Gluten Free Works: TREATMENT GUIDE Get well and stay healthy living gluten free
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Erosions Resulting From Esophagitis Can Be A Cause Of Gastrointestinal Bleeding.
What Is Occult Gastrointestinal Bleeding?
Occult gastrointestinal bleeding is characterized by unseen or minute quantities of blood in stool. The origin of bleeding is from mucosa that lines the inside of the digestive tract at a site that must be found by medical testing and procedures to look at the lining.
Q: What tests and procedures are performed to locate the bleeding?
A: The simplest test to discover blood that cannot be seen is the stool test. This consists of a card with 3 spaces for 3 separate stool collection over 3 separate days. A tiny smear of stool is placed on a test card space on each of three days. Then the card is examined for a reaction that indicates the existence of blood in the stool.
If the stool test is positive, the origin of bleeding must be located. This search requires certain procedures that look at the mucosal lining directly by a gastroenterologist, usually under light sedation.
- Gastroscopy procedure can visualize the upper gastrointestinal tract, which includes the esophagus and stomach.
- Endoscopy procedure can also visualize the upper small intestine. However, endoscopy procedure is limited in that it cannot visualize the middle small intestine (jejunum).
- Colonoscopy can visualize the end of the small intestine and colon all the way to the rectum.
- Capsule endoscopy procedure. If gastroendoscopy and colonoscopy fail to discover the source of bleeding, the physician may administer a capsule endoscopy which visualizes the entire gastrointestinal tract. In this procedure, the patient swallows a capsule size camera (encased) which takes constant pictures over the course of a day until expelled through the rectum. Of course, the patient must be able to swallow the large size capsule.
What Is Occult Gastrointestinal Bleeding In Celiac Disease and/or Gluten Sensitivity?
Occult gastrointestinal bleeding is a complication of celiac disease.
How Prevalent Is Occult Gastrointestinal Bleeding?
Occult gastrointestinal bleeding has increased occurrence in untreated celiac disease.
What Are The Symptoms Of Occult Gastrointestinal Bleeding?
- There may be no symptoms because of the small amount of bleeding.
- Or, there may be pain at the site of bleeding, especially in the stomach.
How Does Occult Gastrointestinal Bleeding Develop In Celiac Disease and/or Gluten Sensitivity?
Occult gastrointestinal bleeding in celiac disease may result from any of these mechanisms:
- Vitamin K and/or vitamin C deficiency due to malabsorption.
- Chronic gastrointestinal inflammation due to the toxic effects of gluten.
- Gastric or small bowel ulceration.
Does Occult Gastrointestinal Bleeding Respond To Gluten-Free Diet?
Yes. Celiac disease-related gastrointestinal bleeding resolves on gluten free diet.
6 Steps To Improve Occult Gastrointestinal Bleeding In Celiac Disease and/or Gluten Sensitivity:
- 1Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:
- Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
- A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
- Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.
Correct Your Individual Nutritional Needs.
- Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
- Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.
Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the absorbing cells that make up the surface lining of your small intestine are better able to function.
- Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
- Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.1
- The intestinal lining may take up to a year to heal.
- 2 Reduce Inflammation. Foods to Eat and Foods Not to Eat:
Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).
- Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.2
- Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
- Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.2
- Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.2.
- Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.2
- Refined Sugars. Includes white sugar, corn fructose and high fructose corn syrup.
- Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.2
- Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.2
- Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
- Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes green leafy vegetables such as lettuce and kale, also onion, broccoli, garlic, and others.
- High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
- Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
- Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.
- Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
- Prebiotics/ High Fiber Foods. Food with fiber keeps our population of colonic microbes healthy.
- Protective Herbs and Spices. See below #6 below for examples.
- 3 Information Sheet You Can Take to Your Doctor or Other Health Professional:
- 4 Manage Your Medications Safely:
Certain medications deplete vitamin K and/or vitamin C that promote occult gastrointestinal bleeding. Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below. Do not stop prescribed medications without supervision.
This is not a complete listing.
ANTIBIOTICS disrupt intestinal permeability which complicates celiac disease.
- Gentomycin, Neomycin, Streptomycin, Cephalosporins, Penicillins deplete Vitamin K, Probiotics, Vitamin C.
ANTI-INFLAMMATORIES disrupt intestinal permeability which complicates celiac disease.
- Corticosteroids (Prednisone, Medrol®, Aristocort®, Decadron) deplete Vitamin C.
- Aspirin and Salicylates deplete Protein, Vitamin C.
ANTICONVULSANTS
- Phenobarbital and Barbituates; and Dilantin®, Tegretol®, Mysoline®, Depakane/Depacon® deplete Vitamin K.
CHOLESTEROL DRUGS
- Colestid® and Questran® deplete Vitamin K.
DIURETICS
- Loop Diuretics (Lasix®, Bumex®, Edecrin®) depletes Vitamin C.
FEMALE HORMONES disrupt intestinal permeability which complicate celiac disease.
- Oral Contraceptives (Norinyl®, Ortho-Novum®, Triphasil®, and others) deplete Vitamin C.
