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Heartburn

Heartburn Due to Acidic Stomach Contents Re-entering the Esophagus. Courtesy kaiserpermanente.org
Heartburn Due to Acidic Stomach Contents Re-entering the Esophagus.

What Is Heartburn?

Heartburn is a functional upper digestive symptom of esophagitis that is characterized by a burning sensation behind the breastbone.

Q: Why does esophagitis cause heartburn?

A: Esophagitis is inflammation of the mucosal lining of the esophagus. The most common cause of esophagitis is the re-entering of stomach contents into the esophagus because the lower esophageal sphincter (LES) does not close tightly after food or fluids enter the stomach from the esophagus and/or the LES does not remain tightly closed.

The LES is located at the junction of the esophagus and the stomach. It functions like a circular band to tighten after food is ingested in order to prevent its going back up the esophagus when powerful stomach muscles churn ingested food.

Damage to the lining of the esophagus (esophagitis) results upon contact with hydrochloric acid and pepsin in gastric juice. Hydrochloric acid, produced by the stomach to dissolve food, inflames the esophagus, which is the opposite, or alkaline. Pepsin, produced by the stomach to dissolve protein in swallowed food, acts on the inflamed esophagus to break down the protein in its sore wall.

Heartburn can be caused by other disorders such as low stomach acid, obesity, and smoking. Relaxation of the LES can also result from dietary items such as chocolate, mint, caffeine, and alcoholic drinks.

Who is Affected in the General Population? Heartburn affects an estimated 42% of the US population.1

What Is Heartburn In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. http://informahealthcare.com/doi/abs/10.1185/03007990903553812. [↩]

Ulceration And Stenosis, Postbulbar Duodenal

What Is Postbulbar Duodenal Ulceration/Stenosis?

Postbulbar duodenal ulceration is a chronic inflammatory disorder characterized by thickening of the intestinal lining with excoriation penetrating the muscularis mucosae (muscle layer of the intestine) associated with villous atrophy.

The ulcer is well-defined. Stenosis due to thickening of the area narrows the hollow inside of the duodenum which impairs passage of foodstuffs and may lead to obstruction.

Q: Is postbulbar duodenal ulceration painful?

A: Postbulbar duodenal ulceration may not cause symptoms but usually causes gnawing pain that is relieved by eating food. After eating there develops nausea and bloating.

Complications include obstruction, bleeding, and perforation of the duodenal lining. Ulcers do not usually become malignant.

What Is Postbulbar Duodenal Ulceration/Stenosis In Celiac Disease and/or Gluten Sensitivity?

Cachexia

Cachexia with Wasted Muscles, Weakness, and That Developed over 3 Years Time.
Cachexia with Wasted Muscles, Weakness, Weight Loss, Anemia, Skin Hemorrhages, Anorexia. GFW

What Is Cachexia?

Cachexia is a state of ill health involving deteriorating body composition that is characterized by general malnutrition and loss of lean tissue such as muscle.

Q: What are typical findings in cachexia?

A: Arm muscle triceps (the muscles at the back of the upper arm), skin folds, subscapular skin folds, fat area index, and bone mineral content are significantly lower than normal.

Cachexia may develop in protein-losing enteropathy such as celiac disease, chronic or severe infection such as pneumonia, tuberculosis, malaria, or many chronic diseases such as heart failure and cancer.

Cachexia can develop in persons of any age.

What Is Cachexia In Celiac Disease and/or Gluten Sensitivity?

Gastroparesis – Delayed Gastric Emptying

Reproduction of a lithograph plate showing inside of the stomach from Gray's Anatomy. Courtesy Wikipedia Commons.
Reproduction of a lithograph plate showing inside of the stomach from Gray’s Anatomy. Courtesy Wikipedia Commons.

What Is Delayed Gastric Emptying?

Delayed gastric emptying is a stomach motility or movement disorder characterized by abnormally slow movement of gastric contents from the stomach through the pyloric sphincter into the duodenum, causing dyspepsia.

Q: What determines how fast the stomach empties?

A: How fast the stomach empties depends on the pressure of strong coordinated muscle contractions in the top region of the stomach propelling chyme against resistance at the pylorus (base region of the stomach).

Chyme is food that has been dissolved and thoroughly mixed with stomach secretions.

In the digestion of carbohydrate, protein and fat, protein leaves the stomach first (1 hour), then carbohydrates (1 1/2 to 2 hours), and fat takes longest to digest (2-4 hours). Plain water is able to pass through the pylorus within 5 minutes.

What Is Delayed Gastric Emptying In Celiac Disease and/or Gluten Sensitivity?

Volvulus

Small Bowel Volvulus, Courtesy African Journal of Pediatric Surgery.
Small Bowel Volvulus Caused the  Enlarged Dark Loops. Courtesy African Journal of Pediatric Surgery.

What Is Volvulus?

Volvulus is twisting of a loop(s) of bowel onto itself which effectively closes it thus preventing digested matter from passing and causing engorgement of the closed loop with gas and fluid.

Q: How does the bowel get untwisted?

A: This condition usually necessitates surgical correction although some do return to their proper position.

The danger is that there may develop necrosis of the twisted loop(s) in which case, if left untreated, death will ensue.

