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Boliviab

Could this be possible gluten allergy?

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I know its probably hard / impossible to say without proper tests but Im looking for opinions on this please.

I have been having a pain in my lower right abdomen for quite some times now , started probably about 10 to 12 months ago whilst training for a marathon, but only slightly on and off. It got progressively more regular and worse and about from about Aug/Sep onwards I was taking anti inflammatory meds and ibuprofen for the pain quite often. I wasnt really in a position to see a doctor as I was "inbetween several countries" aswell as in between living arrangements. I traveled in india for a bit and ended up taking antibiotics there as I thought it was maybe an infection. I did a course of anti parasite tablets thinking it might be that (and there was some but it didnt stop this pain). End of Oct the pain was quite bad one day and I had been getting quite a few fevers aswell I ended up going to ER in the UK and thinking it might be appendicitis but they tested , said it wasnt , that no signs of infection etc and sent me away. A few weeks after I returned to Bolivia to live and have been since and it was getting worse. I ended up going to hospital again new years day (hadnt drunk anything the night before as felt too bad ) and had a scan. They told me it was a gastric infection , there was swelling and signs of fatty liver stage 1. Gave me antibiotics to take and said cut out fatty things etc. It improved with the antibiotics and anti spasmodics I was given but also would come back on some days so Im thinking it cant be an infection when one day it is bad the next less so and then after that bad again (this is after finishing the ABs) - it must be something effecting it. 

I am veggie over 25 years and recently plant based vegan so overall my diet is pretty healthy anyway but I had never avoided gluten, Then we found some seitan vegan sausages for sale and tried them (and in previous days I had been eating gluten / seitan type stuff also) and I got bad again the next day which made me think it was maybe that and maybe it is an allergy to gluten. So i cut out all gluten and 2 days later in the evening (last night) I felt better than I had for ages , today it is a little bit of a swollen feeling there again (i might have had something with gluten by accident yesterday as wasnt sure of ingredient of some lentil burgers we ate) but not very bad. Also , i have been getting quite itchy all over with some red patches (since avoiding gluten) 

Do this sound like a potential gluten intolerance issue ? The intestine area pain is the bit im most wanting to find the reason for as it has been really effecting my life quality. Would that be a typical symptom of gluten intolerance , a dull aching to sharp throbbing type pain , often after eating in lower to mid right side , sometimes constipation and some improvement after going but not completely?

thanks for any help - I am actually hopeful that I might have found the cause because I dont believe the doctors here will find it themselves (this is from lots of experience here)

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6 minutes ago, Boliviab said:

I know its probably hard / impossible to say without proper tests but Im looking for opinions on this please.

I have been having a pain in my lower right abdomen for quite some times now , started probably about 10 to 12 months ago whilst training for a marathon, but only slightly on and off. It got progressively more regular and worse and about from about Aug/Sep onwards I was taking anti inflammatory meds and ibuprofen for the pain quite often. I wasnt really in a position to see a doctor as I was "inbetween several countries" aswell as in between living arrangements. I traveled in india for a bit and ended up taking antibiotics there as I thought it was maybe an infection. I did a course of anti parasite tablets thinking it might be that (and there was some but it didnt stop this pain). End of Oct the pain was quite bad one day and I had been getting quite a few fevers aswell I ended up going to ER in the UK and thinking it might be appendicitis but they tested , said it wasnt , that no signs of infection etc and sent me away. A few weeks after I returned to Bolivia to live and have been since and it was getting worse. I ended up going to hospital again new years day (hadnt drunk anything the night before as felt too bad ) and had a scan. They told me it was a gastric infection , there was swelling and signs of fatty liver stage 1. Gave me antibiotics to take and said cut out fatty things etc. It improved with the antibiotics and anti spasmodics I was given but also would come back on some days so Im thinking it cant be an infection when one day it is bad the next less so and then after that bad again (this is after finishing the ABs) - it must be something effecting it. 

