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Celiac.com 09/12/2024 - Celiac disease is an autoimmune disorder where the ingestion of gluten leads to damage in the small intestine. This condition affects roughly one in 133 people worldwide, though it often goes undiagnosed due to its diverse symptoms. Celiac disease can co-occur with other autoimmune diseases, complicating its presentation and management. The disease’s prevalence and diagnosis are influenced by demographic and genetic factors, making it a significant health concern globally. Ophthalmic Manifestations of Celiac Disease Celiac disease is not just a gastrointestinal disorder; it can also have various ophthalmic manifestations. Patients with celiac disease may exhibit a range of eye-related issues that are not typically associated with the condition, such as decreased endothelial cell density, vitamin A deficiency causing dryness, altered corneal nerve density, cataracts, uveitis, changes in choroidal thickness, papilledema, and neurological issues like nystagmus. These manifestations highlight the systemic nature of celiac disease and the importance of comprehensive care. The Need for Thorough Evaluation Before Corneal Refractive Surgery Corneal refractive surgery, which includes procedures like LASIK, is increasingly popular for correcting vision problems. However, for patients with celiac disease, it is crucial to conduct a thorough evaluation before proceeding with such surgeries. The variability in ocular manifestations among celiac patients necessitates individualized assessments to determine surgical candidacy and optimize outcomes. This evaluation should include both subjective and objective assessments. Subjective Assessments A detailed medical history focusing on the patient’s experience with celiac disease is essential. This includes questions about dietary gluten intake, weight loss, joint pain, and cognitive impairments like brain fog. Understanding these aspects can help in identifying potential complications that might affect surgical outcomes. Objective Assessments A comprehensive objective assessment should include several diagnostic tests: Slit-lamp biomicroscopy to examine the eye’s structures. Schirmer test and tear break-up time (TBUT) to assess tear production and dry eye. Optical coherence tomography (OCT) to measure retinal and choroidal thickness. Scheimpflug imaging and fundoscopy to evaluate the anterior and posterior segments of the eye. Specific Considerations for Celiac Disease Patients Given the diverse ocular manifestations associated with celiac disease, several specific considerations should be addressed: Dry Eye Disease: Patients with celiac disease are more prone to dry eye disease. Symptoms like ocular discomfort, irritation, redness, and burning can be managed with artificial tears and punctal plugs before surgery. Endothelial Cell Density (ECD): Celiac disease patients may have lower ECD, which can lead to corneal edema post-surgery. Specular microscopy is recommended to evaluate ECD before proceeding with surgery. Anterior Chamber Depth (ACD): Some celiac disease patients might have shallower ACDs, which can indicate early-onset cataracts. Scheimpflug imaging can help assess ACD. Choroidal and Retinal Health: OCT is crucial to evaluate choroidal thickness and retinal health. Thinner choroids and other posterior segment abnormalities can affect visual outcomes post-surgery. Thyroid-Associated Orbitopathy (TAO): Celiac disease patients may also suffer from TAO, which can impact corneal health and refractive surgery outcomes. Thyroid function tests and orbital ultrasound are necessary for a thorough evaluation. Vitamin A Deficiency: This can lead to dryness and other ocular surface issues. Serum retinol levels should be checked, and vitamin A supplementation should be managed appropriately. Neurological Issues: Conditions like gluten ataxia and nystagmus can complicate surgery due to motor control issues. These conditions need careful assessment and management. Autoimmune Co-morbidities: The presence of other autoimmune conditions, like Type 1 Diabetes Mellitus, can increase the risk of complications like diabetic retinopathy, impacting surgical outcomes. Comprehensive retinal evaluations are necessary in these cases. Conclusion: The Importance of Comprehensive Care This study underscores the need for a thorough and individualized evaluation of celiac disease patients considering corneal refractive surgery. By addressing the various ophthalmic manifestations and related autoimmune conditions, healthcare providers can improve surgical outcomes and patient satisfaction. The recommendations provided in this study serve as preliminary guidelines, highlighting the importance of further research to better understand the impact of celiac disease on corneal refractive surgery outcomes. For celiac patients, these insights are crucial, as they emphasize the need for comprehensive care and tailored management strategies to ensure the best possible surgical results. Read more at: cureus.com
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Hi all, I'm looking for advice. I have been diagnosed a Celiac a year ago and just had a hysterectomy a few days ago. Day 2 home from the hospital I was glutened but didn't realize until day 6 and My insides are a mess. Didn't recognize my symptoms because of the narcotics. Now I'm just on ibroprofin but hard to take. My stomach is so raw and super tired. Anyone who knows the best way to heal my symptoms while regimented on ibroprofin? Is there something better to take after major surgery? Also going through caffeine whithdraw because I can't stomach coffee or tea now.
