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Constipation, Chronic

Constipation in a young child as seen on X-ray. Lowest circle shows hard feces in the pelvis. Source, James Heilman, MD.

What Is Chronic Constipation?

[dropcap]C[/dropcap]hronic constipation is an intestinal motility disorder characterized by abnormal stool formation, consistency, and evacuation.

Motility disorder means the normal rhythmic movement of intestinal muscles, called peristalsis, that moves food matter through the gut is hampered or dysfunctional.

Studies show that methane gas present in the colon induces constipation by delaying transit time, which is the time it takes for stool to pass through the colon.

Researchers investigating the relationship between methane and constipation found that methane positivity was detected in 75% of patients with slow transit, 44% of patients with normal transit and and 28% of the patients who were controls. However, methane positivity was not related with stool consistency.1

Other researchers investigating the total amount of methane produced found that there was significantly more methane production in patients with constipation (21.1 ppm vs. 6.1 ppm, respectively) than in controls without constipation.2

Q. How does methane get into the colon?

A. Methane is produced in the colon by intestinal methanogens (microbes) that metabolize hydrogen, one of the end products of normal anaerobic (meaning without oxygen) bacterial fermentation.  Fermentation of the undigested starchy part of carbohydrates produces hydrogen in the intestine which is the substrate (food) for methane production by intestinal methanogens.

Hydrogen and methane are excreted in the flatus and in breath giving the opportunity to indirectly measure their production using breath testing. Methane is detected in 30%-50% of the healthy adult population worldwide.3

Other common causes of constipation include not getting enough exercise, not drinking enough fluids, not eating enough fiber in the diet, not eating foods that supply microbes needed by the colon (probiotics), not eating foods that nourish the good microbe population (prebiotics) and supply minerals needed for healthy movement of stool, and food sensitivities. Too much cows milk is a common cause of stool that forms into balls.

Who is Affected in the General Population? Chronic constipation is a remarkably common and costly condition that can negatively impact the quality of life and result in a major social and economic burden. Based on the definition, either self-reported or using Rome criteria, chronic constipation can affect up to 27% of the population. There is strong evidence that constipation occurs more frequently in women.4

What Is Chronic Constipation In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. Triantafyllou K, Chang C, Pimentel M. Methanogens, Methane and Gastrointestinal Motility. J Neurogastroenterol Motil. 2014 Jan;20(1):31-40. Epub 2013 Dec 30. [↩]
  2. Triantafyllou K, Chang C, Pimentel M. Methanogens, Methane and Gastrointestinal Motility. J Neurogastroenterol Motil. 2014 Jan;20(1):31-40. Epub 2013 Dec 30. [↩]
  3. Triantafyllou K, Chang C, Pimentel M. Methanogens, Methane and Gastrointestinal Motility. J Neurogastroenterol Motil. 2014 Jan;20(1):31-40. Epub 2013 Dec 30. [↩]
  4. Sanchez MI, Bercik P. Epidemiology and burden of chronic constipation. Can J Gastroenterol. 2011 Oct;25 Suppl B:11B-15B. [↩]

Weight Gain, Unexplained

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What Is Unexplained Weight Gain?

[dropcap]U[/dropcap]nexplained weight gain is characterized by increased body mass due to excess fat accumulation that is not desired by the individual.

A body mass index (BMI) of 25 to 30 signifies being overweight.

What Is Unexplained Weight Gain In Celiac Disease and/or Gluten Sensitivity?

Depression

Depression and glutenWhat Is Depression?

[dropcap]D[/dropcap]epression is a mood disorder characterized by absence of cheerfulness, dejection, and loss of interest or pleasure in living, making the person dysfunctional and unable to cope with or perform tasks of daily living.

More than a feeling, this negative psychological status can range from mild to profound and can involve other parts of the body, causing physical problems such as poor digestion, constipation, weight gain or weight loss, mentrual irregularities in females, and impotence in males.

Q: How is depression identified?

A: According to the American Psychiatric Association, depression is a psychic condition that lasts for more than a month and involves four or more of these symptoms:

  • Abnormal appetite.
  • Diminished ability to concentrate or think properly.
  • Feelings of worthlessness.
  • Low energy or fatigue.
  • Physical inactivity or hyperactivity.
  • Sleep disturbances.
  • Thoughts of death.

Grief or sadness at the loss of a loved one or a similar event or remorse for sin is normal. However, depression that is prolonged usually involves imbalances of nerve chemicals called neurotransmitters. Imbalances can result from health disorders such as hormonal imbalances, low blood sugar, stress, drug side effects, or nutrient deficiencies.

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

Headache (Emicrania)

headache gluten celiac disease symptomWhat Is Headache Or Emicrania?

[dropcap]E[/dropcap]micrania is a headache resulting from stimulation of, or traction of, or pressure on any of the pain sensitive structures of the head characterized by pain felt anywhere in the head.

In addition to gluten sensitivity and nutritional deficiencies, there are many causes of headache including cardiac, cerebral, vascular, psychiatric, metabolic, and neurologic diseases. Recent studies have highlighted that obesity is significantly associated with headache and disability in adults. This rule also applies to children.1

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

Sources:
  1. Laino D, Vitaliti G, Parisi P,   et. al. Headache, migraine and obesity: an overview on plausible links. J Biol Regul Homeost Agents. 2016 Apr-Jun;30(2):333-8. [↩]

Irritable Bowel Syndrome (IBS)

What Is Irritable Bowel Syndrome? [dropcap]I[/dropcap]rritable bowel syndrome (IBS) is a motility disorder without anatomic cause involving the entire gastrointestinal tract that is characterized by these four features: 1) Abdominal pain usually relieved by defecation… 

Apathy

Apathy celiac disease symptomWhat Is Apathy?