I am veggie over 25 years and recently plant based vegan so overall my diet is pretty healthy anyway but I had never avoided gluten, Then we found some seitan vegan sausages for sale and tried them (and in previous days I had been eating gluten / seitan type stuff also) and I got bad again the next day which made me think it was maybe that and maybe it is an allergy to gluten. So i cut out all gluten and 2 days later in the evening (last night) I felt better than I had for ages , today it is a little bit of a swollen feeling there again (i might have had something with gluten by accident yesterday as wasnt sure of ingredient of some lentil burgers we ate) but not very bad. Also , i have been getting quite itchy all over with some red patches (since avoiding gluten) 

Do this sound like a potential gluten intolerance issue ? The intestine area pain is the bit im most wanting to find the reason for as it has been really effecting my life quality. Would that be a typical symptom of gluten intolerance , a dull aching to sharp throbbing type pain , often after eating in lower to mid right side , sometimes constipation and some improvement after going but not completely?

thanks for any help - I am actually hopeful that I might have found the cause because I dont believe the doctors here will find it themselves (this is from lots of experience here)

First - there is no such thing as a "gluten allergy".  Celiac is an autoimmune disease.  Just so you understand.

It could be Celiac or a different gluten intolerance.  I am guessing you aren't going to get tested for Celiac disease.  IF it were me, I would be more concerned that maybe there is still some sort of infection or parasite from the places you have been.  I think I would try to get a good work-up for that first.

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Karen's point about parasites etc is a good one. They can cause a lot of symptoms similar to celiac /ncgs as you probably know. 

At 11 I had my appendix removed following pain in the lower right side of my torso. On waking up the surgeon told me that it was actually ok, when I asked what caused the pain I think they said it was probably glandular - they didn't know. Later I got pains in the stomach, usually a dull ache although I could get a fierce stabbing pain there too. When I went gluten free those pains stopped. as did my chronic sciatic backache which Ive subsequently realised was probably due to inflammed tissues pressing on nerves.

I would ask the Bolivian doctors if they can get any celiac blood testing done. The standard ttg may not be beyond their labs. can't hurt to ask?

Give your diet my guess is you've had a lot of gluten for a long time. If its an issue for you expect a bumpy ride when removing it. 

Best of luck!

 

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Hi ,  i was thinking that an intolerance and allergy were about the same thing really but sorry if im wrong. I know celiac is an autoimmune disease but was thinking that is different again, more serious and was erring on the side of my possible issue not being that but more of the intolerance type. Clearly im just guessing though and dont know about this stuff , hence the posting for advice,

The problem with trying to get tested is that in bolivia there are very limited tests and doctors are unreliable so you have to rely on yourself to certain degree. I have heard of a test here and was planning on looking into that but it made sense to try to get some opinions and advice online first so Im in a better position to understand if any tests here are actually reliable enough.

I dont think there is an issue with travel parasites etc as I have already taken the medications thats would kill them like a course of albendazol and praziquantel and that was after a 2 week anti parasite cleanse. That did feel like it got rid of anything and the only issue I have been left with is this pain as described.

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11 minutes ago, Jmg said:

Karen's point about parasites etc is a good one. They can cause a lot of symptoms similar to celiac /ncgs as you probably know. 

At 11 I had my appendix removed following pain in the lower right side of my torso. On waking up the surgeon told me that it was actually ok, when I asked what caused the pain I think they said it was probably glandular - they didn't know. Later I got pains in the stomach, usually a dull ache although I could get a fierce stabbing pain there too. When I went gluten free those pains stopped. as did my chronic sciatic backache which Ive subsequently realised was probably due to inflammed tissues pressing on nerves.

I would ask the Bolivian doctors if they can get any celiac blood testing done. The standard ttg may not be beyond their labs. can't hurt to ask?

Give your diet my guess is you've had a lot of gluten for a long time. If its an issue for you expect a bumpy ride when removing it. 

Best of luck!