What Is Volvulus In Celiac Disease and/or Gluten Sensitivity?

Liver Enzymes, Elevated (Hypertransaminasemia)

Hepatitis-C-Healthy-Liver-and-Inflammation-of-Liver

What Are Elevated Liver Enzymes?

Hypertransaminasemia is a chronic condition of elevated blood liver transaminase enzymes, commonly called “liver enzymes,” that signifies hepatocellular (liver) injury.

Q: What are serum transaminases?

A: Transaminases are the liver enzymes ALT and AST. ALT is the abbreviation for alanine aminotransferase enzyme and AST is the abbreviation for aspartate aminotransferase enzyme.

Transaminases are commonly measured in routine blood tests to determine liver function. Elevated ALT and AST transaminases  indicate inflammation of the liver. Other specific tests must follow to determine the cause of inflammation.

What Is Hypertransaminasemia In Celiac Disease and/or Gluten Sensitivity?

Vitality, Loss of

loss of vitalityWhat Is Loss of Vitality?

Loss of vitality is a state of diminished power to live or go on living, interfering with normal functioning and survival.

As weakness and fatigue worsen, the affected person increasingly loses interest in surroundings, activites, and the ability to care for self.

Q: Does loss of vitality affect only older individuals?

A: No. Loss of vitality can affect all ages.

What Is Loss of Vitality In Celiac Disease and/or Gluten Sensitivity?

Multiple Gastric Ulcerations 

Multiple Gastric Ulcerations. Courtesy Dr. Krum.
Multiple Gastric Ulcerations. Courtesy Dr. Krum.

What Are Multiple Gastric Ulcerations?

Multiple gastric ulcerations denote a stomach disorder that involves damage to the superficial mucosa characterized by many sores of the stomach antrum that are marked by inflammation, necrosis (death of the affected cells) and sloughing of destroyed tissue.

Q: Where is the stomach antrum?

A: The antrum is the lower region of the stomach before the pylorus which is nearest the duodenum (first part of the small intestine). The stomach and duodenum are separated by the powerful pyloric sphincter.

The stomach antrum propels food in the stomach against the pylorus which resists passage of food until it is turned into chyme. Chyme is highly acidic liquified food that has been thoroughly mixed with stomach juices.

Gastric ulcerations are typically associated with widespread gastritis (inflammation), inflammatory involvement of acid producing cells, and atrophy of acid and pepsin producing cells.1

The primary causes of gastric ulcerations are H. pylori infection, use of Aspirin and non-steroidal drugs (NSAIDS), and stress.1

What Are Multiple Gastric Ulcerations In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. Kathleen Mahan and Sylvia Escott-Stump, ed. Krause’s Food, Nutrition & Diet Therapy, 10th Edition. Philadelphia, PA. USA: W.B. Saunders Company, 2000. [↩] [↩]

Macrocytosis

Comparison of normoblast and megaloblastWhat Is Macrocytosis?

Macrocytosis is a blood cell disorder characterized by altered blood cell formation that results in abnormally large erythrocytes (red blood cells) circulating in the bloodstream.

The mean corpuscular volume (MCV), which is a measure of the size of red blood cells in the bloodstream, is greater than 100 fL as shown in a complete blood count (CBC) laboratory analysis report.

Macrocytosis produces macrocytic anemias that are classified as megaloblastic or non-megaloblastic:

  1. Megaloblastic anemias result from disorders of DNA synthesis of red blood cell precursors (megaloblasts) in bone marrow due to B vitamin deficiency demonstrated by macro-ovalocytes and hypersegmented neutrophils.1
  2. Non-megaloblastic anemias are or those caused primarily by alcoholism, liver disease and hypothyroidism.2

What Is Macrocytosis In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. Kaferle J, Strzoda CE.Evaluation of macrocytosis. Am Fam Physician. 2009 Feb 1;79(3):203-8. [↩]
  2. Davenport J. Macrocytic anemia. Am Fam Physician. 1996 Jan;53(1):155-62. [↩]

Hypocalcemia (Low Blood Calcium)

hypocalcemia celiac disease gluten symptomWhat Is Hypocalcemia?

Hypocalcemia, or low plasma calcium, means the level of calcium in blood is too low to meet metabolic needs of the body for calcium.

Low blood calcium is characterized by bone and tooth demineralization (loss of calcium causing weak teeth and fragile bones), and these impaired functions: nerve conduction, muscle contraction, blood clotting, blood pressure regulation, glycogen to glucose conversion, many hormone actions, many enzyme activities, and acetylcholine production.

Q: Where is calcium found in the body?

A: Calcium is the most abundant mineral in the body, with 99% residing in bones and teeth where it constitutes 40% of skeletal bone weight along with 45% phosphorus. As a component of bone (hard tissue), calcium fulfills a structural role to maintain body size and act as attachments for musculoskeletal tissues. The remaining 1% of calcium is present in blood and soft tissues.

Calcium levels in the blood are maintained within very strict limits by dietary intake, hormonal regulation by the parathyroid gland and a rapidly exchangeable pool in bone tissue.

What Is Hypocalcemia In Celiac Disease and/or Gluten Sensitivity?