Archive for the ‘Symptoms’ Category

 


“An estimated 40 million adult Americans suffer from anxiety disorder.” (1) These 40 million people total 18.1 percent of the United States that are at least 18 or over. (2)

According to “Recognizing Celiac Disease” anxiety is common in people with celiac disease and may be the only manifestation. Celiac disease patients showed high levels of state anxiety in a significantly higher percentage compared to controls – 71.4% vs. 23.7%.(3)

Chronic maladaptive anxiety is characterized by vague uneasiness or unpleasant feeling of apprehension and dysfunction. It is marked by anticipation of danger and interference with normal functioning, ranging from mild qualms and easy startling to occasional panic, often with headaches and fatigue. Deficiency of amino acids and vitamins implicate reduction of synthesis of neurotransmitters in the central nervous system and could be linked to immunological disregulation in celiac disease patients. Anxiety itself causes depletion of vitamins and minerals. Deficient nutrients could be B vitamins, calcium, iron, magnesium, potassium, tryptophan.(3)

A medical study evaluating bloodflow in the brain showed evidence of significant blood flow alteration in the brains of people with celiac disease who had only anxiety or depression neurological symptoms and were not on a gluten-free diet. Single photon computed tomography (SPECT) scan showed at least one hypoperfused brain region in 73% of untreated celiac disease patients compared to 7% of patients on a gluten-free diet and none in controls.(3)

Therefore, bloodflow in the brain and nutritional deficiencies play a large part in anxiety. If nutritional deficiencies are the source of the problem, then medications will be less effective requiring increasingly strong doses because the body and brain do not have what they need to utilize them.

The good news is that studies showed state anxiety improves and can usually disappear in people with celiac disease after withdrawal of gluten from the diet and improvement of nutrient status.

Consider celiac disease if you or someone you know has anxiety.

Related medical studies are referenced in “Recognizing Celiac Disease.”

Celiac disease is a multi-system, hereditary, chronic, auto-immune disease estimated to affect 1% of the human population (3 million in the US) that is caused by the ingestion of wheat, barley, rye and oats. It is treated by removing these items from the diet. Signs, symptoms, associated disorders and complications can affect any part of the body and removal of the offending foods can result in complete recovery.

“Recognizing Celiac Disease” is a reader-friendly reference manual written for both medical professionals and the general public that specifically answers the call from the National Institutes of Health for “better education of physicians, dietitians, nurses and other healthcare providers.” It has been endorsed by top medical professionals and professors at Harvard, Columbia, Jefferson and Temple Medical Schools as well as the National Foundation for Celiac Awareness and the Celiac Sprue Association – USA. “Recognizing Celiac Disease” is being hailed as the complete guide to recognizing, diagnosing and managing celiac disease and a must-have for physicians, dietitians, nutritionists, nurses, patients and anyone with an interest in this complex disorder.

Click here for more information.

Sources:

(1) ADAA Brief Overview. ww.adaa.org/GettingHelp/Briefoverview.asp
(2) Wikipedia. http://en.wikipedia.org/wiki/Anxiety
(3) Libonati, Cleo. Recognizing Celiac Disease, Gluten Free Works Publishing, 2007. http://www.recognizingceliacdisease.com

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Author Information: John Libonati, Philadelphia, PA
Publisher, Glutenfreeworks.com.
Editor & Publisher, Recognizing Celiac Disease.
John can be reached by e-mail here.


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Category: Anxiety, Symptoms
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Dental Enamel Defects and Celiac Disease

May 19th, 2009 by John Libonati

dental_defects_celiacdiseaseby John Libonati

Dentists can be the first identifiers of celiac disease. Up to 89% of people with celiac disease exhibit dental enamel defects. Dental enamel defects are characterized by alteration in the hard, white, dense, inorganic substance covering the crowns of the teeth. These defects may include demarcated opacities (white spots), undersized teeth, yellowing, grooves and/or pitting on one or more permanent teeth.(1)

A study of 128 patients on a gluten-free diet revealed that changes in the permanent teeth may be the only sign of an otherwise symptomless celiac disease.(1) It should also be noted that calcium and vitamin D deficiencies are common in celiac disease. Deficiencies of these nutrients lead to cavities.