 

Yeah , i will look into getting tested - like you say there is no harm in it . What I found very interesting is the part where you say "Later I got pains in the stomach, usually a dull ache although I could get a fierce stabbing pain there too. When I went gluten free those pains stopped. as did my chronic sciatic backache which Ive subsequently realised was probably due to inflamed tissues pressing on nerves." - I also started to get chronic sciatic nerve pain on the right side over a similar time period and am wondering if its the same kind of thing. If I could solve both those things it would be life changing for me

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Celiac disease can be dormant for years til a strain/stress to the immune system makes it come out. Many of us have had this issues, your infection run in might have triggered the dormant genes for the disease if you had them. I would follow up with the testing, see about getting a full celiac blood panel if you can, you have to be eating gluten for 12 weeks daily prior to testing. http://www.cureceliacdisease.org/screening/

 

If not celiac it could be another food intolerance/sensitivity I suggest keeping a food diary and tracking what you eat, seasonings, how it is cooked etc. And how you feel later. Change up our diet more and look for patterns.  Here is stuff to read up on. https://www.mindbodygreen.com/articles/are-food-sensitivities-for-life

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3 hours ago, Boliviab said:

I also started to get chronic sciatic nerve pain on the right side over a similar time period and am wondering if its the same kind of thing. If I could solve both those things it would be life changing for me

I was completely floored by the realisation after I went gluten free of just how badly it had been affecting me. Before then I had all these different things which I was either barely coping with, ignoring, trying to pretend they weren't there etc. I went gluten free and suddenly all sorts of different things started to resolve. It blew my mind!

Try and get a blood test now before cutting it, its so much easier than going back on it for a gluten challenge. 

If the test is negative, don't assume its not an issue for you. My test was negative but I responded to the diet. 

Lots of help and advice here if you need it :)

Best of luck!

Matt

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2 minutes ago, Jmg said:

I was completely floored by the realisation after I went gluten free of just how badly it had been affecting me. Before then I had all these different things which I was either barely coping with, ignoring, trying to pretend they weren't there etc. I went gluten free and suddenly all sorts of different things started to resolve. It blew my mind!

Try and get a blood test now before cutting it, its so much easier than going back on it for a gluten challenge. 

If the test is negative, don't assume its not an issue for you. My test was negative but I responded to the diet. 

Lots of help and advice here if you need it :)

Best of luck!

Matt

yeah , i might try go tomorrow if I can find out - i literally stopped 2 days ago so unikely to be out of my system and if im due to go for a test tomorrow I could maybe try eating something witha bit of gluten in tonight or something to "top up" as it were

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1 minute ago, Boliviab said:

yeah , i might try go tomorrow if I can find out - i literally stopped 2 days ago so unikely to be out of my system and if im due to go for a test tomorrow I could maybe try eating something witha bit of gluten in tonight or something to "top up" as it were

A couple of days gluten-free probably won't matter.  but it doesn't work that way.  It isn't gluten in your system" they are testing for.  Gluten is not in your blood.  It is the antibodies your body makes to gluten that the blood test looks for.

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3 minutes ago, kareng said:

A couple of days gluten-free probably won't matter.  but it doesn't work that way.  It isn't gluten in your system" they are testing for.  Gluten is not in your blood.  It is the antibodies your body makes to gluten that the blood test looks for.

my thinking was that if I ate gluten tonight again , then the reaction would be there tomorrow not that there would be gluten for them to find exactly. So from what your saying It would make sense - i.e. if my body was going to react to gluten with antibodies then by eating gluten say tonight it would mean they would be in my system tomorrow. Now of course they could be in my system anyway from the gluten I ate a few days ago , but it would be more of a sure thing if id eaten it the day before I would have thought.

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2 minutes ago, Boliviab said:

my thinking was that if I ate gluten tonight again , then the reaction would be there tomorrow not that there would be gluten for them to find exactly. So from what your saying It would make sense - i.e. if my body was going to react to gluten with antibodies then by eating gluten say tonight it would mean they would be in my system tomorrow. Now of course they could be in my system anyway from the gluten I ate a few days ago , but it would be more of a sure thing if id eaten it the day before I would have thought.