[dropcap]A[/dropcap]pathy is an abnormal emotional state that is characterized by indifference to things which others find interesting, moving or exciting, and diminished motivation to perform regular daily activities.

The neural mechanisms of apathy are postulated to involve the brainstem and forebrain circuits that regulate goal-directed behavior.1

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

Sources:
  1. Marin RS. Apathy: Concept, Syndrome, Neural Mechanisms, and Treatment. Semin Clin Neuropsychiatry. 1996 Oct; 1(4):304-314. [↩]

Schizophrenia

schizophrenia gluten
PET scan showing schizophrenia. Courtesy Wikimedia.

What Is Schizophrenia?

[dropcap]S[/dropcap]chizophrenia is a thought disorder characterized by psychotic symptoms and inappropriate and bizarre behavior.

Schizophrenia involves dysfunction in any of these areas:

  • Cognition which are thinking skills that include intellect, language, mathematical ability, memory, perception, reasoning, judgment, learning, and imagination.
  • Interpersonal relationships.
  • Ability to work or attend education.
  • Ability to take care of physical and financial needs.

Q: What are psychotic symptoms?

A: In psychosis the symptoms vary but include loss of contact with reality shown by hallucinations, delusions, disorganized speech, and disorientation. Some may be depressed or manic. Some may be withdrawn and mute while others may become violent if frustrated or thwarted.

In hallucinations, affected persons see what is not real such as a burgler in the process of robbing them but which is not really happening or hear voices that are not real.

In delusions, affected persons may express strange ideas, claim to read minds or that they are a famous person living or dead.

Early-onset schizophrenia with onset before age 18 is defined by the same diagnostic criteria as in adults because it is continuous with adult schizophrenia. The onset before age 12 years comprises less than 1% of adult cases, and onset from age 12–18 years constitutes about 12–33% of all adult cases of schizophrenia.1

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

Sources:
  1. Pagsberg AK, Tarp S, Glintborg D, Stenstrøm AD, Fink-Jensen A, Correll CU, Christensen R. Antipsychotic treatment for children and adolescents with schizophrenia spectrum disorders: protocol for a network meta-analysis of randomised trials. BMJ Open. 2014 Oct 10;4(10):e005708. doi: 10.1136/bmjopen-2014-005708. [↩]

Prurigo Nodularis (Hyde’s Prurigo)

Hyde's Prurigo. Courtesy quizlet.com
Hyde’s Prurigo. Courtesy quizlet.com

What Is Prurigo Nodularis (Hyde’s Prurigo)?

[dropcap]P[/dropcap]rurigo nodularis is a chronic dermatitis characterized by hard, dry, deep seated, intensely itchy papules (small bumps like pimples) and/or nodules (large bumps) that erupt most commonly on the arms, legs, and back.

Papules and nodules vary in number and may become infected after picking or scratching.

Q: Does the itching go away?

A: New nodules develop from time to time, and existing nodules may remain itchy indefinitely, although some may regress spontaneously and leave scars. In most cases, the disease runs a very protracted course with exacerbations and remissions.1

Prurigo nodularis is an unusual disorder of unknown etiology, which is notoriously resistant to therapy. A variety of systemic conditions have been reported to be associated with prurigo nodularis. However, the mechanism by which these disorders may trigger prurigo nodularis is unknown.2

It has been shown to be associated with malnutriton and infection such as tonsillitis, which resolved after removal of tonsils.3

What Is Prurigo Nodularis In Celiac Disease and/or Gluten Sensitivity?

Sources:
  1. Katotomichelakis M, Balatsouras DG, Bassioukas K, Kontogiannis N, Simopoulos K, Danielides V. Recurrent prurigo nodularis related to infected tonsils: a case report. J Med Case Rep. 2008 Jul 24;2:243. doi: 10.1186/1752-1947-2-243. [↩]
  2. Lee MR, Shumack S. Prurigo nodularis: a review. Australas J Dermatol. 2005 Nov;46(4):211-18; quiz 219-20. [↩]
  3. Katotomichelakis M, Balatsouras DG, Bassioukas K, Kontogiannis N, Simopoulos K, Danielides V. Recurrent prurigo nodularis related to infected tonsils: a case report. J Med Case Rep. 2008 Jul 24;2:243. doi: 10.1186/1752-1947-2-243. [↩]

Prolonged Prothrombin Time

bloodvialWhat Is Prolonged Prothrombin Time?

[dropcap]P[/dropcap]rolonged prothrombin time (PT) is a laboratory blood test result showing that blood clots too slowly which makes the patient subject to abnormal bleeding.

Q: What does the prothrombin time (PT) test measure?

A: The prothrombin test measures the clotting ability of blood protein factors I, II (prothrombin), V, VII, and X. If any of these factors are too low, it takes longer than normal for the blood to clot. Prothrombin is a vitamin K dependent factor meaning a deficiency of vitamin K will cause low prothrombin.

Blood is drawn into a blood collection tube with a light blue stopper which has a buffering additive. Tubes must be completely filled.

What Is Prolonged Prothrombin Time In Celiac Disease and/or Gluten Sensitivity?

Recurrent Monoarthritis

monoarthritis gluten celiac disease symptomWhat Is Recurrent Monoarthritis?

[dropcap]R[/dropcap]ecurrent monoarthritis is a joint disorder characterized by pain and inflammation involving just one peripheral joint (elbow, hand, knee, ankle, foot, or hip).

What Is Recurrent Monoarthritis In Celiac Disease and/or Gluten Sensitivity?