A condition that occurs when air or gas collects in the upper parts of the colon and causes pain in the upper left abdomen. The pain often moves to the left chest and may be… 

Same as barium meal.

What Is Progressive Myoclonic Ataxia?

[dropcap]P rogressive myoclonic ataxia is a movement disorder characterized by defective muscular coordination of a muscle group with its origin in the brain.

The pathology is in the cerebellum.¹

Myoclonus in a context of progressive ataxia suggests one clinical form of the Ramsay-Hunt syndrome (progressive myoclonic ataxia, PMA), whose most frequent causes are: celiac disease, mitochondriopathies, some spino-cerebellar degenerations, and some late metabolic disorders.²

What Is Progressive Myoclonic Ataxia In Celiac Disease and/or Gluten Sensitivity?

1. Bhatia KP, Brown P, Gregory R, et al. Progressive myoclonic ataxia associated with coeliac disease. The myoclonus is of cortical origin, but the pathology is in the cerebellum. Brain. Oct 1995;118(Pt 5):1087-93. [↩]
2. Borg M. Symptomatic myoclonus. Neurophysiol Clin. 2006 Sep-Dec;36(5-6):309-18. [↩]

What Is Anxiety?

[dropcap]A nxiety or worry is a distressing emotional state of mind or mood that is characterized by a vague uneasiness, unpleasant feelings of apprehension or anticipation of danger and by interference with normal functioning, ranging from mild qualms and easy startling to occasional panic.

Q: What causes anxiety?

A: Anxiety can be a normal response to stress such as making an important decision, illness, divorce, problems at work or preparing for an exam.

In a dangerous situation, profound physiological changes rapidly prepare us for a “fight or flight” response by release of adrenalin hormone. Adrenalin speeds up metabolism to make available quick energy, tightens muscles in readiness, and speeds up the heartbeat and breathing so that more oxygen is made available to the brain and muscles.

Anxiety becomes a maladaptive disorder when it is excessive, unrealistic, or not provoked and impairs the ability to lead a normal life.

Anxiety that is part of a person’s personality is called “trait anxiety.” Anxiety that comes and goes is “state anxiety,” as in state of mind, and is usually due to unresolved stress or an underlying health problem.

What Is Chronic Anxiety in Celiac Disease?

What Are Bitot’s Spots?

[dropcap]B itot’s spots are superficial foamy patches that develop on the exposed bulbar conjunctiva (white of the eye) as a manifestation of advanced vitamin A deficiency.

This painless eye disorder is reversible only with vitamin A therapy. It is named after Charles Bitot, who first described it.

Q: What makes up these foamy alterations of the conjunctiva?

A: Bitot’s spots are composed of epithelial debris (dead surface cells) and secretions.¹

Bitot’s spots may develop in malnutrition, reduced intake including alcoholism, medication adverse effect, old age, low stomach acid, and disease causing vitamin A deficiency such as celiac disease, Crohn’s disease, pancreatic insufficiency, and short bowel syndrome.  Other conditions associated with vitamin A deficiency may include disordered transport (Abetalipoprotenemia, a genetic disorder) and reduced liver storage caused by liver disease.

What Are Bitot’s Spots In Celiac Disease and/or Gluten Sensitivity?

1. Sadowski B, Rohrback JM, Steuhl KP, Weidle EG, Castrillon-Obendorfer WL. Corneal manifestations in Vitamin A deficiency. Klinische Monatsblatter fur Augenheilkunde. Aug 1994;205(2)76-85. [↩]

What Is Osteomalacia?

[dropcap]O steomalacia is a metabolic bone disorder that causes abnormal skeletal changes characterized by generalized reduction in bone density (bone softening) in adults and pseudofractures (apparant on x-ray) with muscular weakness and bone tenderness.

Bones have the normal amount of living collagen tissue that make up their structure but lack adequate calcium and phosphorus minerals that are required for strength.

Blood studies show the level of parathyroid hormone (PTH), which maintains calcium and phosphorus balance in the body, and the enzyme bone alkaline phosphatase (BALP), which breaks down bone, are elevated while calcium and phosphorus are decreased. Bone biopsy gives the definitive diagnosis.

Q: How do bones get soft?

A: Bones get soft because the normal process of depositing minerals in bone tissue is defective. Bone is continually being remodelled. This is the normal process of breaking down small areas of weak or fractured bone and replacing with healthy bone. The unique cells that break down or dissolve damaged bone are called osteoclasts and cells that build new bone in its place are osteoblasts.