So the simple explanation is - You eat gluten.  It travels along and gets to your small intestine.  For some reason, your small intestine feels it is an invader.  but instead of making antibodies that "attack" the gluten, the small intestine cells make antibodies that attack itself.  Sort of misguided, but that's what happens.  Now these antibodies are in the small intestines .  It can take weeks to make enough of them in the small intestine for them to make it to the blood stream in big enough numbers to show up on a Celiac blood test. 

So, one meal of gluten, after a long period gluten-free, probably wouldn't effect the level of antibodies in the blood.  

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7 minutes ago, kareng said:

So the simple explanation is - You eat gluten.  It travels along and gets to your small intestine.  For some reason, your small intestine feels it is an invader.  but instead of making antibodies that "attack" the gluten, the small intestine cells make antibodies that attack itself.  Sort of misguided, but that's what happens.  Now these antibodies are in the small intestines .  It can take weeks to make enough of them in the small intestine for them to make it to the blood stream in big enough numbers to show up on a Celiac blood test. 

So, one meal of gluten, after a long period gluten-free, probably wouldn't effect the level of antibodies in the blood.  

ok so eating gluten tonight wouldnt really have an effect then but i wouldnt likely still have them in my system after just 2 days of gluten free anyway. Basically the sooner the better I have the test really to have best chances.

On a seperate note - i have just seen that I have developed a rash all over my upper body. I felt a bit itchy yesterday but this is a full on red rash all over my torso , arms  part of my back . Legs feel itchy also but arent as red.Could this be an effect of stopping gluten for just 2 days? and if so would that happen  regardless of me being celiac / gluten intolerant or not or could it be an indication of something?

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2 minutes ago, Boliviab said:

ok so eating gluten tonight wouldnt really have an effect then but i wouldnt likely still have them in my system after just 2 days of gluten free anyway. Basically the sooner the better I have the test really to have best chances.

On a seperate note - i have just seen that I have developed a rash all over my upper body. I felt a bit itchy yesterday but this is a full on red rash all over my torso , arms  part of my back . Legs feel itchy also but arent as red.Could this be an effect of stopping gluten for just 2 days? and if so would that happen  regardless of me being celiac / gluten intolerant or not or could it be an indication of something?

I don't see that stopping gluten would cause a rash for anyone.

 

You might want to look at this site 

http://www.cureceliacdisease.org/

 

Edited by kareng

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31 minutes ago, Boliviab said:

eah , i might try go tomorrow if I can find out - i literally stopped 2 days ago so unikely to be out of my system and if im due to go for a test tomorrow I could maybe try eating something witha bit of gluten in tonight or something to "top up" as it were

If you only stopped 2 days ago no problem. Try and get a test arranged. 

if that can't happen, trial the diet and keep a journal tracking any response. I found that really helpful as some changes are subtle and gradual. 

 

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Hi,

DH (dermatitis herpetiformis) is an itchy rash caused by celiac disease.You should keep eating gluten until all celiac testing is completed.  Usually testing is a blood antibodies test first, followed by an endoscopy later.

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2 hours ago, Jmg said:

I was completely floored by the realisation after I went gluten free of just how badly it had been affecting me. Before then I had all these different things which I was either barely coping with, ignoring, trying to pretend they weren't there etc. I went gluten free and suddenly all sorts of different things started to resolve. It blew my mind!

Ditto, ditto, ditto!!!!!

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5 hours ago, Boliviab said:

ok so eating gluten tonight wouldnt really have an effect then but i wouldnt likely still have them in my system after just 2 days of gluten free anyway. Basically the sooner the better I have the test really to have best chances.

On a seperate note - i have just seen that I have developed a rash all over my upper body. I felt a bit itchy yesterday but this is a full on red rash all over my torso , arms  part of my back . Legs feel itchy also but arent as red.Could this be an effect of stopping gluten for just 2 days? and if so would that happen  regardless of me being celiac / gluten intolerant or not or could it be an indication of something?

BoliviaB,

DH rash can occur in Celiac's who reindtroduce wheat/gluten after a break from gluten.

However I want to go/see that the parasite route has also been exhausted.

The fever's (for most Celiac's anyway) are not typically but low grade inflammation is.

I had annual bronchitis issues and ear aches that went away after stopping gluten.

