Re: Celiac Disease and other digestive problems

[Guest guest]

Kristy,

What is Celiac Disease? is often very gassy after eating and is

stools are loose as often as they are hard.

Maureen, mother to Tyler, 10 and , 7(MDS)

Celiac Disease and other digestive problems

Hi everyone,

I took Tim to the doctor on Monday because he has been having digestive

problems. As soon as he eats a meal (but not at every meal) he has to go to the

restroom almost immediately. He has cramps and loose stools. Also, while at the

doctor, Tim said that he had blood in his stools. (information I did not know!)

The doctor is checking him for Celiac Disease. Tim has always had this

trouble, but it seems that over the past few months, it has gotten worse.

I am wondering what sort of digestive problems your children have and what

the symptoms and remedies are.

Thanks,

Kristy

[Guest guest]

Kristy,

What is Celiac Disease? is often very gassy after eating and is

stools are loose as often as they are hard.

Maureen, mother to Tyler, 10 and , 7(MDS)

Celiac Disease and other digestive problems

Hi everyone,

I took Tim to the doctor on Monday because he has been having digestive

problems. As soon as he eats a meal (but not at every meal) he has to go to the

restroom almost immediately. He has cramps and loose stools. Also, while at the

doctor, Tim said that he had blood in his stools. (information I did not know!)

The doctor is checking him for Celiac Disease. Tim has always had this

trouble, but it seems that over the past few months, it has gotten worse.

I am wondering what sort of digestive problems your children have and what

the symptoms and remedies are.

Thanks,

Kristy

[Guest guest]

Maureen,

To better understand Celiac Disease, I have included Dr. Leshin's essay on the

subject.

Kristy

The small bowel has many roles, one of which is to absorb nutrients from our

food. Celiac disease (CD) arises when the lining of the small bowel becomes

damaged from exposure to gluten, the protein found in wheat, barley and rye.

(Oats may be involved because oats are often contaminted with gluten from other

grains during the milling process.) The small bowel becomes unable to absorb

water and nutrients, causing a number of different symptoms.

Why does a child get CD? First, the disease arises only after exposure to

gluten. Second, there is usually a genetic predisposition toward a " sensitive "

small bowel lining. Third, certain environmental insults may make the lining

more susceptible to injury from gluten, such as surgery on the gastrointestinal

tract or a gastrointestinal infection. Whatever the initial reason, the gluten

causes an immunologic response in the lining of the small bowel: the surface

folds shrink and flatten and a " malabsorption " condition occurs. CD used to be

considered to be much more common in Europe than in the US, but recent studies

indicate that the incidence of CD in people in the US of European ancestry have

the same incidence as in Europe. People of African-Caribbean and far Eastern

Asian ancestry very rarely have CD. Studies in the 1990s indicated that children

with DS are at a higher risk to develop CD than the general population. The

reasons for that aren't entirely clear, but since children

with DS are at a greater risk from auto-immune diseases, that CD represents

another one of these type of diseases. Studies from Europe looking at the

percentage of children with DS that have CD have ranged from 7% to 16%. One

American study found 4 to 5% of children with Down syndrome living on the East

Coast had positive CD, but almost all the subjects were Caucasian, so this group

was mostly of European heritage to begin with. Another American study done in

the southeastern US found 7% of the children with DS studied had CD.

The signs of CD are varied, since the condition may be mild in some and severe

in others. The majority of children with CD have what's called " failure to

thrive: " lack of growth of weight, and sometimes height as well. Most have

diarrhea, and/or vomiting. Children with CD are irritable and usually have a

decreased appetite. The stools may be foul smelling, and in occasional cases,

may not be loose but big and bulky. A small number of children will develop

severe diarrhea leading to dehydration. The children who have had CD for several

months will have bloating of the stomach and a loss of muscle mass. If not

treated, malabsorption will continue to cause undernourishment, producing

anemia, osteoporosis and peripheral neuropathy.

The main way of diagnosing CD has always been through biopsy of the small bowel.

Under a microscope, the small bowel will show characteristic damage to the

lining. One way this is done by having the patient swallow a capsule attached to

a string, which is used to retrieve the capsule after a period of time. Many

doctors prefer to do a biopsy under direct endoscopy, however, especially in

children. The lining of the small bowel has certain characteristics under a

microscope when CD is present.

