroenterol. 2023;81:145–53. Korean. [DOI] [PubMed] [PMC]

Bhuiyan P, Chen Y, Karim M, Dong H, Qian Y. Bidirectional communication between mast cells and the gut-brain axis in neurodegenerative diseases: Avenues for therapeutic intervention. Brain Res Bull. 2021;172:61–78. [DOI] [PubMed]

Agirman G, Yu KB, Hsiao EY. Signaling inflammation across the gut-brain axis. Science. 2021;374:1087–92. [DOI] [PubMed]

Carabotti M, Scirocco A, Maselli MA, Severi C. The gut-brain axis: interactions between enteric microbiota, central and enteric nervous systems. Ann Gastroenterol. 2015;28:203–9. [PubMed] [PMC]

Dargenio VN, Dargenio C, Castellaneta S, De Giacomo A, Laguardia M, Schettini F, et al. Intestinal Barrier Dysfunction and Microbiota-Gut-Brain Axis: Possible Implications in the Pathogenesis and Treatment of Autism Spectrum Disorder. Nutrients. 2023;15:1620. [DOI] [PubMed] [PMC]

Kandpal M, Indari O, Baral B, Jakhmola S, Tiwari D, Bhandari V, et al. Dysbiosis of Gut Microbiota from the Perspective of the Gut-Brain Axis: Role in the Provocation of Neurological Disorders. Metabolites. 2022;12:1064. [DOI] [PubMed] [PMC]

Li J, Wan B, Zhou L, Qian X, Wang F, Gu S, et al. Gut microbiota dysbiosis induces neuroinflammation in major depressive disorders: mechanisms targeting the gut-brain axis. Front Psychiatry. 2025;16:1629182. [DOI] [PubMed] [PMC]

Khanna L, Zeydan B, Kantarci OH, Camilleri M. Gastrointestinal motility disorders in patients with multiple sclerosis: A single-center study. Neurogastroenterol Motil. 2022;34:e14326. [DOI] [PubMed] [PMC]

Kumar KP, Wilson JL, Nguyen H, McKay LD, Wen SW, Sepehrizadeh T, et al. Stroke Alters the Function of Enteric Neurons to Impair Smooth Muscle Relaxation and Dysregulates Gut Transit. J Am Heart Assoc. 2024;13:e033279. [DOI] [PubMed] [PMC]

10.

Soliman H, Coffin B, Gourcerol G. Gastroparesis in Parkinson Disease: Pathophysiology, and Clinical Management. Brain Sci. 2021;11:831. [DOI] [PubMed] [PMC]

11.

Zhou MX, Zhao Y, Chu CL, Behera TR, Shen QQ, Xing YB. Diabetic gastrointestinal autonomic neuropathy: Integrating neuronal degeneration and gut microbial dysbiosis. World J Diabetes. 2025;16:110053. [DOI] [PubMed] [PMC]

12.

Corsello A, Scatigno L, Govoni A, Zuccotti G, Gottrand F, Romano C, et al. Gut dysmotility in children with neurological impairment: the nutritional management. Front Neurol. 2023;14:1200101. [DOI] [PubMed] [PMC]

13.

Singh A, Dawson TM, Kulkarni S. Neurodegenerative disorders and gut-brain interactions. J Clin Invest. 2021;131:e143775. [DOI] [PubMed] [PMC]

14.

Lorsch ZS, Liddle RA. Mechanisms and clinical implications of gut-brain interactions. J Clin Invest. 2026;136:e196346. [DOI] [PubMed] [PMC]

15.

Chen J, Xu Y, Cao P. The Role of the Gut-Brain Axis in Diseases. Physiology (Bethesda). 2026;41. [DOI] [PubMed]

16.

Wanyi Z, Jiao Y, Wen H, Bin X, Xuefei W, Lan J, et al. Bidirectional communication of the gut-brain axis: new findings in Parkinson's disease and inflammatory bowel disease. Front Neurol. 2024;15:1407241. [DOI] [PubMed] [PMC]

17.

Spear ET, Mawe GM. Enteric neuroplasticity and dysmotility in inflammatory disease: key players and possible therapeutic targets. Am J Physiol Gastrointest Liver Physiol. 2019;317:G853–61. [DOI] [PubMed] [PMC]

18.

Isik S, Yeman Kiyak B, Akbayir R, Seyhali R, Arpaci T. Microglia Mediated Neuroinflammation in Parkinson's Disease. Cells. 2023;12:1012. [DOI] [PubMed] [PMC]

19.

Mado H, Adamczyk-Sowa M, Sowa P. Role of Microglial Cells in the Pathophysiology of MS: Synergistic or Antagonistic? Int J Mol Sci. 2023;24:1861. [DOI] [PubMed] [PMC]

20.

Geng ZH, Zhu Y, Li QL, Zhao C, Zhou PH. Enteric Nervous System: The Bridge Between the Gut Microbiota and Neurological Disorders. Front Aging Neurosci. 2022;14:810483. [DOI] [PubMed] [PMC]

21.

Jin H, Li M, Jeong E, Castro-Martinez F, Zuker CS. A body-brain circuit that regulates body inflammatory responses. Nature. 2024;630:695–703. [DOI] [PubMed] [PMC]

22.

Wang H, Foong JPP, Harris NL, Bornstein JC. Enteric neuroimmune interactions coordinate intestinal responses in health and disease. Mucosal Immunol. 2022;15:27–39. [DOI] [PubMed] [PMC]

23.

López-Pingarrón L, Almeida H, Soria-Aznar M, Reyes-Gonzales MC, Rodríguez-Moratinos AB, Muñoz-Hoyos A, et al. Interstitial Cells of Cajal and Enteric Nervous System in Gastrointestinal and Neurological Pathology, Relation to Oxidative Stress. Curr Issues Mol Biol. 2023;45:3552–72. [DOI] [PubMed] [PMC]

24.

Zheng Y, Gao Z, Sun L, Shi J, Song J, Ye W. Calcium and Gastrointestinal Disorders: Mechanistic Insights and Therapeutic Interventions. Int J Vitam Nutr Res. 2025;95:39241. [DOI] [PubMed]

25.

