Search the Community

Celiac.com 06/19/2017 - Adults with celiac disease often show atypical symptoms, though it is not uncommon for them to suffer from malabsorption of vitamins and minerals, which can result in disrupt normal bone metabolism. A team of researchers recently set out to evaluate laboratory deficiencies related to bone metabolism, and to assess the relationship between severity of histological damage and the degree of bone mass loss at celiac diagnosis. The research team included L. Posthumus, and A. Al-Toma A of the Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, The Netherlands. Their team conducted a retrospective cross-sectional study of 176 adult celiac patients. All patients met the histopathological criteria for clinical celiac disease. The team analyzed biochemical data, including calcium, phosphate, alkaline-phosphatase, vitamin D and parathormone. They classified duodenal histology based on Marsh parameters. They used dual X-ray absorptiometry to determine bone mass density (BMD) at the lumbar and femoral regions. P-values below 0.05 were considered significant. They found no correlation between gastrointestinal symptoms and Marsh histopathological stage (P>0.05). Nearly 50 percent of patients showed vitamin D deficiency (44.5%), while only 5.7% showed hypocalcaemia. Patients with Marsh III did show lower calcium (P<0.05) and parathormone was higher (P=0.01). These patients had lower lumbar T-score (P<0.05). Although low BMD occurred in all age groups, most osteoporotic patients were aged 45-49 years (81.8%). A multiple regression analysis did show that Marsh stage could indicate lower lumbar BMD (r=0.322, B=-1.146, P<0.05). At celiac diagnosis, Marsh histopathological stage can predict low BMD, which can develop into osteoporosis. Based on these data, the team suggests that doctors should consider evaluating bone biomarkers and conducting a dual X-ray absorptiometry exam in celiac patients over 30 years of age. Source: Eur J Gastroenterol Hepatol. 2017 Apr 27. doi: 10.1097/MEG.0000000000000880.

Celiac.com 04/27/2017 - Celiac disease is associated with numerous chronic conditions, such as anemia and malabsorption of some critical vitamins. Changes in the gastrointestinal tract, rates of gastric emptying, and gastric pH are responsible for impaired vitamin and mineral absorption. Intestinal CYP3A4 levels may also be disrupted, which may have implications in first-pass metabolism for some drugs that are substrates for this drug metabolizing enzyme. This has led some researcher to investigate the potential impact of celiac disease on drug absorption. This would be of interest to pharmacists, since altered drug absorption can have pharmacokinetic consequences, along with the potential to impact overall drug therapy. A comprehensive review on this topic was published in 2013 by Tran et al. Another review was published in 2014. The review by Tran, et al., considered absorption studies in subjects with celiac disease, and the authors focused on a handful of drugs, including acetaminophen, aspirin, propranolol, levothyroxine, methyldopa, and some antibiotics. They reported that some reports show an altered gastrointestinal environment and sharp differences between drug absorption in patients with celiac disease, while other reports showed no absorption differences between those with and without the disease. The authors concluded that the drugs could potentially alter absorption in celiac patients, and that healthcare professionals should bear that in mind when starting drug therapy. The 2014 review of the potential impact of celiac disease on cardiovascular drug absorption considered many of the same medications previously explored by Tran et al, with a focus on cardiovascular agents. The authors warned that numerous cardiovascular drugs may alter absorption in celiac disease, but noted few published studies with strong, comprehensive data. The authors also stressed the need for more studies on celiac patients, as well as caution when initiating cardiovascular drug treatments. Available research indicates that patients with celiac disease can have altered absorption of many different drugs. Unfortunately, there still isn't much good data on altered drug absorption and disposition in celiac patients. More study will likely help illuminate the influence of celiac disease on drug disposition. The early evidence suggests that celiac disease may alter drug absorption, but studies don't yet tell us how much, or how often. The team is recommending that doctors and pharmacists consider possible absorption issues when prescribing drug treatments for people with celiac disease, and that they review the available literature on specific drugs, when possible. They also recommend increased monitoring for efficacy and adverse effects when beginning a new drug treatment regimen for celiac patients. Source: Pharmacy Times