Since a small bowel biopsy is neither easy nor cheap, it's not in the best

interest of the child or family to do a biopsy on every child with DS. So the

best thing would be to have an easy blood test that can detect the children who

need the diagnostic biopsy. A few blood tests have been tried in the past with

unhelpful results, such as the antigliadin antibody (AGA) test. However, the

blood test looking for antiendomysium (or antiendomysial) antibodies (EMA) seems

to be an effective screen. One study from Sweden looked at a group of children

with DS and found 16% of the children screened to have elevated levels of

antiendomysium antibodies, all of which were found to have biopsies diagnostic

of CD. When the AGA and EMA tests are combined, this produces an effective

screen to determine who should receive the biopsy. Recently, a newer blood test

has been developed looking for IgA antibodies to the enzyme transglutaminase

(TG). TG is an intracellular enzyme that binds gliadin and

starts to process it in a way that starts the autoimmune sequence in CD.

Testing for antibodies to TG (IgA-tTG) may be a more sensitive screen for CD

than EMA. Note that all these tests are measuring IgA levels. One problem is

that IgA deficiency may occur in people with CD, and therefore the IgA markers

for CD may not show up. That would classify as a " false negative. " For that

reason, every time a person has blood tests for CD, the doctor must also test

for total IgA levels.

Recent research has found that 97 to 98% of all cases of CD are found in people

with certain genetic markers. These genetic markers are called HLA ( " human

leukocyte antigen " ) markers. There are two markers that are associated with CD:

HLA-DQ2 and HLA-DQ8. In cases where CD is suspected and there is an IgA

deficiency, these markers can be looked for instead to determine if a small

bowel biopsy is warranted. Children with DS and CD also have the same markers.

Interestingly, the genes for the HLA markers are on the chromosome 6, so the

connection to chromosome 21 still needs to be discovered.

It's important to note that infection from Giardia, a microscopic parasite found

worldwide, can mimic CD. Diagnosis of this infection is done by special tests on

the stools.

Treatment is both simple and difficult: a gluten-free diet. All wheat, barley

and rye products are off limits. Currently, it is recommended that oats be also

eliminated from the diet at the beginning. They can be replaced in the diet as

soon as the patient is doing better. In most cases, the symptoms of CD resolves

in 2 weeks! The older the child, the longer it takes to come under control. CD

is a lifelong disease; symptoms may from time to time subside to the point of

the CD appearing to be gone, but the person must continue on the diet to avoid

illness. The person may need vitamin supplementation to complete the diet.

maureen ferris wrote:

Kristy,

What is Celiac Disease? is often very gassy after eating and is

stools are loose as often as they are hard.

Maureen, mother to Tyler, 10 and , 7(MDS)

[Guest guest]

Maureen,

To better understand Celiac Disease, I have included Dr. Leshin's essay on the

subject.

Kristy

The small bowel has many roles, one of which is to absorb nutrients from our

food. Celiac disease (CD) arises when the lining of the small bowel becomes

damaged from exposure to gluten, the protein found in wheat, barley and rye.

(Oats may be involved because oats are often contaminted with gluten from other

grains during the milling process.) The small bowel becomes unable to absorb

water and nutrients, causing a number of different symptoms.

Why does a child get CD? First, the disease arises only after exposure to

gluten. Second, there is usually a genetic predisposition toward a " sensitive "

small bowel lining. Third, certain environmental insults may make the lining

more susceptible to injury from gluten, such as surgery on the gastrointestinal

tract or a gastrointestinal infection. Whatever the initial reason, the gluten

causes an immunologic response in the lining of the small bowel: the surface

folds shrink and flatten and a " malabsorption " condition occurs. CD used to be

considered to be much more common in Europe than in the US, but recent studies

indicate that the incidence of CD in people in the US of European ancestry have

the same incidence as in Europe. People of African-Caribbean and far Eastern

Asian ancestry very rarely have CD. Studies in the 1990s indicated that children

with DS are at a higher risk to develop CD than the general population. The

reasons for that aren't entirely clear, but since children

with DS are at a greater risk from auto-immune diseases, that CD represents

another one of these type of diseases. Studies from Europe looking at the

percentage of children with DS that have CD have ranged from 7% to 16%. One

American study found 4 to 5% of children with Down syndrome living on the East

Coast had positive CD, but almost all the subjects were Caucasian, so this group

was mostly of European heritage to begin with. Another American study done in

the southeastern US found 7% of the children with DS studied had CD.