In the condition of osteomalacia, there is not adequate calcium and phosphorus to strengthen new bone made by the osteoblasts and this is the result of inadequate vitamin D. The result is soft bones and weak muscles that worsen as the condition progresses.

The main causes of vitamin D deficiency include malabsorption, poor diet, lack of sunshine, and disorders of vitamin D metabolism. Osteomalacia can also be a feature of systemic disorders such as hyperparathyroidism, partial gastrectomy, pancreatic disease, kidney disease, biliary disease and inflammatory bowel disease. Osteomalacia may be induced by tumors and drugs such as bisphosphonates and certain anti-seizure medications.

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

What Is Primary Dyspareunia (Painful Intercourse)?

[dropcap]D yspareunia is a distressing female genital disorder characterized by pain during or after coitus involving the labia, vagina or pelvis.

There are two types of dyspareunia: primary which affect the vagina itself in the abscence of pelvic pathology and secondary which involves problems in the pelvis other than the vagina.¹

• Causes of primary dyspareunia include hormone changes in menopause, Sjogrens syndrome, diabetes, psychological conditions, and nutritional deficiencies.
• Causes of secondary dyspareunia include problems with uterus, bowel disease, urinary tract infection, uterine prolapse, and pelvic disease such as endometriosis and cancer.

Q: How common is dypareunia?

A: Dyspareunia is the most common cause of pelvic pain in women.²

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

1. Osayande AS, Mehulic S. Diagnosis and initial management of dysmenorrhea. Am Fam Physician. 2014 Mar 1;89(5):341-6. [↩]
2. Osayande AS, Mehulic S. Diagnosis and initial management of dysmenorrhea. Am Fam Physician. 2014 Mar 1;89(5):341-6. [↩]

What Is Failure To Thrive And Growth Retardation?

[dropcap]F ailure to thrive (FTT) and growth retardation are conditions affecting children characterized by weight consistently below the 3rd percentile for age or a decrease in the expected rate of growth based on the child’s previously defined growth curve, irrespective of whether below the 3rd parcentile.¹

Q: Why do failure to thrive and growth retardation occur?

A: Failure to thrive and growth retardation occur because there is inadequate nutrition for weight gain and growth to occur.

What Is Failure To Thrive And Growth Retardation In Celiac Disease and/or Gluten Sensitivity?

1. Arnason JA, Gudjonsson H, Freysdottir J, Jonsdottir I, Valdimarsson H. Do adults with high gliadin antibody concentrations have subclinical gluten intolerance? Gut. 1992 February; 33(2): 194–197. [↩]

What Is Chronic Bullous Dermatosis Of Childhood?

[dropcap]C hronic bullous dermatosis of childhood, also termed linear IgA dermatosis, is the most common acquired autoimmune blistering disorder of childhood and is characterized by itchy, urticated papules and plaques as well as polycyclic lesions (merged circles) with blisters at the edge, located on normal looking skin around the mouth and perineum in young children. In children over 7 years, other parts of the body may rather be affected.

Q: What tissue is targeted in chronic bullous dermatosis of childhood?

A: In chronic bullous dermatosis of childhood, there is an autoimmune attack on structural proteins, usually proteolytic fragments of collagen XVII, which renders the dermal-epidermal junction prone to blistering.

The dermal-epidermal junction is where the surface skin layer, or epidermis, meets the lower layer, or dermis. Diagnosis is confirmed by characteristic histology and direct immunofluorescence showing linear IgA (immunoglobulin A antibody) staining of the basement membrane zone.¹

The incidence of chronic bullous disease of childhood is rare. Age of onset is typically before 5 years of age and is seen in all ethnic groups.

What Is Chronic Bullous Dermatosis Of Childhood In Celiac Disease and/or Gluten Sensitivity?

1. Mintz EM, Morel KD.Clinical features, diagnosis, and pathogenesis of chronic bullous disease of childhood. Dermatol Clin. 2011 Jul;29(3):459-62, ix. doi: 10.1016/j.det.2011.03.022. [↩]

Sudden, repeated attacks of severe vomiting, nausea, and physical exhaustion with no apparent cause that occur in children and adults, but more often in children. Attacks can last from a few hours to 10 days.…