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Claire

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Claire Collaborator

I was hunting for one thing and found another. Thought this might be interesting to many here on the forum. Claire

HIGH PREVALENCE OF SMALL INTESTINAL BACTERIAL OVERGROWTH IN CELIAC PATIENTS WITH PERSISTENCE OF GASTROINTESTINAL SYMPTOMS AFTER GLUTEN WITHDRAWEL

Celiac disease is a gluten-sensitive enteropathy with a broad spectrum of clinical manifestation, and most celiac patients respond to a gluten-free diet. However, in some rare cases, celiacs continue to experience GI symptoms after being on a GFD, despite optimal adherence to diet. This study evaluates the causes of persistence of GI symptoms in a series of consecutive celiac patients fully compliant to GFD.

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Claire Collaborator

The above post contains a URL that has been changed and the new one is not turning up the article. I found it elsewhere and am posting it below: - Claire

High Prevalence of Small Intestinal Bacterial Overgrowth in Celiac Patients with Persistence of Gastrointestinal Symptoms after Gluten Withdrawal.

Tursi A, Brandimarte G, Giorgetti G.

Department of Emergency, "L. Bonomo" Hospital, Andria (BA), Italy.

OBJECTIVE: Celiac disease is a gluten-sensitive enteropathy with a broad spectrum of clinical manifestation, and most celiac patients respond to a gluten-free diet (GFD). However, in some rare cases celiacs continue to experience GI symptoms after GFD, despite optimal adherence to diet. The aim of our study was to evaluate the causes of persistence of GI symptoms in a series of consecutive celiac patients fully compliant to GFD. METHODS: We studied 15 celiac patients (five men, 10 women, mean age 36.5 yr, range 24-59 yr) who continued to experience GI symptoms after at least 6-8 months of GFD (even if of less severity). Antigliadin antibody (AGA) test, antiendomysial antibody (EMA) test, and sorbitol H2-breath test (H2-BT), as well as esophagogastroduodenoscopy (EGD) with histological evaluation, were performed before starting GFD. Bioptic samples were obtained from the second duodenal portion during EGD, and histopathology was expressed according to the Marsh classification. To investigate the causes of persistence of GI symptoms in these patients, we performed AGA and EMA tests, stool examination, EGD with histological examination of small bowel mucosa, and sorbitol-, lactose-, and lactulose H2-breath tests. RESULTS: Histology improved in all patients after 6-8 months of GFD; therefore, refractory celiac disease could be excluded. One patient with Marsh II lesions was fully compliant to his diet but had mistakenly taken an antibiotic containing gluten. Two patients showed lactose malabsorption, one patient showed Giardia lamblia and one patient Ascaris lumbricoides infestation, and 10 patients showed small intestinal bacterial overgrowth (SIBO) by lactulose H2-BT. We prescribed a diet without milk or fresh milk-derived foods to the patient with lactose malabsorption; we treated the patients with parasite infestation with mebendazole 500 mg/day for 3 days for 2 consecutive wk; and we treated the patients with SIBO with rifaximin 800 mg/day for 1 wk. The patients were re-evaluated 1 month after the end of drug treatment (or after starting lactose-free diet); at this visit all patients were symptom-free. CONCLUSIONS: This study showed that SIBO affects most celiacs with persistence of GI symptoms after gluten withdrawal.

  • 2 weeks later...
Matilda Enthusiast

..

RiceGuy Collaborator

Thanks from me also.

It just backs up what I've been wondering about, since I still have certain symptoms. Though I haven't eliminated all dairy proteins and soy yet. I also just found out my shampoo has barley extract :(

Symptom free sure sounds nice, but I won't take no drugs. I'll still go the natural route, which I know works from past experience.

Claire Collaborator
Thanks, Claire, this is really interesting. Do you think it's support for probiotics?

Matilda

Yes, I think so. Also think L-Glutamine would be a good way to go. About 5 grams a day. Claire

Thanks from me also.

It just backs up what I've been wondering about, since I still have certain symptoms. Though I haven't eliminated all dairy proteins and soy yet. I also just found out my shampoo has barley extract :(

Symptom free sure sounds nice, but I won't take no drugs. I'll still go the natural route, which I know works from past experience.

Note comments t Matilda. Good for you as well. Claire

bluelotus Contributor

Wow, this may explain my recent hospitalization for bacterial overgrowth....as I had suspected, though my doctors had doubts (doctors seem to be the most un-scientific people I have ever meet - if its not in a textbook or they hadn't heard it before, its impossible......that ideology does not apply well to biological systems and if they just considered what celiac disease does to the intestinal tract, toxic bacterial overgrowth seems like a possible side effect. I hate doctors.)

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    • trents
      Not necessarily. The "Gluten Free" label means not more than 20ppm of gluten in the product which is often not enough for super sensitive celiacs. You would need to be looking for "Certified Gluten Free" (GFCO endorsed) which means no more than 10ppm of gluten. Having said that, "Gluten Free" doesn't mean that there will necessarily be more gluten than "Certified Gluten" in any given batch run. It just means there could be. 
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      I think it is wise to seek a second opinion from a GI doc and to go on a gluten free diet in the meantime. The GI doc may look at all the evidence, including the biopsy report, and conclude you don't need anything else to reach a dx of celiac disease and so, there would be no need for a gluten challenge. But if the GI doc does want to do more testing, you can worry about the gluten challenge at that time. But between now and the time of the appointment, if your symptoms improve on a gluten free diet, that is more evidence. Just keep in mind that if a gluten challenge is called for, the bare minimum challenge length is two weeks of the daily consumption of at least 10g of gluten, which is about the amount found in 4-6 slices of wheat bread. But, I would count on giving it four weeks to be sure.
    • Paulaannefthimiou
      Are Bobresmill gluten free oats ok for sensitive celiacs?
    • jenniber
      thank you both for the insights. i agree, im going to back off on dairy and try sucraid. thanks for the tip about protein powder, i will look for whey protein powder/drinks!   i don’t understand why my doctor refused to order it either. so i’ve decided i’m not going to her again, and i’m going to get a second opinion with a GI recommended to me by someone with celiac. unfortunately my first appointment isn’t until February 17th. do you think i should go gluten free now or wait until after i meet with the new doctor? i’m torn about what i should do, i dont know if she is going to want to repeat the endoscopy, and i know ill have to be eating gluten to have a positive biopsy. i could always do the gluten challenge on the other hand if she does want to repeat the biopsy.    thanks again, i appreciate the support here. i’ve learned a lot from these boards. i dont know anyone in real life with celiac.
    • trents
      Let me suggest an adjustment to your terminology. "Celiac disease" and "gluten intolerance" are the same. The other gluten disorder you refer to is NCGS (Non Celiac Gluten Sensitivity) which is often referred to as being "gluten sensitive". Having said that, the reality is there is still much inconsistency in how people use these terms. Since celiac disease does damage to the small bowel lining it often results in nutritional deficiencies such as anemia. NCGS does not damage the small bowel lining so your history of anemia may suggest you have celiac disease as opposed to NCGS. But either way, a gluten-free diet is in order. NCGS can cause bodily damage in other ways, particularly to neurological systems.
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