The signs of CD are varied, since the condition may be mild in some and severe

in others. The majority of children with CD have what's called " failure to

thrive: " lack of growth of weight, and sometimes height as well. Most have

diarrhea, and/or vomiting. Children with CD are irritable and usually have a

decreased appetite. The stools may be foul smelling, and in occasional cases,

may not be loose but big and bulky. A small number of children will develop

severe diarrhea leading to dehydration. The children who have had CD for several

months will have bloating of the stomach and a loss of muscle mass. If not

treated, malabsorption will continue to cause undernourishment, producing

anemia, osteoporosis and peripheral neuropathy.

The main way of diagnosing CD has always been through biopsy of the small bowel.

Under a microscope, the small bowel will show characteristic damage to the

lining. One way this is done by having the patient swallow a capsule attached to

a string, which is used to retrieve the capsule after a period of time. Many

doctors prefer to do a biopsy under direct endoscopy, however, especially in

children. The lining of the small bowel has certain characteristics under a

microscope when CD is present.

Since a small bowel biopsy is neither easy nor cheap, it's not in the best

interest of the child or family to do a biopsy on every child with DS. So the

best thing would be to have an easy blood test that can detect the children who

need the diagnostic biopsy. A few blood tests have been tried in the past with

unhelpful results, such as the antigliadin antibody (AGA) test. However, the

blood test looking for antiendomysium (or antiendomysial) antibodies (EMA) seems

to be an effective screen. One study from Sweden looked at a group of children

with DS and found 16% of the children screened to have elevated levels of

antiendomysium antibodies, all of which were found to have biopsies diagnostic

of CD. When the AGA and EMA tests are combined, this produces an effective

screen to determine who should receive the biopsy. Recently, a newer blood test

has been developed looking for IgA antibodies to the enzyme transglutaminase

(TG). TG is an intracellular enzyme that binds gliadin and

starts to process it in a way that starts the autoimmune sequence in CD.

Testing for antibodies to TG (IgA-tTG) may be a more sensitive screen for CD

than EMA. Note that all these tests are measuring IgA levels. One problem is

that IgA deficiency may occur in people with CD, and therefore the IgA markers

for CD may not show up. That would classify as a " false negative. " For that

reason, every time a person has blood tests for CD, the doctor must also test

for total IgA levels.

Recent research has found that 97 to 98% of all cases of CD are found in people

with certain genetic markers. These genetic markers are called HLA ( " human

leukocyte antigen " ) markers. There are two markers that are associated with CD:

HLA-DQ2 and HLA-DQ8. In cases where CD is suspected and there is an IgA

deficiency, these markers can be looked for instead to determine if a small

bowel biopsy is warranted. Children with DS and CD also have the same markers.

Interestingly, the genes for the HLA markers are on the chromosome 6, so the

connection to chromosome 21 still needs to be discovered.

It's important to note that infection from Giardia, a microscopic parasite found

worldwide, can mimic CD. Diagnosis of this infection is done by special tests on

the stools.

Treatment is both simple and difficult: a gluten-free diet. All wheat, barley

and rye products are off limits. Currently, it is recommended that oats be also

eliminated from the diet at the beginning. They can be replaced in the diet as

soon as the patient is doing better. In most cases, the symptoms of CD resolves

in 2 weeks! The older the child, the longer it takes to come under control. CD

is a lifelong disease; symptoms may from time to time subside to the point of

the CD appearing to be gone, but the person must continue on the diet to avoid

illness. The person may need vitamin supplementation to complete the diet.

maureen ferris wrote:

Kristy,

What is Celiac Disease? is often very gassy after eating and is

stools are loose as often as they are hard.

Maureen, mother to Tyler, 10 and , 7(MDS)