“Dentists mostly say it’s from fluoride, that the mother took tetracycline, or that there was an illness early on,” said Peter H.R. Green, M.D., director of the Celiac Disease Center at Columbia University. “Celiac disease isn’t on the radar screen of dentists in this country. Dentists should be made aware of these manifestations to help them identify (more…)

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Category: Dental Defects, Symptoms
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If you or someone you know has a child with a mental illness, behavioral problem or unexplained neurological issue, you must watch these videos. They vividly illustrate how gluten and celiac disease can cause neurological illnesses and how removing gluten and casein from the diet can improve or cure the child.

Eamon Murphy started exhibiting mental aberrations and problems eating at three months of age. By the time he was three, his parents were frantically trying to understand what had caused his developmental delay in walking and talking, and now his trances, seizure-like episodes and regression. After a determined effort by his mother and a series of extraordinarily lucky events, he was finally diagnosed with celiac disease…and FULLY RECOVERED.

Watch these videos NOW and then forward this message to everyone you know with a child with a similar mental illness and their healthcare providers…because it is unacceptable that any child should be unnecessarily consigned to a life of suffering and diminished potential when a simple change in diet may cure them.

Eamon is totally normal now. If he had not been diagnosed, it is easy to see how he could have become incapacitated within a few years as his body and mind became sicker and sicker. Eventually, he may have been labeled autistic or schizophrenic. He may just have been called odd and slow.

Was it a miracle that Eamon recovered? No. It was a miracle that Eamon was diagnosed…

Here are some facts:

Autism affects 1 in 150 children. Medical experts recommend behavioral management and specialized speech, physical and occupational therapies (costing an estimated $70,000 per year per child), medications, community support and parental training.

Medical experts recommend AGAINST dietary intervention, yet the gluten-free/casein-free diet that helped Eamon has been demonstrated in thousands of cases to improve or resolve symptoms.

Celiac disease is still considered a rare gastrointestinal disorder that affects children by the majority of health professionals. In reality, celiac disease affects 1 in 100 people of any age, classifying it an epidemic by NIH standards. More people have celiac disease than Type 1 diabetes, breast cancer or autism. Diagnosis of celiac disease is estimated to take up to 11 years from first presentation of symptoms. Only 5% of people with celiac disease are estimated to be diagnosed.

Gastrointestinal problems occur in about 20% of people with celiac disease whereas neurological problems have been seen in as high as 51% at time of diagnosis.

The treatment for celiac disease is removing gluten from the diet and correcting nutrient deficiencies and any complications that have developed.

Unless you have symptoms that doctors expect to see – chronic diarrhea, failure to thrive, abdominal bloating and pain, and anemia – your likelihood of being diagnosed is extremely low.

For a complete list of symptoms related to celiac disease including dozens of neurological issues and problems in childhood, visit Gluten Free Works.

An excellent resource that outlines over 300 signs and symptoms and explains the relationship between celiac disease and the nutrient deficiencies that cause them is the book Recognizing Celiac Disease, by Cleo Libonati, RN, BSN. Recognizing Celiac Disease was endorsed by Dr. Peter Green, the director of the Celiac Disease Center at Columbia University who diagnosed Eamon Murphy.

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Category: Gluten Free Casein Free Diet, Mental Disorders, Neurological Disorders, Symptoms, Videos
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cow

The following questions concern whether villous atrophy can be caused by milk and whether anemia can result from milk ingestion. The answer is yes: bovine beta casein enteropathy can cause both. See full explanation below.

Question:Does anyone know can a defiency in lactase enzyme cause the villi to be blunted? My 3 year old son jsut had an endoscopy and it showed the villi are blunted.

My son has a lactase deficiency and has been gluten free for 18 months. We took him off lactose for the first 6 months after being diagnosed but then added it back and he seemed fine for 6 months.

