Kharief M, O’Byrne R, William K, Hasabarsoul MA, Tuohy O, Morcos A. Anti-glutamic acid decarboxylase autoimmunity presenting as chronic intestinal pseudo-obstruction with dysautonomia and late-onset autoimmune diabetes: A case report. World J Gastroenterol 2026; 32(36): 120568 [DOI: 10.3748/wjg.120568]
Corresponding Author of This Article
Mohamed Kharief, MD, Department of Gastroenterology, University Hospital Waterford, Dunmore Road, Waterford X91 ER8E, Ireland. mohdkharief@gmail.com
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Gastroenterology & Hepatology
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case-report
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Kharief M, O’Byrne R, William K, Hasabarsoul MA, Tuohy O, Morcos A. Anti-glutamic acid decarboxylase autoimmunity presenting as chronic intestinal pseudo-obstruction with dysautonomia and late-onset autoimmune diabetes: A case report. World J Gastroenterol 2026; 32(36): 120568 [DOI: 10.3748/wjg.120568]
World J Gastroenterol. Sep 28, 2026; 32(36): 120568 Published online Sep 28, 2026. doi: 10.3748/wjg.120568
Anti-glutamic acid decarboxylase autoimmunity presenting as chronic intestinal pseudo-obstruction with dysautonomia and late-onset autoimmune diabetes: A case report
Mohamed Kharief, Roz O’Byrne, Karl William, Mohammed Ali Hasabarsoul, Orla Tuohy, Ashraf Morcos
Mohamed Kharief, Roz O’Byrne, Karl William, Mohammed Ali Hasabarsoul, Ashraf Morcos, Department of Gastroenterology, University Hospital Waterford, Waterford X91 ER8E, Ireland
Orla Tuohy, Department of Neurology, University Hospital Waterford, Waterford X91 ER8E, Ireland
Author contributions: Kharief M was primarily responsible for clinical data collection, case documentation, and drafting of the initial manuscript; O’Byrne R contributed substantially to data interpretation, manuscript structuring, and critical revision with significant intellectual input, particularly in contextualizing the autoimmune mechanisms and therapeutic implications; William K and Hasabarsoul MA contributed to the data interpretation and manuscript revision; Tuohy O provided neurological expertise and contributed to the discussion; Morcos A supervised the study and critically revised the manuscript; Kharief M, O’Byrne R, William K, Hasabarsoul MA, Tuohy O, and Morcos A contributed to the conception and design of the study; all authors have read and approved the final manuscript.
AI contribution statement: The manuscript was written by the authors based on clinical data, interpretation, and scientific expertise. However, ChatGPT were used strictly for language polishing and grammar correction to improve clarity and readability. No AI tools were involved in the generation of scientific content, study design, data analysis, or interpretation of results. No images or figures included in this manuscript were generated using AI tools.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Mohamed Kharief, MD, Department of Gastroenterology, University Hospital Waterford, Dunmore Road, Waterford X91 ER8E, Ireland. mohdkharief@gmail.com
Received: March 2, 2026 Revised: April 18, 2026 Accepted: June 10, 2026 Published online: September 28, 2026 Processing time: 172 Days and 23.1 Hours
Abstract
BACKGROUND
Chronic intestinal pseudo-obstruction is a rare disorder characterized by recurrent symptoms of intestinal obstruction in the absence of a mechanical cause. Although uncommon, it is associated with significant morbidity and may be life-threatening. Emerging evidence suggests that autoimmune mechanisms, including anti-glutamic acid decarboxylase (anti-GAD) antibodies, may contribute to gastrointestinal dysmotility.
CASE SUMMARY
A 69-year-old man presented with recurrent episodes of small bowel obstruction, progressive weight loss, and newly diagnosed insulin-dependent diabetes mellitus. Comprehensive investigations excluded structural, infectious, metabolic, and neoplastic causes. Imaging demonstrated dilated bowel loops without a clear transition point. Surgical exploration revealed an atonic small bowel without mechanical obstruction. Markedly elevated anti-GAD antibody levels, together with dysautonomia and proximal myopathy, supported an autoimmune etiology. The patient showed significant clinical improvement following treatment with corticosteroids, intravenous immunoglobulin, and rituximab, with resolution of gastrointestinal symptoms and normalization of glycemic control.
CONCLUSION
Autoimmune etiologies should be considered in cases of unexplained chronic intestinal pseudo-obstruction. Anti-GAD antibodies may aid diagnosis, and early initiation of immunotherapy can improve clinical outcomes and reduce unnecessary surgical intervention.
Core Tip: Chronic intestinal pseudo-obstruction is a rare and diagnostically challenging disorder that may be associated with autoimmune mechanisms. This case highlights anti-glutamic acid decarboxylase antibody-associated dysautonomia presenting with gastrointestinal dysmotility and evolving insulin-dependent diabetes mellitus. It underscores the importance of considering autoimmune etiologies in unexplained chronic intestinal pseudo-obstruction and demonstrates the potential benefit of immunomodulatory therapy, including corticosteroids, intravenous immunoglobulin, and rituximab, in achieving sustained clinical improvement.