Dantzer R, Konsman JP, Bluthé RM, Kelley KW. Neural and humoral pathways of communication from the immune system to the brain: parallel or convergent? Auton Neurosci. 2000;85:60–5. [DOI] [PubMed]

26.

Huerta TS, Chen AC, Chaudhry S, Tynan A, Morgan T, Park K, et al. Neural representation of cytokines by vagal sensory neurons. Nat Commun. 2025;16:3840. [DOI] [PubMed] [PMC]

27.

Faraji N, Payami B, Ebadpour N, Gorji A. Vagus nerve stimulation and gut microbiota interactions: A novel therapeutic avenue for neuropsychiatric disorders. Neurosci Biobehav Rev. 2025;169:105990. [DOI] [PubMed]

28.

Holzer P, Farzi A, Hassan AM, Zenz G, Jačan A, Reichmann F. Visceral Inflammation and Immune Activation Stress the Brain. Front Immunol. 2017;8:1613. [DOI] [PubMed] [PMC]

29.

Kearns R. Gut-Brain Axis and Neuroinflammation: The Role of Gut Permeability and the Kynurenine Pathway in Neurological Disorders. Cell Mol Neurobiol. 2024;44:64. [DOI] [PubMed] [PMC]

30.

Lee S, Jun GW, Jeon SB, Kim CJ, Kim JH. Paroxysmal sympathetic hyperactivity in brainstem-compressing huge benign tumors: clinical experiences and literature review. Springerplus. 2016;5:340. [DOI] [PubMed] [PMC]

31.

Levinson S, Pulli B, Heit JJ. Neuroinflammation and acute ischemic stroke: impact on translational research and clinical care. Front Surg. 2025;12:1501359. [DOI] [PubMed] [PMC]

32.

Lehmann HC, Jangouk P, Kierysch EK, Meyer zu Hörste G, Hartung HP, Kieseier BC. Autoantibody-mediated dysfunction of sympathetic neurons in guillain-barre syndrome. Arch Neurol. 2010;67:203–10. [DOI] [PubMed]

33.

Ullah H, Arbab S, Tian Y, Liu CQ, Chen Y, Qijie L, et al. The gut microbiota-brain axis in neurological disorder. Front Neurosci. 2023;17:1225875. [DOI] [PubMed] [PMC]

34.

Islam MM, Mahbub NU, Hong ST, Chung HJ. Gut bacteria: an etiological agent in human pathological conditions. Front Cell Infect Microbiol. 2024;14:1291148. [DOI] [PubMed] [PMC]

35.

O’Riordan KJ, Collins MK, Moloney GM, Knox EG, Aburto MR, Fülling C, et al. Short chain fatty acids: Microbial metabolites for gut-brain axis signalling. Mol Cell Endocrinol. 2022;546:111572. [DOI] [PubMed]

36.

Pérez-Reytor D, Puebla C, Karahanian E, García K. Use of Short-Chain Fatty Acids for the Recovery of the Intestinal Epithelial Barrier Affected by Bacterial Toxins. Front Physiol. 2021;12:650313. [DOI] [PubMed] [PMC]

37.

Becker A, Abuazab M, Schwiertz A, Walter S, Faßbender KC, Fousse M, et al. Short-chain fatty acids and intestinal inflammation in multiple sclerosis: modulation of female susceptibility by microbial products? Auto Immun Highlights. 2021;12:7. [DOI] [PubMed] [PMC]

38.

Duan WX, Wang F, Liu JY, Liu CF. Relationship Between Short-chain Fatty Acids and Parkinson's Disease: A Review from Pathology to Clinic. Neurosci Bull. 2024;40:500–16. [DOI] [PubMed] [PMC]

39.

Jia M, Fan Y, Ma Q, Yang D, Wang Y, He X, et al. Gut microbiota dysbiosis promotes cognitive impairment via bile acid metabolism in major depressive disorder. Transl Psychiatry. 2024;14:503. [DOI] [PubMed] [PMC]

40.

Qu S, Yu Z, Zhou Y, Wang S, Jia M, Chen T, et al. Gut microbiota modulates neurotransmitter and gut-brain signaling. Microbiol Res. 2024;287:127858. [DOI] [PubMed]

41.

Sulatsky MI, Belousov MV, Stepanenko OV, Stepanenko OV, Mikhailova EV, Fayoud H, et al. The bacterial OMP amyloids modulate alpha-synuclein and amyloid-beta aggregation. Int J Biol Macromol. 2025;327:147485. [DOI]

42.

Nemati MH, Yazdanpanah E, Kazemi R, Orooji N, Dadfar S, Oksenych V, et al. Microbiota-Driven Mechanisms in Multiple Sclerosis: Pathogenesis, Therapeutic Strategies, and Biomarker Potential. Biology (Basel). 2025;14:435. [DOI] [PubMed] [PMC]

43.

Padhi P, Worth C, Zenitsky G, Jin H, Sambamurti K, Anantharam V, et al. Mechanistic Insights Into Gut Microbiome Dysbiosis-Mediated Neuroimmune Dysregulation and Protein Misfolding and Clearance in the Pathogenesis of Chronic Neurodegenerative Disorders. Front Neurosci. 2022;16:836605. [DOI] [PubMed] [PMC]

44.

Thomasi B, Valdetaro L, Ricciardi MC, Gonçalves de Carvalho M, Fialho Tavares I, Tavares-Gomes AL. Enteric glia as a player of gut-brain interactions during Parkinson’s disease. Front Neurosci. 2023;17:1281710. [DOI] [PubMed] [PMC]

45.

Bonaz B, Bazin T, Pellissier S. The Vagus Nerve at the Interface of the Microbiota-Gut-Brain Axis. Front Neurosci. 2018;12:49. [DOI] [PubMed] [PMC]

46.

Breit S, Kupferberg A, Rogler G, Hasler G. Vagus Nerve as Modulator of the Brain-Gut Axis in Psychiatric and Inflammatory Disorders. Front Psychiatry. 2018;9:44. [DOI] [PubMed] [PMC]

47.