So I am hoping maybe the fact that he was drinking alot of milk casued the villi to be blunted and not ingesting any gluten?

Also, can that cause anemia?

My son is also slightly anemic. But we are very strict with his diet and I am pretty sure he is not gettign any gluten ( i know its possible but I dont think so… his diet hasnt changed..)

Celiac antibody blood tests indicate he is not getting gluten?

So i am wondering if the lactose coudl be causing the villi to be blunted and the anemia???

Thanks,
S

Answer:
Dear S,

The most common cause of villous atrophy in people with celiac disease is unintentional gluten ingestion. This answer assumes no gluten is being ingested.

Cow dairy can cause an enteropathy similar to celiac disease. It is called Bovine Beta Casein Enteropathy. It acts like celiac disease, causing inflammation leading to villous blunting. The milk protein elicits the antibody reaction just like gluten does in celiac disease.

The resulting villous blunting would explain lactose intolerance, as the lactase enzymes needed to digest lactose are produced and release near the tips of the villi. If the villi are blunted, no lactase is being produced and milke digestion does not occur.

Bovine beta casein enteropathy is marked by diarrhea, failure to thrive, vomiting, atopic eczema and recurrent respiratory infections. It causes malabsorption of nutrients, just like celiac disease, so it can lead to nutrient deficiencies including anemia. 12% of those with bovine beta casein enteropathy are found to have celiac disease.

-John Libonati

Source: Recognizing Celiac Disease. p. 147
www.recognizingceliacdisease.com

recognizing_celiac_disease_website_cover_132x162

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Category: Bovine Beta Casein Enteropathy, Symptoms
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cataract1
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The post below is a response to a young woman with cataracts and celiac disease. Cataracts are directly related to nutrient deficiencies of Vitamin A, calcium and possibly vitamin B2 in celiac disease. (Editor’s note.)

Hello,

I am 20 years old, have celiac disease and cataracts. The optometrist told me it is because I have fair skin and light eyes and have had too much sun exposure. I grew up in Mobile, AL and spent everyday I could at the beach so this could be true. It is very interesting that you brought up this topic though. It never crossed my mind that these two could have anything to do with each other.

-L

Hi L,

Many eye problems are found in celiac disease. Cataracts are directly related to nutrient deficiencies. “Cataract formation, a feature of vitamin A deficiency and long standing hypocalcemia, is characterized by clouding of the lens of the eye. In celiac disease, it results from malabsorption of vitamin A and calcium. Vitamin B2 may be involved. GFD (gluten-free diet) is preventive and limits further changes.” (Recognizing Celiac Disease, p. 213) That said, we know that malnutrition can persist on a GFD due to unintentional gluten ingestion, poor diet, etc. Ask your physician to take levels of vitamin A, B2 and calcium to make sure you are absorbing adequate amounts.

-John

————————————–
Author Information: John Libonati, Philadelphia, PA
Publisher, Glutenfreeworks.com.
Editor & Publisher, Recognizing Celiac Disease.
John can be reached by e-mail here.

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Category: Cataracts, Symptoms
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restless leg syndrome treatment

RLS from low iron in celiac disease responds to a gluten-free diet

Low iron levels have been associated with increased severity of restless leg syndrome. The following medical case report discusses four patients with low iron and restless leg syndrome who were tested positive for celiac disease and placed on a gluten free diet. All four had improvement on the gluten free diet.

“Celiac disease as a Possible Cause for Low Serum Ferritin in Patients with Restless Legs Syndrome.”

Manchanda S, Davies CR, Picchietti D.

University of Illinois at Urbana-Champaign, College of Medicine, 506 S. Mathews Avenue, Suite 190, Urbana, IL 61801, USA.

OBJECTIVE: To describe celiac disease as a possible cause for low serum ferritin in patients with restless legs syndrome (RLS). BACKGROUND: Low iron stores have been found to be a risk factor for RLS with serum ferritin levels less than 45-50ng/mL associated with increased severity of RLS. It has become routine clinical practice to test serum ferritin in the initial assessment of RLS. Celiac disease is a common genetic disorder that can cause iron deficiency.

