when gluten attacks, ted paradowski, md
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Springfield Clinic's September 2012 Doctor Is In Lecture Series, When Gluten Attacks, presented by Ted Paradowski, MD.TRANSCRIPT
When Gluten Attacks: Celiac DiseaseTed J. Paradowski, MD, Gastroenterology and Hepatology
www.SpringfieldClinic.comwww.SpringfieldClinic.com
What is Celiac Disease/Sprue?
• Defined as a permanent intolerance to the storage proteins or gluten found in wheat, rye, and barley
• Chronic (long-term) digestive disease caused by inflammation/irritation of the small intestine
Celiac Disease – Key Points
• Autoimmune disorder
• Ingested gluten is trigger
• Unknown cause – genetics involved
• Inflammation of small intestine
• Blocks absorption of nutrients
• Small increase in mortality + lymphoma
• Lifelong, but treatment straightforward
Celiac Disease – other facts
• About 2 million Americans
• About 1/100 people
• But only 1/10 diagnosed
• 1st degree relatives: 10%
• Type I Diabetes: 2-8%
• Whites >
What is gluten?
• A protein found in wheat, rye, barley
• Technically not in oats, but often contaminated w/other grains
• Examples– Wheat: durum, faro, graham, spelt, kamut, seminola– Wheat starch, bran, germ, cracked wheat– Barley, malt/flavoring, malt vinegar– Rye– Triticale (cross b/w wheat and rye)
Gluten Ingestion in Celiac Dz
Many processed foods contain GLUTEN
• Beer• Bouillon cubes• Candy• Communion wafer• Gravy• Rice mixes• Seasoned tortilla
chips• Soups
• Chips/potato chips• Cold cuts, salami• Hot dogs, sausage• French fries• Matzo• Sauces• Self-basting turkey• Soy sauce
Wide Variety of Symptoms
• Gas, bloating, pain• Chronic diarrhea >
constipation• Foul-smelling stool• Fatty stool• Fatigue• Unexplained anemia• Low iron levels• Behavioral changes;
irritability in children
• Tingling numbness in legs (nerve damage)
• Bone or joint pain• Muscle cramps• Delayed growth • Pale sores in mouth• Specific skin rash,
dermatitis herpetiformis
Diagnosis of Celiac Disease
• Recognize symptoms - overlap• Think of celiac disease• Blood test for autoantibodies
– TTG (tissue transglutaminase) IgA– EMA (endomysial) IgA
• Upper Endoscopy (EGD)– small intestine biopsy
• Do NOT eliminate gluten before testing
Treatment of Celiac Disease
• Gluten-free diet (GFD)
• Strict lifelong adherence
• Dietitian assistance
• Regular interval evaluations– Physician: check blood tests again– Physician: repeat biopsies if needed– Dietitian visits
Some foods without gluten
• Amaranth• Buckwheat• Legumes• Potatoes• Soy• Arrowroot• Corn• Millet
• Quinoa• Tapioca• Brown rice• Flax• Nuts• Seeds• Wild rice
Inadvertent gluten ingestion
• Brown rice syrup• Breading/coating• Energy bars• Flour/cereal products• Imitation bacon• Imitation seafood• Marinades• Panko • Pastas
• Processed lunch meat• Sauces/gravies• Soup bases• Stuffing/dressing• Thickeners• Drugs/OTC meds• Supplements• Kids: Play-dough,
crayons, paint, glue…
Complications of Celiac Disease
• Malabsorption problems– Anemia, growth delay, weight loss,
osteoporosis, infertility
• Refractory – if untreated for years
• Slight increased risk of– Death – SB lymphoma
• Fortunately all can be avoided with GFD
Mimickers
• Pancreatic diseases – loss of enzymes• Small intestinal bacterial overgrowth• Lactase deficiency/lactose intolerance• Intestinal lymphoma• Autoimmune enteropathy• CVID• Tropical sprue• Eosinophilic gastroenteritis
Just to confuse you more…• “Latent” Celiac Disease
– Positive blood antibodies – But normal SB biopsy– Don’t need GFD…yet– Ongoing monitoring, biopsies
• “Silent” Celiac Disease– Positive blood antibodies + abnormal biopsy– But no symptoms– Check for malabsorption– MAY need GFD
Resources for Patients/Families
• www.nlm.nih.gov/medlineplus/celiacdisease.html - The National Library of Medicine
• www.celiac.org – The Celiac Disease Foundation• www.gluten.net – Gluten Intolerance Group of NA• www.csaceliacs.org – The Celiac Sprue Association• www.americanceliac.org – American Celiac Dz Alliance• www.celiacawareness.org – National Foundation for
Celiac Awareness (NFCA)• About.com Celiac disease forum
– http://celiacdisease.about.com/forum
Questions?