You did not say if your were a native Bolivian or not but if you are you  probably know about Chagas disease carried by the Kissing Bug.

A blood test will confirm that the Chagas parasite's were killed with your AB's round.

Though many AB's rounds can be as long as 2 months . . . not just two weeks for complete control.

I wonder if you have Chagas (possibly) and it is causing you colon problems.  GI problems can be a sign of advanced Chagas complications.

If you are having your blood drawn again it should be (re)checked.

In the US (since it is not endemic) as it is in Bolivia people typically find out if they have it (Chagas) by giving blood.

Chagas is considered a Neglected Tropical Disease (NTD) in the US but in Bolivia it should be ruled out as a possible cause of your fever(s) and GI problems.

https://www.cdc.gov/parasites/chagas/disease.html

quoting

"a dilated esophagus or colon, leading to difficulties with eating or passing stool" can be a sign of chagas.

if you hadn't mentioned parasites in your regimen I might not of mentioned it.  And in the UK if they didn't know your country of origin or your home country they might not of think to ask about it since it is a Neglected Tropical Disease and therefore had no reason to suspect Chagas to test your blood for it.

I was only aware of it because it has begun to show up in Texas and CNN run an article about it a couple of years ago.

http://www.cnn.com/2015/11/24/health/kissing-bugs-chagas-disease/index.html

 If you have an outdoor dog --- dog's can also contract Chagase disease from the bite of the Kissing Bug much like in the US dog's can get heart worm from a mosquito bite.

The CDC (the US health agency) says most people are assymptomatic but GI problems can be a severe sign of undiagnosed Chagas in about 30% of the population.

quoting again

"In people who have suppressed immune systems (for example, due to AIDS or chemotherapy), Chagas disease can reactivate with parasites found in the circulating blood. This occurrence can potentially cause severe disease." . . (NCGS and/or undiagnosed Celiac Disease (my words) could certaintly complicate someone's response to the Chagas parasite).

This might be higher in Bolivia. . . and probably is since Chagas is endemic to Bolivia.

The good news a blood test can help you find out if undidangosed Celiac or undiagnosed Chagas is causing your problems or if it is a complicated mix of the two.

**** this is not medical advice but it explains your fevers' better than Celiac (usuallY) but the rash defiantly could be a DH reaction to gluten.

I hope this is helpful.

2 Timothy 2:7 “Consider what I say; and the Lord give thee understanding in all things” this included.

posterboy by the grace of God,

ETA: Here is the FAQ link from the CDC on Blood Screening for Chagas disease in the US.

 https://www.cdc.gov/parasites/chagas/gen_info/screening.html

Again I hope this helpful.

 

 

Edited by Posterboy
To Add CDC's FAQs on Blood Screening for Chagas Disease in the US

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12 hours ago, Boliviab said:

When I went gluten free those pains stopped. as did my chronic sciatic backache which Ive subsequently realised was probably due to inflamed tissues pressing on nerves."

Me too. I still get transient lower back pain occasionally when my bladder or colon is full. It goes away immediately on voiding.

Regardless of anything other diseases you may have, being wheat free gives you relief so even if not Celiac you are Non Celiac Wheat Sensitive. There are over 200 symptoms that are improved with GFD gluten free diet. Google it. It is an impressive list. In any case, while it is good to have a diagnosis, there is only one treatment, do not eat wheat and deal with the inevitable malnutrition damage.(think Biafra babies 1970.) Most will improve over time. Whatever doesn't improve should be investigated to be safe, but realize that recovery may take years.

Wheat flour used should be limited to Paper Mache sculpture and library paste.:P

 

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3 hours ago, Wheatwacked said:

Wheat flour used should be limited to Paper Mache sculpture and library paste.

I would say no even then....it belongs in its own little corner in hell. We have had members get sick from cross contact touching and handling paper mache, playdough, and dry wall spackle containing wheat then touching their mouths, or food.....heck you can inhale the powder from the sanding spackle and have it get trapped in the mucus in you respiratory tract to run down your stomach and make you sick......has happened to a few on many occasions.