METHODS: Consecutive case series of four patients with RLS and serum ferritin below 25ng/mL, who had positive screening tests for celiac disease. RESULTS: We report four patients who had serum ferritin <12ng/mL and positive screening tests for celiac disease. All had celiac disease confirmed by duodenal biopsy and response to a gluten-free diet. RLS symptoms improved in all four, with two able to discontinue RLS medication and two responding without medication.

CONCLUSIONS: In patients with RLS and low serum ferritin who do not have an obvious cause for iron deficiency, we suggest looking for celiac disease by simple, inexpensive serologic testing. Diagnosis and treatment of celiac disease is likely to improve the outcome for RLS, as well as identify individuals who are at risk for the significant long-term complications of celiac disease.

Source: Sleep Med. 2009 Jan 10. [Epub ahead of print]
url: http://www.ncbi.nlm.nih.gov/pubmed/19138881

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Category: Celiac disease, Health, Restless Leg Syndrome
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New IBS Guidelines Include Screening for Celiac Disease

December 20th, 2008 by John Libonati

New guidelines for the treatment of IBS published by the American College of Gastroenterology include screening for celiac disease…

New IBS Guidelines Offer Treatment Ideas

American College of Gastroenterology Updates Recommendations for Irritable Bowel Syndrome
By Bill Hendrick

WebMD Health NewsReviewed by Louise Chang, MDDec. 19, 2008 — New guidelines have been issued by the nation’s gastroenterologists that are aimed at easing the abdominal pain, diarrhea, and other symptoms of irritable bowel syndrome (IBS), which afflicts millions of Americans.

The guidelines, issued by the American College of Gastroenterology, also offer hope to patients who’ve struggled with the condition and found satisfactory treatments lacking.

IBS is diagnosed in people whose symptoms include abdominal pain, bloating, gas, diarrhea, and constipation, or a combination of these symptoms. Though sometimes confused with inflammatory bowel disease, which includes Crohn’s disease and ulcerative colitis, IBS is a separate condition.

IBS care uses up more than $20 billion a year in direct and indirect expenditures, according to William Chey, MD, professor of medicine and director of the Gastrointestinal Physiology Laboratory at the University of Michigan Health System. He developed the guidelines in conjunction with Philip Schoenfeld, MD.

“The last time the American College of Gastroenterology published guidelines for the management of IBS was in 2002, and the College recognized that in the span of five to six years there has been a remarkable explosion in knowledge that’s become available that’s helped us to understand the cause and management of IBS,” Chey says in a news release.

Tests and Treatments for IBS
According to the new guidelines:

Patients with symptoms typical for IBS — and without alarm features like rectal bleeding, low blood count due to iron deficiency, weight loss, or a family history of colon cancer, IBD, or celiac disease — do not need extensive testing before being diagnosed.

IBS patients with diarrhea, or a combination of constipation and diarrhea, should be screened with blood tests for celiac disease, a disorder in which patients can’t tolerate the gluten protein found in wheat or other grains.

When IBS patients have alarm features or are over 50 years old, they should have further tests (such as colonoscopy) to rule out other bowel disease such as IBD and colon cancer.
IBS patients and their doctors should consider treatments involving antidepressants, which have been shown to offer relief.

The drug Amitiza helps with women who have IBS with constipation; the non-absorbable antibiotic rifaximin can ease IBS and bloating as a short-term treatment. And Lotronex, a drug that affects serotonin receptors, can be considered for patients with severe IBS with diarrhea.

Certain anti-spasm treatments may offer short-term help with abdominal pain from IBS. These include hyoscine, cimetropium, and peppermint oil.

A probiotic called Bifidobacteria may help some IBS patients.

According to the guidelines, women are twice as likely as men to suffer from IBS, which often begins in young adulthood. Gastroenterologists have found that dietary changes have proved helpful, including the addition of dietary fiber supplements such as psyllium.