Escalante J, Artaiz O, Diwakarla S, McQuade RM. Leaky gut in systemic inflammation: exploring the link between gastrointestinal disorders and age-related diseases. Geroscience. 2025;47:1–22. [DOI] [PubMed] [PMC]

48.

Arumugam P, Saha K, Nighot P. Intestinal Epithelial Tight Junction Barrier Regulation by Novel Pathways. Inflamm Bowel Dis. 2025;31:259–71. [DOI] [PubMed] [PMC]

49.

Awad WA, Hess C, Hess M. Enteric Pathogens and Their Toxin-Induced Disruption of the Intestinal Barrier through Alteration of Tight Junctions in Chickens. Toxins (Basel). 2017;9:60. [DOI] [PubMed] [PMC]

50.

Bindas AJ, Nichols KN, Roth NJ, Brady R, Koppes AN, Koppes RA. Aggregation of alpha-synuclein in enteric neurons does not impact function in vitro. Sci Rep. 2022;12:22211. [DOI] [PubMed] [PMC]

51.

Harsanyiova J, Buday T, Kralova Trancikova A. Parkinson’s Disease and the Gut: Future Perspectives for Early Diagnosis. Front Neurosci. 2020;14:626. [DOI] [PubMed] [PMC]

52.

Ren J, Niu Z, Wang J, Guo J, Hao H, Gao F, et al. The link between gut microbiota and multiple sclerosis from the perspective of barrier function. Front Immunol. 2025;16:1652796. [DOI] [PubMed] [PMC]

53.

Fried S, Wemelle E, Cani PD, Knauf C. Interactions between the microbiota and enteric nervous system during gut-brain disorders. Neuropharmacology. 2021;197:108721. [DOI] [PubMed]

54.

Buchholz BM, Bauer AJ. Membrane TLR signaling mechanisms in the gastrointestinal tract during sepsis. Neurogastroenterol Motil. 2010;22:232–45. [DOI] [PubMed] [PMC]

55.

Luesma MJ, López-Marco L, Monzón M, Santander S. Enteric Nervous System and Its Relationship with Neurological Diseases. J Clin Med. 2024;13:5579. [DOI] [PubMed] [PMC]

56.

O’Riordan KJ, Moloney GM, Keane L, Clarke G, Cryan JF. The gut microbiota-immune-brain axis: Therapeutic implications. Cell Rep Med. 2025;6:101982. [DOI] [PubMed] [PMC]

57.

Luo S, Pan M, Fu G, Meng X, Zhao Z, Yu H, et al. Vagus nerve and brain-gut communication in neurodegenerative diseases: Mechanism and therapeutic perspectives. Pharmacol Res. 2025;221:107974. [DOI] [PubMed]

58.

Khowdiary MM, Al-Kuraishy HM, Al-Gareeb AI, Albuhadily AK, Elhenawy AA, Babalghith AO, et al. Dysregulation of serotonergic neurotransmission in Parkinson disease: A key duet. Eur J Pharmacol. 2025;995:177419. [DOI] [PubMed]

59.

Dicks LMT. Key Signals Produced by Gut Microbiota Associated with Metabolic Syndrome, Cancer, Cardiovascular Diseases, and Brain Functions. Int J Mol Sci. 2025;26:10539. [DOI] [PubMed] [PMC]

60.

Bertollo AG, Santos CF, Bagatini MD, Ignácio ZM. Hypothalamus-pituitary-adrenal and gut-brain axes in biological interaction pathway of the depression. Front Neurosci. 2025;19:1541075. [DOI] [PubMed] [PMC]

61.

Huckemann S, Mueller K, Averdunk P, Kühn E, Hilker L, Kools S, et al. Vagal cross-sectional area correlates with parasympathetic dysfunction in Parkinson’s disease. Brain Commun. 2023;5:fcad006. [DOI] [PubMed] [PMC]

62.

Kleinz T, Scholz L, Huckemann S, Rohmann R, Kühn E, Averdunk P, et al. The association of vagal atrophy with parameters of autonomic function in multiple system atrophy and progressive supranuclear palsy. Ther Adv Neurol Disord. 2024;17:17562864241267300. [DOI] [PubMed] [PMC]

63.

McQuade RM, Singleton LM, Wu H, Lee S, Constable R, Di Natale M, et al. The association of enteric neuropathy with gut phenotypes in acute and progressive models of Parkinson's disease. Sci Rep. 2021;11:7934. [DOI] [PubMed] [PMC]

64.

Derkinderen P, Rouaud T, Lebouvier T, Bruley des Varannes S, Neunlist M, De Giorgio R. Parkinson disease: the enteric nervous system spills its guts. Neurology. 2011;77:1761–7. [DOI] [PubMed]

65.

Takahashi R, Yamakado H, Uemura N, Taguchi T, Ueda J. The Gut-Brain Axis Based on α-Synuclein Propagation-Clinical, Neuropathological, and Experimental Evidence. Int J Mol Sci. 2025;26:3994. [DOI] [PubMed] [PMC]

66.

Ochoa-Cortes F, Turco F, Linan-Rico A, Soghomonyan S, Whitaker E, Wehner S, et al. Enteric Glial Cells: A New Frontier in Neurogastroenterology and Clinical Target for Inflammatory Bowel Diseases. Inflamm Bowel Dis. 2016;22:433–49. [DOI] [PubMed] [PMC]

67.

Kabatas S, Yu D, He XD, Thatte HS, Benedict D, Hepgul KT, et al. Neural and anatomical abnormalities of the gastrointestinal system resulting from contusion spinal cord injury. Neuroscience. 2008;154:1627–38. [DOI] [PubMed]

68.

Hediyal TA, Vichitra C, Anand N, Bhaskaran M, Essa SM, Kumar P, et al. Protective effects of fecal microbiota transplantation against ischemic stroke and other neurological disorders: an update. Front Immunol. 2024;15:1324018. [DOI] [PubMed] [PMC]

69.

Luk KC, Kehm V, Carroll J, Zhang B, O’Brien P, Trojanowski JQ, et al. Pathological α-synuclein transmission initiates Parkinson-like neurodegeneration in nontransgenic mice. Science. 2012;338:949–53. [DOI] [PubMed] [PMC]

70.