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    9. Molteni N, Bardella MT, Baldassarri AR, Bianchi PA. Celiac disease associated with epilepsy and intracranial calcifications: report of two patients. Am J Gastroenterol. 1988 Sep;83(9):992-4.
    10. http://ezinearticles.com/?Food-Allergy-and-Stuttering-Link&id=1235725 
    11. http://www.craig.copperleife.com/health/stuttering_allergies.htm 
    12. https://www.celiac.com/forums/topic/73362-any-help-is-appreciated/
    13. Ford RP. The gluten syndrome: a neurological disease. Med Hypotheses. 2009 Sep;73(3):438-40. Epub 2009 Apr 29.
    14. Hadjivassiliou M, Gibson A, Davies-Jones GA, Lobo AJ, Stephenson TJ, Milford-Ward A. Does cryptic gluten sensitivity play a part in neurological illness? Lancet. 1996 Feb 10;347(8998):369-71.

    Jefferson Adams
    Celiac.com 06/14/2018 - Refractory celiac disease type II (RCDII) is a rare complication of celiac disease that has high death rates. To diagnose RCDII, doctors identify a clonal population of phenotypically aberrant intraepithelial lymphocytes (IELs). 
    However, researchers really don’t have much data regarding the frequency and significance of clonal T cell receptor (TCR) gene rearrangements (TCR-GRs) in small bowel (SB) biopsies of patients without RCDII. Such data could provide useful comparison information for patients with RCDII, among other things.
    To that end, a research team recently set out to try to get some information about the frequency and importance of clonal T cell receptor (TCR) gene rearrangements (TCR-GRs) in small bowel (SB) biopsies of patients without RCDII. The research team included Shafinaz Hussein, Tatyana Gindin, Stephen M Lagana, Carolina Arguelles-Grande, Suneeta Krishnareddy, Bachir Alobeid, Suzanne K Lewis, Mahesh M Mansukhani, Peter H R Green, and Govind Bhagat.
    They are variously affiliated with the Department of Pathology and Cell Biology, and the Department of Medicine at the Celiac Disease Center, New York Presbyterian Hospital/Columbia University Medical Center, New York, USA. Their team analyzed results of TCR-GR analyses performed on SB biopsies at our institution over a 3-year period, which were obtained from eight active celiac disease, 172 celiac disease on gluten-free diet, 33 RCDI, and three RCDII patients and 14 patients without celiac disease. 
    Clonal TCR-GRs are not infrequent in cases lacking features of RCDII, while PCPs are frequent in all disease phases. TCR-GR results should be assessed in conjunction with immunophenotypic, histological and clinical findings for appropriate diagnosis and classification of RCD.
    The team divided the TCR-GR patterns into clonal, polyclonal and prominent clonal peaks (PCPs), and correlated these patterns with clinical and pathological features. In all, they detected clonal TCR-GR products in biopsies from 67% of patients with RCDII, 17% of patients with RCDI and 6% of patients with gluten-free diet. They found PCPs in all disease phases, but saw no significant difference in the TCR-GR patterns between the non-RCDII disease categories (p=0.39). 
    They also noted a higher frequency of surface CD3(−) IELs in cases with clonal TCR-GR, but the PCP pattern showed no associations with any clinical or pathological feature. 
    Repeat biopsy showed that the clonal or PCP pattern persisted for up to 2 years with no evidence of RCDII. The study indicates that better understanding of clonal T cell receptor gene rearrangements may help researchers improve refractory celiac diagnosis. 
    Source:
    Journal of Clinical Pathologyhttp://dx.doi.org/10.1136/jclinpath-2018-205023

