When Gluten Attacks: Celiac Disease                            Ted J. Paradowski, MD,                            Gastroent...
What is Celiac Disease/Sprue? • Defined as a permanent intolerance to   the storage proteins or gluten found in   wheat, r...
Celiac Disease – Key Points  •   Autoimmune disorder  •   Ingested gluten is trigger  •   Unknown cause – genetics involve...
Celiac Disease – other facts  •   About 2 million Americans  •   About 1/100 people  •   But only 1/10 diagnosed  •   1st ...
What is gluten? • A protein found in wheat, rye, barley • Technically not in oats, but often   contaminated w/other grains...
Gluten Ingestion in Celiac Dz
Many processed foods contain             GLUTEN• Beer                •   Chips/potato chips• Bouillon cubes      •   Cold ...
Wide Variety of Symptoms• Gas, bloating, pain        • Tingling numbness in• Chronic diarrhea >           legs (nerve dama...
Diagnosis of Celiac Disease • Recognize symptoms - overlap • Think of celiac disease • Blood test for autoantibodies   – T...
Treatment of Celiac Disease •   Gluten-free diet (GFD) •   Strict lifelong adherence •   Dietitian assistance •   Regular ...
Some foods without gluten•   Amaranth       •   Quinoa•   Buckwheat      •   Tapioca•   Legumes        •   Brown rice•   P...
Inadvertent gluten ingestion•   Brown rice syrup        •   Processed lunch meat•   Breading/coating        •   Sauces/gra...
Complications of Celiac Disease • Malabsorption problems   – Anemia, growth delay, weight loss,     osteoporosis, infertil...
Mimickers•   Pancreatic diseases – loss of enzymes•   Small intestinal bacterial overgrowth•   Lactase deficiency/lactose ...
Just to confuse you more…• “Latent” Celiac Disease  – Positive blood antibodies  – But normal SB biopsy  – Don’t need GFD…...
Resources for Patients/Families• www.nlm.nih.gov/medlineplus/celiacdisease.html - The  National Library of Medicine• www.c...
Questions?
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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.

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When Gluten Attacks, Ted Paradowski, MD

  1. 1. When Gluten Attacks: Celiac Disease Ted J. Paradowski, MD, Gastroenterology and Hepatologywww.SpringfieldClinic.com
  2. 2. 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
  3. 3. 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
  4. 4. 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 >
  5. 5. 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)
  6. 6. Gluten Ingestion in Celiac Dz
  7. 7. Many processed foods contain GLUTEN• Beer • Chips/potato chips• Bouillon cubes • Cold cuts, salami• Candy • Hot dogs, sausage• Communion wafer • French fries• Gravy • Matzo• Rice mixes • Sauces• Seasoned tortilla • Self-basting turkey chips • Soy sauce• Soups
  8. 8. Wide Variety of Symptoms• Gas, bloating, pain • Tingling numbness in• Chronic diarrhea > legs (nerve damage) constipation • Bone or joint pain• Foul-smelling stool • Muscle cramps• Fatty stool • Delayed growth• Fatigue • Pale sores in mouth• Unexplained anemia • Specific skin rash,• Low iron levels dermatitis• Behavioral changes; herpetiformis irritability in children
  9. 9. 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
  10. 10. 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
  11. 11. Some foods without gluten• Amaranth • Quinoa• Buckwheat • Tapioca• Legumes • Brown rice• Potatoes • Flax• Soy • Nuts• Arrowroot • Seeds• Corn • Wild rice• Millet
  12. 12. Inadvertent gluten ingestion• Brown rice syrup • Processed lunch meat• Breading/coating • Sauces/gravies• Energy bars • Soup bases• Flour/cereal products • Stuffing/dressing• Imitation bacon • Thickeners• Imitation seafood • Drugs/OTC meds• Marinades • Supplements• Panko • Kids: Play-dough,• Pastas crayons, paint, glue…
  13. 13. 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
  14. 14. Mimickers• Pancreatic diseases – loss of enzymes• Small intestinal bacterial overgrowth• Lactase deficiency/lactose intolerance• Intestinal lymphoma• Autoimmune enteropathy• CVID• Tropical sprue• Eosinophilic gastroenteritis
  15. 15. 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
  16. 16. 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
  17. 17. Questions?

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