Kim JS, Sung HY. Gastrointestinal Autonomic Dysfunction in Patients with Parkinson’s Disease. J Mov Disord. 2015;8:76–82. [DOI] [PubMed] [PMC]

71.

Koh YH, Ratnagopal P. Multiple sclerosis with intractable vomiting and atypical area postrema lesion. Mult Scler Relat Disord. 2020;45:102348. [DOI] [PubMed]

72.

Sakakibara R. Gastrointestinal Dysfunction in Multiple Sclerosis and Related Conditions. Semin Neurol. 2023;43:598–608. [DOI] [PubMed]

73.

Xiao B, Zhou Z, Chao Y, Tan EK. Pathogenesis of Parkinson’s Disease. Neurol Clin. 2025;43:185–207. [DOI] [PubMed]

74.

Halli-Tierney AD, Luker J, Carroll DG. Parkinson Disease. Am Fam Physician. 2020;102:679–91. [PubMed]

75.

Safarpour D, Sharzehi K, Pfeiffer RF. Gastrointestinal Dysfunction in Parkinson’s Disease. Drugs. 2022;82:169–97. [DOI] [PubMed]

76.

Pare JR, Kahn JH. Basic neuroanatomy and stroke syndromes. Emerg Med Clin North Am. 2012;30:601–15. [DOI] [PubMed]

77.

Owais SB, Bulwa ZB, Ammar FE. Differences in stroke clinical presentation among sexes. J Stroke Cerebrovasc Dis. 2024;33:107807. [DOI] [PubMed]

78.

Peh A, O’Donnell JA, Broughton BRS, Marques FZ. Gut Microbiota and Their Metabolites in Stroke: A Double-Edged Sword. Stroke. 2022;53:1788–801. [DOI] [PubMed]

79.

Román GC, Jackson RE, Gadhia R, Román AN, Reis J. Mediterranean diet: The role of long-chain ω-3 fatty acids in fish; polyphenols in fruits, vegetables, cereals, coffee, tea, cacao and wine; probiotics and vitamins in prevention of stroke, age-related cognitive decline, and Alzheimer disease. Rev Neurol (Paris). 2019;175:724–41. [DOI] [PubMed]

80.

Correale J, Gaitán MI, Ysrraelit MC, Fiol MP. Progressive multiple sclerosis: from pathogenic mechanisms to treatment. Brain. 2017;140:527–46. [DOI] [PubMed]

81.

Ford H. Clinical presentation and diagnosis of multiple sclerosis. Clin Med (Lond). 2020;20:380–3. [DOI] [PubMed] [PMC]

82.

Oh J, Vidal-Jordana A, Montalban X. Multiple sclerosis: clinical aspects. Curr Opin Neurol. 2018;31:752–9. [DOI] [PubMed]

83.

Yousefi B, Babaeizad A, Banihashemian SZ, Feyzabadi ZK, Dadashpour M, Pahlevan D, et al. Gastrointestinal Tract, Microbiota and Multiple Sclerosis (MS) and the Link Between Gut Microbiota and CNS. Curr Microbiol. 2022;80:38. [DOI] [PubMed]

84.

Özkan İ, Polat Dünya C, Taylan S. Non-pharmacological interventions for fecal incontinence in people with multiple sclerosis: A scoping review. Mult Scler Relat Disord. 2026;105:106864. [DOI]

85.

Shaw KA, Williams S, Patrick ME, Valencia-Prado M, Durkin MS, Howerton EM, et al. Prevalence and Early Identification of Autism Spectrum Disorder Among Children Aged 4 and 8 Years—Autism and Developmental Disabilities Monitoring Network, 16 Sites, United States, 2022. MMWR Surveill Summ. 2025;74:1–22. [DOI] [PubMed] [PMC]

86.

Lord C, Elsabbagh M, Baird G, Veenstra-Vanderweele J. Autism spectrum disorder. Lancet. 2018;392:508–20. [DOI] [PubMed] [PMC]

87.

Famitafreshi H, Karimian M. Overview of the Recent Advances in Pathophysiology and Treatment for Autism. CNS Neurol Disord Drug Targets. 2018;17:590–4. [DOI] [PubMed]

88.

Kasari C, Shire S, Shih W, Landa R, Levato L, Smith T. Spoken language outcomes in limited language preschoolers with autism and global developmental delay: RCT of early intervention approaches. Autism Res. 2023;16:1236–46. [DOI] [PubMed] [PMC]

89.

Chaste P, Leboyer M. Autism risk factors: genes, environment, and gene-environment interactions. Dialogues Clin Neurosci. 2012;14:281–92. [DOI] [PubMed] [PMC]

90.

Esposito M, Mirizzi P, Fadda R, Pirollo C, Ricciardi O, Mazza M, et al. Food Selectivity in Children with Autism: Guidelines for Assessment and Clinical Interventions. Int J Environ Res Public Health. 2023;20:5092. [DOI] [PubMed] [PMC]

91.

Sharp WG, Burrell TL, Berry RC, Stubbs KH, McCracken CE, Gillespie SE, et al. The Autism Managing Eating Aversions and Limited Variety Plan vs Parent Education: A Randomized Clinical Trial. J Pediatr. 2019;211:185–92.e1. [DOI] [PubMed] [PMC]

92.

Eli I, Lerner DP, Ghogawala Z. Acute Traumatic Spinal Cord Injury. Neurol Clin. 2021;39:471–88. [DOI] [PubMed]

93.

Walia S, Kumar P, Kataria C. Interventions to Improve Standing Balance in Individuals With Incomplete Spinal Cord Injury: A Systematic Review and Meta-Analysis. Top Spinal Cord Inj Rehabil. 2023;29:56–83. [DOI] [PubMed] [PMC]

94.

McDonald JW, Sadowsky C. Spinal-cord injury. Lancet. 2002;359:417–25. [DOI] [PubMed]

95.

Wallace DJ, Sayre NL, Patterson TT, Nicholson SE, Hilton D, Grandhi R. Spinal cord injury and the human microbiome: beyond the brain-gut axis. Neurosurg Focus. 2019;46:E11. [DOI] [PubMed]

96.