    Jefferson Adams
    Celiac.com 06/13/2018 - There have been numerous reports that olmesartan, aka Benicar, seems to trigger sprue‐like enteropathy in many patients, but so far, studies have produced mixed results, and there really hasn’t been a rigorous study of the issue. A team of researchers recently set out to assess whether olmesartan is associated with a higher rate of enteropathy compared with other angiotensin II receptor blockers (ARBs).
    The research team included Y.‐H. Dong; Y. Jin; TN Tsacogianis; M He; PH Hsieh; and JJ Gagne. They are variously affiliated with the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School in Boston, MA, USA; the Faculty of Pharmacy, School of Pharmaceutical Science at National Yang‐Ming University in Taipei, Taiwan; and the Department of Hepato‐Gastroenterology, Chi Mei Medical Center in Tainan, Taiwan.
    To get solid data on the issue, the team conducted a cohort study among ARB initiators in 5 US claims databases covering numerous health insurers. They used Cox regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for enteropathy‐related outcomes, including celiac disease, malabsorption, concomitant diagnoses of diarrhea and weight loss, and non‐infectious enteropathy. In all, they found nearly two million eligible patients. 
    They then assessed those patients and compared the results for olmesartan initiators to initiators of other ARBs after propensity score (PS) matching. They found unadjusted incidence rates of 0.82, 1.41, 1.66 and 29.20 per 1,000 person‐years for celiac disease, malabsorption, concomitant diagnoses of diarrhea and weight loss, and non‐infectious enteropathy respectively. 
    After PS matching comparing olmesartan to other ARBs, hazard ratios were 1.21 (95% CI, 1.05‐1.40), 1.00 (95% CI, 0.88‐1.13), 1.22 (95% CI, 1.10‐1.36) and 1.04 (95% CI, 1.01‐1.07) for each outcome. Patients aged 65 years and older showed greater hazard ratios for celiac disease, as did patients receiving treatment for more than 1 year, and patients receiving higher cumulative olmesartan doses.
    This is the first comprehensive multi‐database study to document a higher rate of enteropathy in olmesartan initiators as compared to initiators of other ARBs, though absolute rates were low for both groups.
    Source:
    Alimentary Pharmacology & Therapeutics

    Jefferson Adams
    Celiac.com 06/12/2018 - A life-long gluten-free diet is the only proven treatment for celiac disease. However, current methods for assessing gluten-free diet compliance are lack the sensitivity to detect occasional dietary transgressions that may cause gut mucosal damage. So, basically, there’s currently no good way to tell if celiac patients are suffering gut damage from low-level gluten contamination.
    A team of researchers recently set out to develop a method to determine gluten intake and monitor gluten-free dietary compliance in patients with celiac disease, and to determine its correlation with mucosal damage. The research team included ML Moreno, Á Cebolla, A Muñoz-Suano, C Carrillo-Carrion, I Comino, Á Pizarro, F León, A Rodríguez-Herrera, and C Sousa. They are variously affiliated with Facultad de Farmacia, Departamento de Microbiología y Parasitología, Universidad de Sevilla, Sevilla, Spain; Biomedal S.L., Sevilla, Spain; Unidad Clínica de Aparato Digestivo, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Celimmune, Bethesda, Maryland, USA; and the Unidad de Gastroenterología y Nutrición, Instituto Hispalense de Pediatría, Sevilla, Spain.
    For their study, the team collected urine samples from 76 healthy subjects and 58 patients with celiac disease subjected to different gluten dietary conditions. To quantify gluten immunogenic peptides in solid-phase extracted urines, the team used a lateral flow test (LFT) with the highly sensitive and specific G12 monoclonal antibody for the most dominant GIPs and an LFT reader. 
    They detected GIPs in concentrated urines from healthy individuals previously subjected to gluten-free diet as early as 4-6 h after single gluten intake, and for 1-2 days afterward. The urine test showed gluten ingestion in about 50% of patients. Biopsy analysis showed that nearly 9 out of 10 celiac patients with no villous atrophy had no detectable GIP in urine, while all patients with quantifiable GIP in urine showed signs of gut damage.
    The ability to use GIP in urine to reveal gluten consumption will likely help lead to new and non-invasive methods for monitoring gluten-free diet compliance. The test is sensitive, specific and simple enough for clinical monitoring of celiac patients, as well as for basic and clinical research applications including drug development.
    Source:
    Gut. 2017 Feb;66(2):250-257.  doi: 10.1136/gutjnl-2015-310148.