Celiac Disease Showing Up in Many Forms and at All Ages

It’s nice to see more emphasis and greater study put toward celiac research.
— Dr. Dale
By Janice Neumann

(Reuters Health) - A classical set of celiac disease symptoms no longer reflects the profile of most newly-diagnosed patients, according to a new study from Italy.

Instead, doctors should take other symptoms into account and consider the possibility of celiac disease, even when patients don't fit the old image of the condition, researchers say.

"It's been a gradual phenomenon since the 1970s that fewer people are presenting with the classical diarrhea and more with non-classical or silent presentation, both in adults and children," said Dr. Peter Green, who wasn't involved in the study.

"We don't actually know why one person has diarrhea and another presents with abdominal pain or osteoporosis," said Green, director of the Celiac Disease Center at Columbia University in New York.

Dr. Umberto Volta and his coauthors wrote November 18 online in the journal BMC Gastroenterology that just 15 years ago, celiac disease was still thought of mainly as a rare pediatric food intolerance, whose most common signs were diarrhea and intestinal damage.

Volta, a professor of medicine at the University of Bologna in Italy and vice president of the Ethical Committee at St. Orsola-Malpighi University Hospital, and colleauges looked at the celiac patients diagnosed over the course of 15 years at that hospital.

The study involved 770 patients, 599 of them female, diagnosed between 1998 and 2007. Nearly half were diagnosed during the first 10 years of the study period and the rest in the last five years, indicating a steep rise in rates of diagnosis.

Among all the patients, 610 people, or 79%, had symptoms when they were diagnosed. But most of their problems were not the typical diarrhea and weight loss, but rather "non-classical" issues like bloating, osteoporosis and anemia. Diarrhea was a symptom in just 27%.

Indeed, classical symptoms became less common over the years, decreasing from 47% of patients during the first 10 years to 13% in the last five. Meanwhile, other problems, as well as a lack of any significant related illness, increased by more than 86%.

"The most striking change in clinical presentation of celiac disease over time has been the decrease of diarrhea as the leading symptom and the progressive increase of other non-classical gastrointestinal symptoms (such as constipation, bloating and alternate bowel habits as well as gastro-esophageal reflux, nausea, vomiting and dyspepsia)," Volta said in an e-mail to Reuters Health.

"A high proportion of celiac disease patients did not show any gastrointestinal symptom, but they displayed extra-intestinal manifestations such as iron-deficiency anemia, unexplained osteoporosis, abnormalities of liver-function tests and recurrent miscarriages," he said.

The most common illness associated with celiac was thyroid disease. Only half the patients had severe intestinal damage.

In later years, more patients were diagnosed with blood tests. That may be one factor accounting for the changing pattern of typical symptoms, Volta said, because the patients were diagnosed earlier.

"The effects of gluten weren't as severe yet," Volta said. "The story of celiac disease has been radically changed by the discovery celiac disease-related antibodies, which identify plenty of unsuspected cases."

Green agreed that testing has vastly improved diagnosis of the disease. He said that in the UK, anyone with iron deficiency or migraine is tested for celiac disease.

While most celiac specialists understand the varied symptoms, other physicians might not, he said. Green pointed out that in the United States, only 17% of people with the disease are actually diagnosed.

"Anyone can have celiac disease, it's common and underdiagnosed," said Green. "The message we want to get out is if you think you've got celiac disease, don't just go on a gluten-free diet, test for it."

Volta said he hoped the study reminded doctors about the many problems that can signal celiac disease.

"I hope doctors keep in mind that celiac disease is a very frequent food intolerance, which should be investigated not only in patients with diarrhea and overt malabsorption, but also in people (with other symptoms)," Volta said.

"The treatment by gluten-free diet improves the quality of life in symptomatic patients and prevents complications in all celiac disease patients including those without symptoms," he said.


BMC Gastroenterol 2014.

7 Sneaky Reasons You're Bloated

As a stomach doctor, these are all true!  Also, I'd add "gluten" sensitivity as another major cause for bloating. -- Dr. Dale



The Huffington Post  | By Abigail Wise

It’s uncomfortable, gross and occasionally embarrassing, but bloating is something we all deal with at one point or another. Gassiness isn't just from gorging yourself at the last family meal. Bloating happens because your body can't break down gas, like it does the food you swallow. Sometimes even the digestive process itself creates gas right in your abdomen. If it's not released, air begins to build up in the stomach and intestines, which can make your belly feel like a balloon.

This type of abdominal discomfort can pop up at any time, last for hours and sometimes antacids and burping just don't quite do the trick. Can't seem to beat the bloat? Here are seven reasons that gas is gurgling in your gut.

You're stressed out.

When stress hits us hard, some of our bodies react by driving blood away from the usual digestive process, Dr. Anne Nedrow, M.D., told As a result, you could end up with bloating, constipation, diarrhea or a plain old stomachache.

While stress itself could be to blame for bloating, the nervous habits that many of us pick up when we're anxious could also be the culprits, according to the Mayo Clinic. We chew gum, down carbonated drinks or even gulp air when we're nervous or feeling anxious. All of these habits push extra air into the stomach, which the body can't digest. This abdominal side effect is yet another reason to practice yoga, go for a run or do whatever it takes to de-stress.