Chey says IBS can be managed in most patients with counseling, dietary and lifestyle interventions, and use of both over-the-counter and prescription medications.

The guidelines suggest many treatments might be tried, though the authors concede no single magical answer has yet been found to eliminate symptoms in IBS patients. But the guidelines offer hope for people with IBS that their doctors can try a number of methods to reduce discomfort, and that some of the steps that can be taken seem to work.

ARTICLE SOURCE: http://www.webmd.com:80/ibs/news/20081219/new-ibs-guidelines-offer-treatment-ideas

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Category: Diagnosis, Irritable Bowel Syndrome, Symptoms, Testing
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A new study brings more evidence that there is a link between celiac disease and gluten. This article in Scientific American reviews the study.

Diabetes and celiac disease: A genetic connection
Patients with type 1 diabetes have been known to be more prone to another autoimmune disorder, celiac disease, in which gluten in wheat, rye and barley triggers an immune response that damages the small intestine or gut. Now there’s evidence that the two diseases have a genetic link: they share at least seven chromosome regions.

The discovery, published in this week’s New England Journal of Medicine, indicates that both diseases may be triggered by similar genetic and environmental mechanisms, such as certain foods, that cause patients’ immune systems to become overactive and destroy healthy instead of infected tissue. Previous research has found that celiac disease is five to 10 times more common in people with type 1 diabetes than in the general population, an editorial accompanying the study notes.

“These findings suggest common mechanisms causing both celiac and type 1 diabetes – we did not expect to see this very high degree of shared genetic risk factors,” said study co-author David van Heel, a gastrointestinal geneticist at Barts and the London School of Medicine and Dentistry.

Van Heel and his colleagues studied genetic material or DNA from about 20,000 people, half of them healthy, nearly half with type 1 diabetes, and 2,000 with celiac disease. The overlapping genetic variants occurred on regions of chromosomes (parts of cells that carry genetic code) that are believed to regulate the gut’s immune system, the BBC notes.

Type 1 diabetes occurs when a person’s immune system mistakenly attacks healthy beta cells in the pancreas that produce the hormone insulin, which is needed to convert glucose into energy. In celiac disease, a similar attack occurs on the small intestine when sufferers eat gluten-rich grains, causing inflammation in the gut that can lead to bloating, abdominal pain, nausea, constipation, diarrhea, fatigue, anemia, headaches, weight loss and failure to thrive in children. Whereas diabetes 1 patients must inject insulin daily to make up for their deficiency, people with celiac disease can avoid damage and symptoms by sticking to a gluten-free diet.

“The finding raises the question of whether eating cereal and other gluten products might trigger type 1 diabetes by altering the function of the gut and its interaction with the pancreas, the authors write. But Robert Goldstein, chief scientific officer of the Juvenile Diabetes Research Foundation, which helped fund the study, says it would be premature to assume from this study that gluten is also a diabetes trigger.

“I fear the newspaper headlines in the popular press will read like, ‘Eating wheat will cause type 1 diabetes,’” Goldstein tells us. “The presence or absence of these associations has to be linked to some biological consequence” for a person’s health.

Article Source: http://www.sciam.com/blog/60-second-science/post.cfm?id=diabetes-and-celiac-disease-a-genet-2008-12-11

*UK Study Source: Shared and Distinct Genetic Variants in Type 1 Diabetes and Celiac Disease, New England Journal of Medicine. http://content.nejm.org/cgi/content/full/NEJMoa0807917

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Category: Celiac disease, Diabetes, News
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Dentists Can Help to Recognize Celiac Disease

July 21st, 2008 by John Libonati

gluten free dentist
Photo © ADAM

Dentistry Blog

By Tammy Davenport, About.com Guide to Dentistry since 2005

Celiac disease causes the body’s immune system to damage and attack the small intestine upon consumption of proteins in barley, rye, wheat and possibly oats. Since there are no specific blood tests to determine if someone has Celiac disease, doctors use blood tests to look for certain autoantibodies and biopsy the small intestine to look for traits of Celiac disease.Nancy Lapid, our Guide to Celiac Disease, points out that certain dental conditions are more common in people with this disease, which puts dentists in a good position to help notice when a patient might have Celiac disease.