Jing Y, Yu Y, Bai F, Wang L, Yang D, Zhang C, et al. Effect of fecal microbiota transplantation on neurological restoration in a spinal cord injury mouse model: involvement of brain-gut axis. Microbiome. 2021;9:59. [DOI] [PubMed] [PMC]

97.

Hanewinckel R, Ikram MA, Van Doorn PA. Peripheral neuropathies. Handb Clin Neurol. 2016;138:263–82. [DOI] [PubMed]

98.

Tesfaye S, Sloan G, Petrie J, White D, Bradburn M, Julious S, et al. Comparison of amitriptyline supplemented with pregabalin, pregabalin supplemented with amitriptyline, and duloxetine supplemented with pregabalin for the treatment of diabetic peripheral neuropathic pain (OPTION-DM): a multicentre, double-blind, randomised crossover trial. Lancet. 2022;400:680–90. [DOI] [PubMed] [PMC]

99.

Freeman R. Autonomic Peripheral Neuropathy. Continuum (Minneap Minn). 2020;26:58–71. [DOI] [PubMed]

100.

Galiero R, Caturano A, Vetrano E, Beccia D, Brin C, Alfano M, et al. Peripheral Neuropathy in Diabetes Mellitus: Pathogenetic Mechanisms and Diagnostic Options. Int J Mol Sci. 2023;24:3554. [DOI] [PubMed] [PMC]

101.

Bharucha AE, Kudva YC, Prichard DO. Diabetic Gastroparesis. Endocr Rev. 2019;40:1318–52. [DOI] [PubMed] [PMC]

102.

Sun Z, Wang X, Feng S, Xie C, Xing Y, Guo L, et al. A review of neuroendocrine immune system abnormalities in IBS based on the brain-gut axis and research progress of acupuncture intervention. Front Neurosci. 2023;17:934341. [DOI] [PubMed] [PMC]

103.

Mignini I, Piccirilli G, Di Vincenzo F, Covello C, Pizzoferrato M, Esposto G, et al. Intestinal-Failure-Associated Liver Disease: Beyond Parenteral Nutrition. Biomolecules. 2025;15:388. [DOI] [PubMed] [PMC]

104.

Polavarapu A, Hasbani D. Neurological Complications of Nutritional Disease. Semin Pediatr Neurol. 2017;24:70–80. [DOI]

105.

Pascual V, Dieli-Crimi R, López-Palacios N, Bodas A, Medrano LM, Núñez C. Inflammatory bowel disease and celiac disease: overlaps and differences. World J Gastroenterol. 2014;20:4846–56. [DOI] [PubMed] [PMC]

106.

Gryka-Marton M, Grabowska AD, Szukiewicz D. Breaking the Barrier: The Role of Proinflammatory Cytokines in BBB Dysfunction. Int J Mol Sci. 2025;26:3532. [DOI] [PubMed] [PMC]

107.

Rong Z, Huang Y, Cai H, Chen M, Wang H, Liu G, et al. Gut Microbiota Disorders Promote Inflammation and Aggravate Spinal Cord Injury Through the TLR4/MyD88 Signaling Pathway. Front Nutr. 2021;8:702659. [DOI] [PubMed] [PMC]

108.

Wei J, Chen A, Huang D, Teng C, Cai D, Wu X, et al. Gut microbiome-derived lipopolysaccharides aggravate cognitive impairment via TLR4-mediated inflammatory signaling in neonatal rats following hypoxic-ischemic brain damage. Brain Behav Immun. 2025;127:4–24. [DOI] [PubMed]

109.

Park J, Kim CH. Regulation of common neurological disorders by gut microbial metabolites. Exp Mol Med. 2021;53:1821–33. [DOI] [PubMed] [PMC]

110.

Das S, Banerjee P, Jana S, Mondal H. Unveiling the mechanistic nexus: how micronutrient enrichment shapes brain function, and cognitive health. Front Mol Biosci. 2025;12:1623547. [DOI] [PubMed] [PMC]

111.

Zhao M, Chu J, Feng S, Guo C, Xue B, He K, et al. Immunological mechanisms of inflammatory diseases caused by gut microbiota dysbiosis: A review. Biomed Pharmacother. 2023;164:114985. [DOI] [PubMed]

112.

Ruan G, Sun Y, Yu Z, Bai X, Yang H, Qian J. Global, regional, and national burden of inflammatory bowel disease from 1990 to 2021: findings from the Global Burden of Disease 2021. Gastroenterol Rep (Oxf). 2025;13:goaf082. [DOI] [PubMed] [PMC]

113.

Yuan Z, Chen L, Ng CS, Zhuang P, Huang C, Wang J, et al. Analysis of global burden of inflammatory bowel disease among adolescents and young adults from 1990 to 2021 and projections to 2040. BMC Public Health. 2025;25:3087. [DOI] [PubMed] [PMC]

114.

Ferro JM. Neurologic Manifestations of Inflammatory Bowel Disease. Gastroenterol Hepatol (N Y). 2014;10:599–600. [PubMed] [PMC]

115.

Perler BK, Ungaro R, Baird G, Mallette M, Bright R, Shah S, et al. Presenting symptoms in inflammatory bowel disease: descriptive analysis of a community-based inception cohort. BMC Gastroenterol. 2019;19:47. [DOI] [PubMed] [PMC]

116.

Vavricka SR, Schoepfer A, Scharl M, Lakatos PL, Navarini A, Rogler G. Extraintestinal Manifestations of Inflammatory Bowel Disease. Inflamm Bowel Dis. 2015;21:1982–92. [DOI] [PubMed] [PMC]

117.

Qian Y, Chen Y, Liu L, Wu T, Chen X, Ma G. Depression and anxiety in inflammatory bowel disease: mechanisms and emerging therapeutics targeting the microbiota-gut-brain axis. Front Immunol. 2025;16:1676160. [DOI] [PubMed] [PMC]

118.

