Gluten Free Works: TREATMENT GUIDE Get well and stay healthy living gluten free
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What Is Small Bowel Intussusception?
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Small bowel intussusception is a bowel derangement that is characterized by the slipping of one section of intestine into another, leading to bowel obstruction.
Acute bowel intussusception is a rare manifestation in adults, which mainly involves the small intestine.1
What Is Small Bowel Intussusception In Celiac Disease and/or Gluten Sensitivity?
- Relationship between small bowel intussusception and celiac disease. Small bowel intussusception is a serious complication of celiac disease. Intussusception associated with celiac disease often presents in an atypical way: elementary forms, spontaneously resolvent and recidivious.2
- Relationship between small bowel intussusception and failure to thrive with pain. Concomitant failure to thrive in a child and cramping abdominal pain should prompt investigation for celiac disease and small bowel intussusception.3
- Relationship between small bowel intussusception and diagnosis. The diagnosis of celiac disease should be considered in children with intussusception, even in the absence of signs of nutritional compromise.4 Celiac disease can favor small bowel intussusception, even in adulthood. Therefore, diagnosis of celiac disease must be discussed in the presence of unexplained intussusception.5
How Prevalent Is Small Bowel Intussusception In Celiac Disease and/or Gluten Sensitivity?
Among children with celiac disease, 1.2% experienced an intussusception less than 9 months prior to their diagnosis with celiac disease. According to physicians at the Celiac Center of Columbia University Hospital in NYC, “Intussusception was far more common among children in our cohort with untreated celiac disease than in the general pediatric population simultaneously seen at our center.”6
What Are The Symptoms Of Small Bowel Intussusception?
Small bowel intussusception is marked by these symptoms:
- Weight loss.
- Denutrition symptoms.
- Concomitant cramping abdominal pain.
- Severe failure to thrive in children.
- Signs of malnutrition may be absent.4
How Does Small Bowel Intussusception In Celiac Disease and/or Gluten Sensitivity Develop?
- Small bowel intussusception results from disorders of motility in celiac disease as an indirect cause that allows the slipping of a segment of bowel into another.7.
- Magnesium deficiency impairs small bowel motility, or peristalsis, and promotes irregular movement which predisposes to intussusception.
- In 15 of 25 celiac disease patients there were one or more central or marginal lacunar images probably due in varying degrees to disorder of intestinal motility in hypotonic loops (limp) with edematous walls.8.
Does Small Bowel Intussusception Respond To Gluten-Free Diet?
Yes. Gluten free diet allows evolution and prevents recurrence of intussusception.2
6 Steps To Improve Small Bowel Intussusception 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.9
- 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.10
- 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.10
- 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.10.
- 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.10
- 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.10
- Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.10
- 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 magnesium that slows bowel motility and predisposes to intussusception. Ask your doctor or pharmacist about this possible adverse effect if taking any of the drugs listed below. Do not stop prescribed medications without supervision.
This is not a complete listing.
ANTACIDS / ULCER MEDICATIONS
- Pepcid®, Tagamet®, Zantac® deplete Magnesium.
- Magnesium and Aluminum Antacid preparations (Gaviscon®, Maalox®, Mylanta®) deplete Magnesium.
- Alka Seltzer®, Baking Soda deplete Magnesium.
ANTIBIOTICS disrupt intestinal permeability which complicates celiac disease.
- Tetracyclines deplete Magnesium.
ANTI-INFLAMMATORIES disrupt intestinal permeability which complicates celiac disease.
- Corticosteroids (Prednisone, Medrol®, Aristocort®, Decadron) deplete Magnesium.
ANTIVIRAL AGENTS
- Zidovudine (Retrovir®, AZT and other related drugs) deplete Magnesium.
DIURETICS
- Thiazide Diuretics (Hydrochlorothiazide, Enduron®, Diuril®, Lozol®, Zaroxolyn®, Hygroton® and others) deplete Magnesium.
- Loop Diuretics (Lasix®, Bumex®, Edecrin®) deplete Magnesium.
FEMALE HORMONES disrupt intestinal permeability which complicate celiac disease.
- 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.
- Chelated magnesium as prescribed but do not take at same time as calcium because they compete for absorption.
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 Small Bowel Intussusception In Celiac Disease and/or Gluten Sensitivity?
RESEARCH STUDY SUMMARIES
“Lacunar images and invagination in 25 patients with celiac disease.” This study investigating results of barium meal with flow-through examinations of the small intestine in Celiac Disease patients demonstrated one or more images of invagination present in 4 of 25 cases. In 15 of 25 Celiac Disease patients there were one or more central or marginal lacunar images probably due in varying degrees to disorder of intestinal motility in hypotonic loops with edematous walls.11
CASE REPORT SUMMARIES
“Transient small bowel intussusception in adults: an overlooked feature of coeliac disease.” This case study describes diagnosing celiac disease in a 46-year-old woman with known dilated cardiomyopathy, who presented with non-specific abdominal symptoms that were not initially attributed to gastrointestinal disease.