Some examples of dental related problems in a patient with Celiac disease are tooth enamel defects, canker sores and delayed eruption in the teeth.

Source: http://dentistry.about.com/b/2008/05/14/dentists-can-help-to-recognize-celiac-disease.htm

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Category: Bone Health, Dental Defects, Dentistry, Diagnosis
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Cleo Libonati, RN, BSN

Making the Connection – in Celiac Disease

May 19th, 2008 by Cleo Libonati, RN, BSN

Advance For Nurses Magazine
Vol. 9 •Issue 11 • Page 21

Making the Connection

Underdiagnosed in the U.S., celiac disease can be identified and treated if the condition is understood

By Cleo Libonati, RN, BSN

Celiac disease is a common food sensitivity that can be the underlying source of hundreds of health problems mistakenly attributed to other causes. This insidious disorder has the potential to disfigure, disable and destroy lives at any age. Yet, of the 3 million affected Americans, only 3 percent are diagnosed and treated.1 Prevalence rates are higher in certain populations, such as blood relatives of a person with celiac disease and those with autoimmune disorders.

Unfortunately, people in the U.S. with this condition actively seeking help for their symptoms can go a lifetime without diagnosis and proper treatment. Typically, worldwide diagnosis is faster.
Genetic Susceptibility & Gluten

Celiac disease is also called celiac sprue, nontropical sprue, gluten-sensitive enteropathy or simply celiac by the public.

This immune-mediated disorder stems from an inherited lifelong intolerance to the gluten protein found in wheat, barley, rye and oats. When ingested, gluten resists the breakdown action of normal digestive enzymes into harmless amino acids. Undigested peptides precipitate hyperpermeability of the small intestinal lining (so-called “leaky gut”) to breach the intestinal barrier defense system. In this way, gluten unnaturally gains entrance to the lamina propria.

Within the lamina propria, gluten peptides encounter the enzyme transglutaminase and the local immune system. Transglutaminase deamidates, or breaks off, the rich glutamine residues in gluten. This deamidation creates the toxic molecular compounds, or epitopes, the immune system identifies as foreign.

These epitopes trigger autoimmune antibodies in genetically susceptible individuals. Ensuing inflammation swells affected portions of the small intestinal lining and damages its delicate structures, interfering with its function to finish digestion and absorb nutrients.

While gluten itself is the environmental cause for antibody development, some stressors that can trigger active disease include gluten overload, pregnancy, viral gastrointestinal infection, surgery and severe stress.
Recognizing Celiac Disease

Despite dramatic advancements in knowledge and testing procedures, recognition of this multifaceted disorder is lacking.1Celiac disease often is undiagnosed due to ignorance of the following:

Pathophysiology — The traditional description of celiac disease as an intestinal disorder with malabsorption as the primary defect is a shadow of the real condition.

Prevalence — In contrast to the historic belief celiac disease affected just one in 5,000 individuals, antibody testing demonstrated prevalence of one in 100.

Diagnostic tests — Healthcare providers are unfamiliar with new and improved testing methods.

Manifestations — Many patients do not have diarrhea and wasting symptoms of classic celiac disease. Extraintestinal symptoms predominate in people with atypical symptoms.
How It’s Diagnosed

Diagnosis of celiac disease is made by a positive serologic antibody study and confirmed by histological findings of small-bowel biopsy specimens obtained by endoscopy and improved clinical response following a gluten-free diet.

The single most important step in diagnosing celiac disease is to recognize its myriad clinical features. No single test can definitively diagnose or exclude celiac disease in every individual; there also is a continuum of laboratory and histopathologic results.1

Positive anti-endomysium antibodies and positive anti-tissue transglutaminase antibodies show celiac disease. Positive antigliadin antibodies demonstrate sensitivity to gliadin itself, the gluten in wheat.