Durairajan SSK, Singh AK, Sulaiman SM, Patnaik S, Krishnamoorthi S, Iyaswamy A, et al. Molecular links between inflammatory bowel disease and Alzheimer’s disease through immune signaling and inflammatory pathways. World J Gastroenterol. 2025;31:111301. [DOI] [PubMed] [PMC]

119.

Nunez SG, Rabelo SP, Subotic N, Caruso JW, Knezevic NN. Chronic Stress and Autoimmunity: The Role of HPA Axis and Cortisol Dysregulation. Int J Mol Sci. 2025;26:9994. [DOI] [PubMed] [PMC]

120.

Wang S, van Schooten FJ, Jin H, Jonkers D, Godschalk R. The Involvement of Intestinal Tryptophan Metabolism in Inflammatory Bowel Disease Identified by a Meta-Analysis of the Transcriptome and a Systematic Review of the Metabolome. Nutrients. 2023;15:2886. [DOI] [PubMed] [PMC]

121.

Saedi S, Derakhshan S, Sadeghi J, Hasani A, Khoshbaten M, Poortahmasebi V, et al. A study on gut microbiota and short-chain fatty acids in patients with inflammatory bowel disease from northwest Iran. Lett Appl Microbiol. 2025;78:ovaf111. [DOI] [PubMed]

122.

Nasereddin L, Alnajjar O, Bashar H, Abuarab SF, Al-Adwan R, Chellappan DK, et al. Corticosteroid-Induced Psychiatric Disorders: Mechanisms, Outcomes, and Clinical Implications. Diseases. 2024;12:300. [DOI] [PubMed] [PMC]

123.

Siebenhüner AR, Rossel JB, Schreiner P, Butter M, Greuter T, Krupka N, et al. Effects of anti-TNF therapy and immunomodulators on anxiety and depressive symptoms in patients with inflammatory bowel disease: a 5-year analysis. Ther Adv Gastroenterol. 2021;14:17562848211033763. [DOI] [PubMed] [PMC]

124.

Székely H, Tóth LM, Rancz A, Walter A, Farkas N, Sárközi MD, et al. Anti-tumor Necrosis Factor Alpha Versus Corticosteroids: A 3-fold Difference in the Occurrence of Venous Thromboembolism in Inflammatory Bowel Disease—A Systematic Review and Meta-analysis. J Crohns Colitis. 2024;18:773–83. [DOI] [PubMed] [PMC]

125.

Kurppa K, Mulder CJ, Stordal K, Kaukinen K. Celiac Disease Affects 1% of Global Population: Who Will Manage All These Patients? Gastroenterology. 2024;167:148–58. [DOI] [PubMed]

126.

Antunes A, Andrade F, Kotze LMDS, Nisihara R. HLA DQ2/DQ8 haplotypes and the clinical presentation of patients with celiac disease. Rev Esp Enferm Dig. 2025;[Epub ahead of print]. [DOI] [PubMed]

127.

Bogielski B, Michalczyk K, Głodek P, Tempka B, Gębski W, Stygar D. Association between small intestine bacterial overgrowth and psychiatric disorders. Front Endocrinol (Lausanne). 2024;15:1438066. [DOI] [PubMed] [PMC]

128.

Kamboj AK, Oxentenko AS. Clinical and Histologic Mimickers of Celiac Disease. Clin Transl Gastroenterol. 2017;8:e114. [DOI] [PubMed] [PMC]

129.

Alkhiari R. Psychiatric and Neurological Manifestations of Celiac Disease in Adults. Cureus. 2023;15:e35712. [DOI] [PubMed] [PMC]

130.

Scarampi M, Mengoli C, Miceli E, Di Stefano M. Vitamins and Celiac Disease: Beyond Vitamin D. Metabolites. 2025;15:78. [DOI] [PubMed] [PMC]

131.

Hadjivassiliou M, Aeschlimann P, Sanders DS, Mäki M, Kaukinen K, Grünewald RA, et al. Transglutaminase 6 antibodies in the diagnosis of gluten ataxia. Neurology. 2013;80:1740–5. [DOI] [PubMed]

132.

Spagnoli C, Pisani F, Di Mario F, Leandro G, Gaiani F, De’ Angelis GL, et al. Peripheral neuropathy and gastroenterologic disorders: an overview on an underrecognized association. Acta Biomed. 2018;89:22–32. [DOI] [PubMed] [PMC]

133.

Rogalidou M, Christodoulou D. Unraveling the Complexity of Celiac Disease: A Narrative Review of Its Multisystem Nature. Medicina (Kaunas). 2026;62:120. [DOI] [PubMed] [PMC]

134.

Batarfi MA. Thiamine Deficiency and Brain Injury: Neuroanatomical Changes in the Wernicke-Korsakoff Syndrome. Cureus. 2025;17:e92643. [DOI] [PubMed] [PMC]

135.

Kleopa KA, Kyriacou K, Zamba-Papanicolaou E, Kyriakides T. Reversible inflammatory and vacuolar myopathy with vitamin E deficiency in celiac disease. Muscle Nerve. 2005;31:260–5. [DOI] [PubMed]

136.

Saji AM, Lui F, De Jesus O. Spinal Cord Subacute Combined Degeneration. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2026. [PubMed]

137.

Marciano F, Savoia M, Vajro P. Celiac disease-related hepatic injury: Insights into associated conditions and underlying pathomechanisms. Dig Liver Dis. 2016;48:112–9. [DOI] [PubMed]

138.

Rubio-Tapia A, Murray JA. Liver involvement in celiac disease. Minerva Med. 2008;99:595–604. [PubMed] [PMC]

139.

Giuffrè M, Gazzin S, Zoratti C, Llido JP, Lanza G, Tiribelli C, et al. Celiac Disease and Neurological Manifestations: From Gluten to Neuroinflammation. Int J Mol Sci. 2022;23:15564. [DOI] [PubMed] [PMC]

140.

Rubio-Tapia A, Murray JA. The Liver and Celiac Disease. Clin Liver Dis. 2019;23:167–76. [DOI] [PubMed] [PMC]

141.

