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Refractory Celiac Disease and EATL Patients Show Severe Malnutrition and Malabsorption at Diagnosis

Celiac.com 06/17/2015 - Refractory celiac disease type II (RCDII) and EATL (Enteropathy Associated T-cell Lymphoma) are pre-malignant complications of celiac disease. However, there is scant medical literature and data what role malnutrition and intestinal absorption may play in these conditions.

Walking Man; Alberto Giocometti. Photo: Wikimedia CommonsWith this in mind, a team of researchers set out to conduct a comprehensive assessment of nutritional status and intestinal absorption capacity of patients with RCDII and EATL, and to compare that with data of newly diagnosed celiac disease patients. The research team included N.J. Wierdsma, P. Nijeboer, M.A. de van der Schueren, M. Berkenpas, A.A. van Bodegraven, and C.J. Mulder.

They are affiliated with the Department of Nutrition and Dietetics, the Department of Gastroenterology, the Celiac Centre Amsterdam, the Department of Nutrition and Dietetics at VU University Medical Centre in Amsterdam, The Netherlands; and with the Department of Internal Medicine, Gastroenterology and Geriatrics at ATRIUM-ORBIS Medical Centre, Sittard, The Netherlands.

They conducted an observational study in tertiary care setting in for 24 RCDII patients, averaging 63.8 ± 8.2 years of age, 25 EATL patients averaging 62.3 ± 5.7 years of age, and 43 celiac disease patients averaging 45.6 ± 14.8 years of age.

At diagnosis, the team evaluated anthropometry (BMI, unintentional weight loss, fat-free mass index (FFMI), handgrip strength (HGS), nutritional intake, fecal losses and Resting Energy Expenditure (REE)).

They found low BMI (<18.5) more often in RCDII patients than in celiac disease or EATL patients (in 33%, 12% and 12%, respectively, p = 0.029). Also, 58% of EATL patients had unintentional weight loss greater than 10% of total weight, compared to 19% of celiac disease patients, and 39% for RCDII patients (p = 0.005/0.082).

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The team found energy malabsorption (below 85%) in 44% of RCDII patients, and in 33% of EATL patients, compared with 21.6% in celiac disease (NS).

Fecal energy losses were higher in RCDII than in celiac disease patients (589 ± 451 vs 277 ± 137 kcal/d, p = 0.017). REE was lower than predicted, with reulst greater than 10% in 60% of RCDII, 89% of EATL, and 38% of celiac disease patients (p = 0.006).

Between one third and two thirds of all patients showed Low FFMI and HGS.

Patients with RCDII and EATL show far worse nutritional profiles than untreated naïve celiac disease patients at presentation. This malnutrition is at least partly due to malabsorption as well as hypermetabolism.

This study shows the importance of proper diagnosis, and of nutrition in the treatment of these conditions.

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Some people, like me, never get a positive on the TTG (even on follow-up Testing) and I stated that some celiacs (10%) have negative tests results period. Your doctor is doing the colonoscopy. Ask him if he is going into the small intestine via that route.

Yep. Initially I had the full panel. DGP was the only positive and it's the only one my doctor orders now.

Well I wish mine was dia. earlier, I got all kinds of other food issues, and other auto immune disease that came up as complications. If you deal with and change over now you can prevent a even more limited diet. I was running a bucket list thinking I was going to die before my dia. I had slight ...

So, do they just test your DGP like they just test my TTG?

The only test I have had done is the TTG because that's what I had done initially after taking matters into my own hands and going to my local health fair. Celiac is so common they do that screening at our health fair. My number was so high that my doctor didn't order other labs and went straight...