Radiological investigations of the abdomen demonstrated transient small bowel intussusception without other abnormality, leading to the suggestion of celiac disease as a cause, which was subsequently confirmed as the diagnosis.12
“Acute bowel intussusception revealing celiac disease a new case and literature review.” This case report describes a patient in whom spontaneously regressive small bowel intussusception was the presenting manifestation of celiac disease. A 40-year-old man was admitted for a right-sided iliac abdominal pain related to a small bowel intussusception. Laparotomy ruled out a digestive tumor. Persistence of diffuse abdominal pain associated with progressive and unexplained weight loss for several months led to the diagnosis of celiac disease, which was confirmed by the presence of specific serum autoantibodies and histological duodenal villous atrophy. Celiac disease can favor small bowel intussusception, even in adulthood. Therefore, diagnosis of celiac disease must be discussed in the presence of unexplained intussusception.5
“Celiac disease presenting as an intestinal intussusception. Report of one case.” This case report describes intestinal obstruction secondary to an intussusception in a 45 year-old female consulting for diarrhea and vomiting lasting one week and progressive abdominal bloating. A plain abdominal X ray showed air fluid levels in the small bowel and a CT scan showed an intussusception. She was operated and discharged but continued with diarrhea. She was admitted again and a new CT scan showed three intussusceptions that were resolved with the administration of oral contrast media. Anti-endomisial antibodies were positive and a celiac disease was diagnosed. After one year with a gluten free diet, the patient remains asymptomatic. Dodds B F, Aguancha S I, Santamarina R M, Vega S J. Celiac disease presenting as an intestinal intussusception. Report of one case. Rev Med Chil. 2008 Sep;136(9):1179-82. doi: /S0034-98872008000900014.
“Acute intestinal invagination revealing celiac disease in a 9-month-old infant.” This case report of diagnosis of celiac disease in a 9 month old infant with bowel intussusception appears to be the earliest described.13
- Grados A, Bernard F, Coquet-Reinier B, Rossi P, Bagneres D, Demoux AL, Marciano S, Frances Y, Granel B. Acute bowel intussusception revealing celiac disease a new case and literature review. Rev Med Interne. 2011 Oct;32(10):628-32. doi: 10.1016/j.revmed.2011.03.334 [↩]
- Lastennet F, Piloquet H, Camby C, Moussally F, Siret D. Acute intestinal invagination revealing celiac disease in a 9-month-old infant. Archives De Pediatrie: Organe Officiel De La Societe Francaise De Pediatrie. Feb 2002;9(2):151-4. [↩] [↩]
- Martinez G, Israel NR, White JJ. Celiac disease presenting as entero-enteral intussusception. Pediatric Surgery International. 2001;17(1):68-70. [↩]
- Reilly NR, Aguilar KM, Green PH. Should Intussusception in Children Prompt Screening for Celiac Disease? J Pediatr Gastroenterol Nutr. 2012 Jul 23. [↩] [↩]
- Grados A, Bernard F, Coquet-Reinier B, Rossi P, Bagneres D, Demoux AL, Marciano S, Frances Y, Granel B. Acute bowel intussusception revealing celiac disease a new case and literature review. Rev Med Interne. 2011 Oct;32(10):628-32. doi: 10.1016/j.revmed.2011.03.334. [↩] [↩]
- Reilly NR, Aguilar KM, Green PH. Should Intussusception in Children Prompt Screening for Celiac Disease? J Pediatr Gastroenterol Nutr. 2012 Jul 23. [↩]
- Lastennet F, Piloquet H, Camby C, Moussally F, Siret D. Acute intestinal invagination revealing celiac disease in a 9-month-old infant. Archives De Pediatrie: Organe Officiel De La Societe Francaise De Pediatrie. Feb 2002;9(2):151-4. [↩]
- Bret P, Francoz JB, Bret P, Cuche C, Gerard C. Lacunar images and invagination in 25 patients with celiac disease. Journal Da Radiologie. Nov 1980;61(11):723-7. [↩]
- 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. [↩] [↩] [↩] [↩] [↩] [↩]
- Bret P, Francoz JB, Bret P, Cuche C, Gerard C. Lacunar images and invagination in 25 patients with celiac disease. Journal Da Radiologie. Nov 1980;61(11):723-7. [↩]
- Briggs JH, McKean D, Palmer JS, Bungay H. Transient small bowel intussusception in adults: an overlooked feature of coeliac disease. BMJ Case Rep. 2014 Jun 20;2014. pii: bcr2013203156. doi: 10.1136/bcr-2013-203156. [↩]
- Lastennet F, Piloquet H, Camby C, Moussally F, Siret D. Acute intestinal invagination revealing celiac disease in a 9-month-old infant. Archives De Pediatrie: Organe Officiel De La Societe Francaise De Pediatrie. Feb 2002;9(2):151-4. [↩]