Agarwal A, Pachisia AV, Agarwal S, Mehta S, Kumari A, Ahmed A, et al. Celiac Disease and Its Impact on Liver-Related Outcomes in Patients With All-Cause Cirrhosis: The CELIHEP Study. J Gastroenterol Hepatol. 2025;40:2857–66. [DOI] [PubMed]

142.

Rhodes K, Wang Y, DeMorrow S, Gurumallesh P. The Role of Neuroinflammation in the Pathogenesis of Hepatic Encephalopathy. J Immunol Res. 2025;2025:6855563. [DOI] [PubMed] [PMC]

143.

Goldbecker A, Buchert R, Berding G, Bokemeyer M, Lichtinghagen R, Wilke F, et al. Blood-brain barrier permeability for ammonia in patients with different grades of liver fibrosis is not different from healthy controls. J Cereb Blood Flow Metab. 2010;30:1384–93. [DOI] [PubMed] [PMC]

144.

Chastre A, Jiang W, Desjardins P, Butterworth RF. Ammonia and proinflammatory cytokines modify expression of genes coding for astrocytic proteins implicated in brain edema in acute liver failure. Metab Brain Dis. 2010;25:17–21. [DOI] [PubMed]

145.

Llansola M, Montoliu C, Agusti A, Hernandez-Rabaza V, Cabrera-Pastor A, Gomez-Gimenez B, et al. Interplay between glutamatergic and GABAergic neurotransmission alterations in cognitive and motor impairment in minimal hepatic encephalopathy. Neurochem Int. 2015;88:15–9. [DOI] [PubMed]

146.

Purchase R. The link between copper and Wilson's disease. Sci Prog. 2013;96:213–23. [DOI] [PubMed] [PMC]

147.

Khan S, Jahagirdar V, Tapper EB. Tides of emotion: Hepatologists’ role in navigating depression and anxiety in liver disease. Hepatol Commun. 2025;9:e0741. [DOI] [PubMed] [PMC]

148.

Mukhtar K, Nawaz H, Abid S. Functional gastrointestinal disorders and gut-brain axis: What does the future hold? World J Gastroenterol. 2019;25:552–66. [DOI] [PubMed] [PMC]

149.

Park JC, Chang L, Kwon HK, Im SH. Beyond the gut: decoding the gut-immune-brain axis in health and disease. Cell Mol Immunol. 2025;22:1287–312. [DOI] [PubMed] [PMC]

150.

Camilleri M, Atieh J. New Developments in Prokinetic Therapy for Gastric Motility Disorders. Front Pharmacol. 2021;12:711500. [DOI] [PubMed] [PMC]

151.

Del Negro I, Pez S, Versace S, Marziali A, Gigli GL, Tereshko Y, et al. Impact of Disease-Modifying Therapies on Gut-Brain Axis in Multiple Sclerosis. Medicina (Kaunas). 2023;60:6. [DOI] [PubMed] [PMC]

152.

Jha M, Waheed A, Hooti JA, Nair S, Najam A, Mal M, et al. Advancements in Immunomodulatory Therapies for IBD and Their Interplay With the Gut-Brain Axis: An Updated Review of Current Literature and Beyond. Health Sci Rep. 2025;8:e71157. [DOI] [PubMed] [PMC]

153.

Nattagh-Eshtivani E, Barghchi H, Mansouri AH, Rahbarinejd P, Mokari-Yamchi A, Barati M, et al. The role of dietary factors in the prevention and management of inflammatory bowel disease: a comprehensive review. Nutr Metab (Lond). 2025;22:157. [DOI] [PubMed] [PMC]

154.

Hou S, Yu J, Li Y, Zhao D, Zhang Z. Advances in Fecal Microbiota Transplantation for Gut Dysbiosis-Related Diseases. Adv Sci (Weinh). 2025;12:e2413197. [DOI] [PubMed] [PMC]

155.

Maghsoumi-Norouzabad L, Bagherzadeh-Karimi A, Aliakbari Majd S, Hosseini L, Shahi F. The Effects of Prebiotic Dietary Fibers, Probiotics, and Synbiotics on Gut Permeability and Immunity: A Systematic Review. Iran J Med Sci. 2025;50:500–29. [DOI] [PubMed] [PMC]

156.

Li X, Zhou W, Yang S, Huang X, Zheng K. Pharmacological interventions targeting the gut-brain axis in neurological disorders: mechanisms and translational applications. Front Neurosci. 2026;20:1806532. [DOI] [PubMed] [PMC]

157.

Loh JS, Mak WQ, Tan LKS, Ng CX, Chan HH, Yeow SH, et al. Microbiota-gut-brain axis and its therapeutic applications in neurodegenerative diseases. Signal Transduct Target Ther. 2024;9:37. [DOI] [PubMed] [PMC]

158.

Yang J, Yang X, Wu G, Huang F, Shi X, Wei W, et al. Gut microbiota modulate distal symmetric polyneuropathy in patients with diabetes. Cell Metab. 2023;35:1548–62.e7. [DOI] [PubMed]

159.

Liu J. Vagus nerve neuromodulation: A promising method for treating gastrointestinal dysmotility. World J Gastrointest Pharmacol Ther. 2025;16:111266. [DOI] [PubMed] [PMC]

160.

Law M, Pickering I, Bartlett E, Sebaratnam G, Varghese C, Gharibans A, et al. Cognitive behavioural therapy-based interventions for gastroduodenal disorders of gut-brain interaction: A systematic review. J Psychosom Res. 2023;175:111516. [DOI] [PubMed]

161.

Quan Y, Zhou T. Efficacy and mechanisms of vagus nerve stimulation in irritable bowel syndrome: a comprehensive literature review. Front Immunol. 2026;17:1769070. [DOI] [PubMed] [PMC]

162.

Hu Q, Wang J, Cao R, Liu W, Wang L. Therapeutic potential of vagus nerve stimulation in neurodegenerative diseases: research progress and mechanisms. Front Immunol. 2026;17:1811107. [DOI] [PubMed] [PMC]

163.

Wang X, Liu M, Cao L, Huang H, Yang J, Zhang H, et al. Gut microbiota-neuroinflammation axis: A new mechanism and therapeutic target for comorbid depression in epilepsy. Brain Behav Immun Health. 2025;50:101150. [DOI] [PubMed] [PMC]

164.