Not all patients have positive antibodies at presentation. When symptoms are present but test results are negative, further testing is warranted, including selective immunoglobin A deficiency. In the event the patient started a gluten-free diet prior to testing, suggest a gluten challenge of 3 months or longer in the expectation of antibody development.

Positive small intestinal biopsy shows the degree of villous atrophy, yet this is not foolproof either. The gastroenterologist must be skilled in taking accurate specimens from multiple sites, and the pathologist must be skilled in examining them properly. In addition, damage may be submicroscopic, returning a level not yet detectable by histological examination.

Additional studies include sonogram and genetic testing. Sonogram shows edema and abnormal appearance of the bowel wall. This is especially helpful for children or those who cannot undergo an endoscopy.

More than 97 percent of people with celiac disease share the same genetic human leukocyte antigen (HLA) haplotype markers, HLA-DQ2 and HLA-DQ8. While HLA genotyping is not specific for celiac disease, it has a very high negative predictive value. If the markers are not present, genetic testing essentially rules out the disease.

Annual follow-up testing is warranted for patients with negative test results who continue to show symptoms.
Recognizing Symptoms

There are no typical symptoms of celiac disease, although the most common clinical presentation is unexplained iron-deficiency anemia with or without gastrointestinal symptoms.

Celiac disease, by way of malnutrition, immunity or the direct toxic effect of gluten on cellular structures, has the potential to produce a broad range of symptoms, associated disorders and complications that may affect any organ or body system. Manifestations vary and may appear at any age.

Nutrient deficits are responsible for many seemingly unrelated conditions, such as depression, inability to concentrate, anxiety, insomnia, defective tooth enamel, coagulopathies, hypertension, obesity, anorexia and excessive thirst.

Associated autoimmune disorders may affect any body tissue, including type I diabetes mellitus, hypothyroidism and Grave’s disease, to name a few. Further, severe complications include various cancers such as B-cell non-Hodgkin lymphoma, cryptic intestinal T cell lymphoma and enteropathy-associated T cell lymphoma.

Chronic diarrhea in childhood should provoke screening. Pediatric presentation for celiac disease could involve hypotonia, failure to thrive, growth retardation, short stature, convulsions, poor bone and tooth development, thymic atrophy and delayed puberty.
Treatment

Treatment is a gluten-free diet. Excluding gluten usually results in rapid healing of the small intestinal mucosa, resolution or improvement of nutritional deficiencies, and disappearance of many manifestations of celiac disease.

The gluten-free diet is challenging due to the plethora of gluten-containing foods in the standard American diet. To succeed, patients need detailed diet instruction, including how to read food labels and identify hidden sources of gluten, such as in medications and supplements. Refer patients to a qualified dietitian if possible; otherwise, nurses can teach appropriate information.

Inform patients about community help such as celiac support groups, which offer practical advice on how to shop and cook, and where to dine. Many support groups hold their meetings at local hospitals.
Prognosis

Clinical outcome depends on duration of exposure to gluten. The longer gluten is consumed, the more the body is damaged, and the greater the likelihood of health disorders and complications developing.

Intestinal permeability improves within 2 months of starting a gluten-free diet. Despite a good clinical response, abnormal endoscopic and histologic appearances persist in the majority of patients.2Patients who receive adequate education about celiac disease and treatment with the gluten-free diet are better able to prevent intestinal damage and improve their health by dietary self-management. Clearly, nursing intervention that uncovers hidden celiac disease, provides nutritional education and promotes regular follow-up will considerably improve prognosis. n
References for this article can be accessed at www.advanceweb.com/nurses. Click on Education, then References.
Cleo Libonati is author of Recognizing Celiac Disease, and co-founder, president and CEO of Gluten Free Works Inc., Ambler, PA.
This article copyrighted to Advance For Nurses and can be accessed online at their website at http://nursing.advanceweb.com/Editorial/Search/AViewer.aspx?AN=NW_08may12_n4p21.html&AD=05-12-2008

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