- Oral Estrogen/Hormone Replacement (Evista®, Prempro®, Premarin®, Estratab® and others) deplete Vitamin C.
WEIGHT LOSS DRUGS THAT BIND FAT also interfere with absorption of some nutrients.
- Zenicol (Orlistat®) depletes Vitamin K.
- 5Nutritional Supplements To Help Correct Deficiencies:
The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.
- Multivitamin/mineral combination once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.
- Vitamin K as prescribed following blood test for status.
- Vitamin C as prescribed.
Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table.
- 6Manage Natural Remedies:
- Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
- If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
- Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
- What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.
Carminative Food Remedies:
- Raspberry.
- Carrot is also a cleansing digestive tonic.
- Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
- Redbeets also stimulate and improve digestion and are easily digested.
- Cabbage also stimulates and improves digestion and is also a liver decongestant.
- Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
- Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.
Carminative Herb Remedies:
- Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa. Drink as tea or use in cooking.
- Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
- Parsley also relieves indigestion.
- Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
- Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.
Carminative Spice Remedies:
- Cloves are also antispasmodic.
- Nutmeg is also useful for indigestion.
- Ginger.
Exercise improves circulation and rids the body of toxins.
- Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
- Weight training builds muscle. Read more about Exercise and Fitness.
- Stretching improves flexibilty. Read more about Exercise and Fitness.
Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal.
What Do Medical Research Studies Tell About Occult Gastrointestinal Bleeding In Celiac Disease and/or Gluten Sensitivity?
CASE REPORT SUMMARIES
“Laparoscopic treatment of mucinous adenocarcinoma of jejunum associated with celiac disease.” This case report describes a unique case of jejunal mucinous adenocarcinoma in which a concomitant celiac disease with occult gastrointestinal bleeding has been histologically recognized.
A 49-year-old man presented with recurrent melena, nausea, vomiting and anemia. A stenosis of the jejunum was documented by means of CT scan and video capsule enteroscopy. A laparoscopy was scheduled. A tumor, found in the first jejunal loop, was removed by laparoscopic surgery. Histopathology revealed a rare mucinous adenocarcinoma associated with epithelial changes secondary to celiac disease. Although small bowel tumors are rare entity, in patients with celiac disease complaining of symptoms related to altered intestinal transit or occult bleeding, an appropriate work-up should be planned for diagnosis. Laparoscopic surgery is often essential for the diagnosis and treatment.3
“Obscure gastrointestinal bleeding persisting for a decade: a rare manifestation of a common disease.” This case report describes the difficult course of a 60-year-old female who presented with obscure gastrointestinal blood loss for more than a decade necessitating multiple transfusions and was eventually diagnosed to have celiac disease. After introduction of gluten-free diet, her symptoms improved and there has been no recurrence of gastrointestinal bleeding.
She had earlier undergone repeat evaluations at multiple private hospitals. She was initially diagnosed with duodenal ulcer and underwent exploratory laparotomy with pyloroplasty and truncal vagotomy. However, she rebled and thereafter underwent antrectomy with retrocolic gastrojejunostomy. She also received proton pump inhibitors, and eradication therapy for Helicobacter pylori. Despite the aggressive treatment, the patient continued to have melena episodes and required multiple blood transfusions (~170 transfusions over a decade).
Esophagogastroduodenoscopy, colonoscopy and barium meal follow through did not reveal any abnormality. Contrast enhanced computed tomography (CECT) of abdomen and the technetium-99m red blood cell scan were also non-contributory. A capsule endoscopy was performed by placing capsule in efferent limb under endoscopic guidance. It revealed multiple ulcers of varying sizes throughout the small bowel. As there was no history of non steroidal anti inflammatory drugs (NSAID) ingestion, a possibility of chronic non-specific small bowel ulcers was kept. Antinuclear antibodies and anti-neutrophil cytoplasmic antibodies were negative. However, IgA anti-tissue transglutaminase and anti-gliadin antibodies were positive. Antegrade double balloon enteroscopy was performed and biopsies were obtained from ulcer edge as well as mucosal folds. Histological examination of the biopsies from the ulcer edge revealed chronic inflammation and from the mucosal folds revealed increased intraepithelial lymphocytes. She was started on prednisolone 40 mg daily along with gluten-free diet. The melena subsided and thereafter steroids were tapered off. She remains well after one-year follow up, there has been no recurrence of bleeding and her hemoglobin has risen to 13.4 mg/dL.4
- Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
- Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩] [↩]
- Vecchio R, Marchese S, Gangemi P, Alongi G, Ferla F, Spataro C, Intagliata E. Laparoscopic treatment of mucinous adenocarcinoma of jejunum associated with celiac disease. Case report. G Chir. 2012 Apr;33(4):126-8. [↩]
- Rana SS, Sharma V, Rao C, Singh K, Bhasin DK. Obscure gastrointestinal bleeding persisting for a decade: a rare manifestation of a common disease. Ann Gastroenterol. 2012;25(3):271-273. [↩]