Lahoda Brodska H, Klempir J, Zavora J, Kohout P. The Role of Micronutrients in Neurological Disorders. Nutrients. 2023;15:4129. [DOI] [PubMed] [PMC]

165.

Naliboff BD, Fresé MP, Rapgay L. Mind/Body psychological treatments for irritable bowel syndrome. Evid Based Complement Alternat Med. 2008;5:41–50. [DOI] [PubMed] [PMC]

166.

Thakur ER, Tran T, Duarte BA, Horrigan JM, Lampe EW, Said H, et al. Mind-Body Interventions for Comorbid Sleep and Gastrointestinal Concerns. Curr Sleep Med Rep. 2025;11:37. [DOI] [PubMed] [PMC]

167.

Islam Z, D’Silva A, Raman M, Nasser Y. The role of mind body interventions in the treatment of irritable bowel syndrome and fibromyalgia. Front Psychiatry. 2022;13:1076763. [DOI] [PubMed] [PMC]

168.

Cao Q, Shen M, Li R, Liu Y, Zeng Z, Zhou J, et al. Elucidating the specific mechanisms of the gut-brain axis: the short-chain fatty acids-microglia pathway. J Neuroinflammation. 2025;22:133. [DOI] [PubMed] [PMC]

169.

Carloni S, Rescigno M. The gut-brain vascular axis in neuroinflammation. Semin Immunol. 2023;69:101802. [DOI] [PubMed]

170.

Deng W, Yi P, Xiong Y, Ying J, Lin Y, Dong Y, et al. Gut Metabolites Acting on the Gut-Brain Axis: Regulating the Functional State of Microglia. Aging Dis. 2024;15:480–502. [DOI] [PubMed] [PMC]

171.

Gao K, Mu CL, Farzi A, Zhu WY. Tryptophan Metabolism: A Link Between the Gut Microbiota and Brain. Adv Nutr. 2020;11:709–23. [DOI] [PubMed] [PMC]

172.

Suganya K, Koo BS. Gut-Brain Axis: Role of Gut Microbiota on Neurological Disorders and How Probiotics/Prebiotics Beneficially Modulate Microbial and Immune Pathways to Improve Brain Functions. Int J Mol Sci. 2020;21:7551. [DOI] [PubMed] [PMC]

173.

Romano S, Wirbel J, Ansorge R, Schudoma C, Ducarmon QR, Narbad A, et al. Machine learning-based meta-analysis reveals gut microbiome alterations associated with Parkinson’s disease. Nat Commun. 2025;16:4227. [DOI] [PubMed] [PMC]

174.

Qian S, Hou J, Xiong X, Duan Q, Jiang T, Zheng Y, et al. Exploring the Fecal Microbiome Dysbiosis and Its Plasma Metabolome Determinants in Advanced Parkinson’s Disease With Motor Complications. CNS Neurosci Ther. 2026;32:e70750. [DOI] [PubMed] [PMC]

175.

Christopher CJ, Morgan KH, Tolleson CM, Trudell R, Fernandez-Romero R, Rice L, et al. Specific Bacterial Taxa and Their Metabolite, DHPS, May Be Linked to Gut Dyshomeostasis in Patients with Alzheimer’s Disease, Parkinson’s Disease, and Amyotrophic Lateral Sclerosis. Nutrients. 2025;17:1597. [DOI] [PubMed] [PMC]

176.

Fricova D, Harsanyiova J, Kralova Trancikova A. Alpha-Synuclein in the Gastrointestinal Tract as a Potential Biomarker for Early Detection of Parkinson’s Disease. Int J Mol Sci. 2020;21:8666. [DOI] [PubMed] [PMC]

177.

Liu Y, Li W, Yang H, Zhang X, Wang W, Jia S, et al. Leveraging 16S rRNA Microbiome Sequencing Data to Identify Bacterial Signatures for Irritable Bowel Syndrome. Front Cell Infect Microbiol. 2021;11:645951. [DOI] [PubMed] [PMC]

178.

Chen CC, Chiu JY, Tan AH, Toh TS, Lim SY, Tan EK, et al. Investigating Plasma Metabolomics and Gut Microbiota Changes Associated With Parkinson Disease: A Focus on Caffeine Metabolism. Neurology. 2025;104:e213592. [DOI] [PubMed] [PMC]

179.

Mallick R, Basak S, Chowdhury P, Bhowmik P, Das RK, Banerjee A, et al. Targeting Cytokine-Mediated Inflammation in Brain Disorders: Developing New Treatment Strategies. Pharmaceuticals (Basel). 2025;18:104. [DOI] [PubMed] [PMC]

180.

Kuai XY, Yao XH, Xu LJ, Zhou YQ, Zhang LP, Liu Y, et al. Evaluation of fecal microbiota transplantation in Parkinson’s disease patients with constipation. Microb Cell Fact. 2021;20:98. [DOI] [PubMed] [PMC]

181.

Memariani M, Memariani H. Dysbiosis and Therapeutic Modulation of the Gut Microbiota in Multiple Sclerosis: A Narrative Review. Health Sci Rep. 2025;8:e71564. [DOI] [PubMed] [PMC]

182.

Mao X, Cheng L, Liu Y, Wu Y. Mechanistic study on the restoration of intestinal barrier integrity and alleviation of inflammatory bowel disease by rhynchophylline via the AhR-NR4A1 pathway. Front Pharmacol. 2025;16:1629012. [DOI] [PubMed] [PMC]

183.

Claeys W, Geerts A, Van Hoecke L, Van Steenkiste C, Vandenbroucke RE. Role of astrocytes and microglia in hepatic encephalopathy associated with advanced chronic liver disease: lessons from animal studies. Neural Regen Res. 2025;20:3461–75. [DOI] [PubMed] [PMC]

184.

Zacharias HD, Zacharias AP, Gluud LL, Morgan MY. Pharmacotherapies that specifically target ammonia for the prevention and treatment of hepatic encephalopathy in adults with cirrhosis. Cochrane Database Syst Rev. 2019;6:CD012334. [DOI] [PubMed] [PMC]