What further evaluation should the patient undergo to arrive at the diagnosis?
Endoscopy evaluating GI integrity
Describe the venn diagram that compares IBS, celiac, and gluten sensitivity
Based upon report of GI symptoms, how should the patient be evaluated and what is the likely diagnosis?
Rome III criteria (for IBS diagnosis) - any other potential evaluations????
What dietary interventions are available to celiac patients?
What are some of the non-GI symptoms of celiac?
iron deficiency anemia, folate (B12) deficiency, short stature, delayed puberty, recurrent feral loss, low birth weight infants, reduced fertility, persistant aphthous stomatitis, dental enamel hypoplasia, idiopathic peripheral neuropathy, nonhereditary cerebellar ataxia, recurrent migrane headaches
Patient; "I've been having some tummy pain for 3 months now. I just noticed it one day, and it's been there ever since. It's all over the tummy, like a sort of cramping feeling, a bit like a period pain, I supposed, but I'm getting it throughout the month. It comes on most days; there doesn't really seem to be a pattern to it. It's usually sore for a few hours, once it's come on. Some days it seems a bit worse than others, but as I said, there is no pattern to it."
What are some possible, suspected diagnoses?
IBS-D, Celiac Dz
What are the lecturer's recommendations?
Physicians work with dieticians
Address patient misunderstanding
Restuarants that label gluten-free items aren't as harshly regulated
What are some of the gluten containing grains?
Wheat, Rye, Triticale (wheat-rye cross), Barley, Questionable Oat
What are three tests that can help in the diagnosis of celiac?
Serologic evaluation (IgA - gliadin specific, anti-tissue transglutaminase tTG)
What are some of the gluten-free substitutes?
Corn, rice, amaranth, buck wheat, millet, montina, quinoa, sorghum, teff
What must be remembered about the grains that can't be consumed?
NO WHEAT, NO RYE, NO BARLEY!
For Case #2
(possible IBS-D, celiac dz)
Have any change in stress level over the past 3 months?
What forms are your BMs, typically? Loose, formed, hard, small? Blood in stool?
Do you notice bloating?
Family history of IBS/CD/IBD?
What is important in the treatment of celiac?
Gluten free (gliadin free diet mandatory)
What three things must happen for someone to develop celiac dz?
- Inherit the gene
- Consume gluten
- Have gene triggered
What is questionably gluten free?
Since the severity of the gluten sensitivity can be variable, celiac is described as?
A continuum (celiac dz to gluten-sensitive enteropathy)
What are the two main associated conditions with celiac?
T1DM - 2-19%
Down Syndrome - 16%
Where might gluten lurk within a patient's diet?
What are some of the nutritional impacts of gluten free diets?
Many people gain weight
Fewer servings of grains; nearly all refined
Low in Fiber
If testing indicates CD, how should her case be managed?
Primary Dietary/ Nutrition Intervention and Management
How should said patient with suspected celiac be evaluated?
What is the cue-diagnosis matrix for adominal pain scenario?
What are the consequences of consuming gliadin for a patient with celiac?
villous atrophy, decreased surface area for nutrient absorption, chronic inflammation down-regulates transport proteins in the epithelium, atrophy leads to decreased CCK and secretin leading to pancreatic insufficiency, bacterial overgrowth
Describe the layers of the celiac iceberg model
Top: typical celiac
Second: atypical celiac
Third: people who could potentially develop celiac
Bottom: Healthy individuals
What are some of the health risks associated with celiac?
Dyspepsia, dirrhea, gut pain
Weight loss, weakness
Iron deficiency anemia
Metabolic bone loss
What might the patient have?
An adverse response to gluten storage proteins (prolamines) that triggers an immune response resulting in damage to the mucosa of the small intestine
What are the celiac trifecta factors?
Genetics (HLA-DQ2, HLA-DQ8)
If one restricts their diet to strictly gluten free, what might they be at risk of inadequately consuming?
B-vitamins, iron, and fiber
What testing is required for CD diagnosis?
What is the potential diagnosis for the patient based on the EGD findings?
What are some of the gluten-free substitutes that substitute well?
Flax, hemp, poppy seed and sesame, nuts, salba, soy, legumes, tapioca, arrowroot, nuts
What might cause the insufficient intake of vitamins when switching to a gluten free diet?
What within gluten is targeted in the immune response?
What is the worldwide incidence of celiac?
1 in 100
Inflammation of the mucosa causes what within the small intestine?
Destruction of villi in the intestine (leading to partial or complete flattening)