Your medication is bringing on the bloat. Medications can come with a long, and sometimes nasty, list of possible side effects, including bloating. Meds that contain lactulose or sorbitol, or the diabetes medicine acarbose, are especially common culprits.

You ate too much.

Is that lump more than a food baby from your last big meal? An uncomfortable bubble in your belly could be gas trapped from eating too much in one sitting. Overeating is one of the most common causes of bloating. Research published in the International Journal of Obesity found that if you're binge eating, you're even more likely to encounter gassiness.

You chow down at superspeed. Stop gulping down your grub. Eating too quickly or drinking through a straw can result in swallowing bubbles of air along with your meal.

Plus, insufficient chewing can reduce your body's ability to digest carbs, nutritionist Monica Reinagel, M.S., LDN, CNS, tells The Huffington Post. This can create gas in the intestines, which makes you feel uncomfortable. Even if you're starved after a long day at the office, force yourself to chew thoroughly and take small sips before you swallow. This will help eliminate the air pockets that bloat your belly.

You're dehydrated. Just like crash diets cause the body go into starvation mode and cling to fat, your body begins to retain fluid when it's dehydrated, Marilyn Glenville, nutritional therapist, told Good Housekeeping. If you feel like you're retaining fluid, that probably means it's time to drink some more. Avoid carbonated drinks, which will likely exacerbate your problem. Instead, reach for herbal tea or a good old glass of water.

You're eating gassy foods.

Some foods are notorious for causing gas, Reinagel tells HuffPost. Cabbage, broccoli, kale, apples and avocados have all been known to cause bloating. Eating too much salt can also cause water retention, which can leave you feeling puffy. Plus, downing lots of fiber -- especially from supplements -- without drinking enough water is a fast track to a gassy gut. If you know the foods you're intolerant of -- dairy if you're lactose intolerant, for instance -- those might also be good to steer clear of if you're trying to break the bloat.

You have a chronic medical condition. Many disorders cause bloating, including celiac disease, dumping syndrome and even ovarian cancer. Irritable bowel syndrome is one of the most common. IBS affects the large intestine and causes food to be forced through the intestines faster than it should be, often resulting in gas and diarrhea. If you just can't seem to reduce your bloating, visit your doctor. Symptoms of many disorders can improve dramatically as people learn to control their condition.

Constipated? Swallow thisSSss.

How amazing is this?! Live a healthy day!

-- Dr. Dale



Vibrating capsule may relieve chronic constipation

A vibrating capsule may provide relief for those who suffer from chronic constipation, according to a small study presented at Digestive Disease Week, an annual meeting of gastroenterologists, hepatologists, endoscopy specialists and GI surgeons.

Twenty-six study participants, who all suffer from chronic idiopathic constipation or constipation predominant irritable bowel syndrome (IBS), were asked to take a vibrating capsule twice a week and then complete a questionnaire, according to the study, presented Saturday.

More than half of the 26 patients experienced an increase in bowel movements, says Dr. Yishai Ron, lead study author and director of Neurogastroenterology and Motility at Tel-Aviv Sourasky Medical Center. "The number of bowel movements rose from around two to nearly four bowel movements per week – this was an average figure.” Ron adds patients also saw a decrease in constipation symptoms.

In addition, patients reported minimal side effects. Before participating in the study, patients were asked to refrain from using laxatives for two weeks before ingesting the capsule.

"The vibrating of the capsule induces a motor activity of the large bowel which moves content forward and helps expel it out," says Ron.

The concept is based on the current technology where a patient swallows a video-chip capsule to allow doctors to capture pictures inside the bowels instead of undergoing a standard endoscopy, Emory Saint Joseph's Hospital gastroenterologist Dr. Tom McGahan said in an e-mail.

This new capsule doesn't take any pictures, but rather acts as a "small engine" which stimulates the bowel nerves, says McGahan, thus creating vibrations that help induces bowel peristalsis. "Peristalsis is the coordinated wave-like action of the intestine muscles that propels bowel contents along."

"This is a new concept - not yet proven true or effective, but novel at least," says McGahan. He adds this is just a pilot study to assess safety and it's not proof that this capsule is more effective than other treatments.

"No conclusion as to the benefit of the capsule can be made from this study because of the small number of people tested, that they all knew they took the Vibrant Capsule (it was not a blinded study), and they did not compare this group of 25 to a similar group who received no treatment (control group)," he says.

Ron admits more research needs to be done but says he is hopeful "this might be a revolutionary solution for constipation," especially since patients found relief after taking only two capsules per week. "It's a non-chemical medical device, no side effects, nothing is absorbed, there were minimal side effects with maximal effects."

Chronic constipation affects about 16% of people in the United States, according to a 2010 study in American Journal of Gastroenterology. Dr. Ron says, "this is a chronic syndrome and these people suffer daily from this inconvenience," and he adds, "most people are unsatisfied with their current laxative use."

McGahan agrees, saying many people do not find relief of their symptoms with their current treatment and admits there is no perfect regimen because of so many side effects.

The study was paid for by Vibrant Ltd. a medical device company which developed the capsule.