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Celiac.com 06/24/2017 - A long-time pasta lover with celiac disease is desperately fundraising for surgery after losing half his body weight on a gluten-free diet. Years of eating lots of pasta and high calorie meals had left Christopher DeLorenzo weighing over 400 pounds. "My grandparents were Italian so I grew up eating lots of pasta…all I would do was eat, eat, eat always pasta and pizza, my stomach was like an endless pit," said the Phillipsburg, New Jersey, native. DeLorenzo's battle with portions and weight began early. At just 12 years old, he already tipped the scales at 250 pounds. His struggles with food led to years of dieting, and numerous attempts to lose weight. "My digestive system was terrible before weight loss surgery. I was forever complaining to doctors that there was something wrong but I was told that I was eating too much," says DeLorenzo. DeLorenzo found some improvement with weight loss surgery, but it wasn't until he was diagnosed with celiac disease and gave up gluten that he saw his health return. "Now I believe I can attribute a lot of the problems I was having to my body reacting badly to gluten." Still, the experience has left DeLorenzo with a mass of excess skin that looks, he says, like a 'deflated airbag.' He is currently seeking donations to fund surgery to remove the excess skin. Read more at Entertainmentdaily.co.uk
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Celiac.com 06/15/2016 - Every so often, a medical case comes along that puzzles or interests clinicians. One recent case of celiac disease fits that bill. The patient in this case is a 61-year-old obese woman who developed severe diarrhea that started soon after bariatric surgery and did not respond to standard medical treatment. The team treating the woman reports that, to their knowledge, this is the first reported case of clinical onset of celiac disease (celiac disease) following duodenal switch surgery. The research team included A Pané, A Orois, M Careaga, A Saco, E Ortega, J Vidal, P Leyes, and AJ Amor. They are variously affiliated with the Department of Endocrinology and Nutrition, and the Department of Anatomic Pathology at the Hospital Clínic in Barcelona, Spain. After the team ruled out the most common post-operative causes of diarrhea, they ran some blood tests, and made a final diagnosis based on positive results for anti-tissue transglutaminase antibody. In light of this case report, the team proposes that celiac disease should be ruled out in any patient presenting with typical or atypical symptoms after bariatric surgery, regardless of the latency of onset. Read more on this case in the Eur J Clin Nutr. 2016 Apr 20. doi: 10.1038/ejcn.2016.65.
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Celiac.com 03/04/2013 - Morbid obesity is a common medical condition. In many cases, bariatric surgery is necessary. Although for decades celiac disease has been associated with chronic diarrhea and weight loss, and other classic symptoms, recent data shows that the clinical spectrum of celiac disease is extremely wide. A group of researchers recently reported on the benefits of diagnosing celiac disease during pre-operative work-up for bariatric surgery. The researchers included Federico Cuenca-Abente, Fabio Nachman, and Julio C. Bai of the Department of Surgery and Department of Medicine at Dr C. Bonorino Udaondo Gastroenterology Hospital in Buenos Aires, Argentina. They reported on the cases of five morbidly obese patients diagnosed with celiac disease during preoperative work-up for bariatric surgery. Celiac disease was suspected upon routine upper endoscopy, and confirmed by histology and positive celiac disease-specific blood tests. Interestingly, four of the five patients had no obvious symptoms. One complained of chronic diarrhea and anemia. All patients began a gluten-free diet. Due to their celiac disease diagnosis, doctors offered all five patients a purely restrictive bariatric procedure. At the time of the report, three of the patients had received a sleeve gastrectomy, while the other two were still undergoing pre-operative evaluation. The team's findings help to enlarge the clinical spectrum of untreated celiac disease. Even though rates of celiac disease in obese patients seems to be similar to that in the general population, the team recommends that patients with morbid obesity be tested for celiac disease in order to determine the best surgical strategy and outcome. Source: Open Original Shared Link
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Celiac.com 04/15/2013 - Enteropathy-associated T cell lymphoma (EATL) is a gut cancer that often ends in death. Currently, doctors have very little idea what factors might help patients survive. The manner in which clinical presentation, pathological features and therapies influence EATL outcome was the subject of a recent study by a team of researchers. The research team included: G. Malamut; O. Chandesris; V. Verkarre; B.Meresse, C. Callens, E. Macintyre, Y. Bouhnik, J.M. Gornet; M. Allez; R. Jian; A. Berger; G. Châtellier; N. Brousse, O. Hermine, N. Cerf-Bensussan, and C. Cellier. They are variously affiliated with the Université Paris Descartes, the Gastroenterology Department of Hôpital Européen Georges Pompidou, APHP, and Inserm U989 in Paris, France. For their study, the team evaluated the medical files of 37 well-documented patients with celiac disease and T-cell lymphoma. They then analyzed lymphoma and intestinal mucosa by histopathology, multiplex PCR and intestinal intraepithelial lymphocytes phenotyping. Using Kaplan-Meier curves with Logrank test and Cox Model they then analyzed patient survival and prognostic factors. They found 15 patients with lymphoma-complicated non-clonal enteropathy, celiac disease, two patients with type I refractory celiac disease, and 20 patients with clonal type II refractory celiac disease. Twenty-five patients underwent surgery with resection of the main tumor mass in 22 cases. Univariate analysis showed that non-clonal celiac disease, serum albumin levels under 21.6g/L at diagnosis, chemotherapy and surgical resection predicted good survival (p=0.0007, p Multivariate analysis showed that serum albumin level>21.6g/L, chemotherapy and reductive surgery were all significantly associated with increased survival rates (p The results reinforce the value of assessing celiac disease type in patients with T-cell lymphoma, and suggest that a combination of nutritional, chemotherapy and reductive surgery may improve survival rates in cases of EATL. Source: Dig Liver Dis. 2013 Jan 9. pii: S1590-8658(12)00438-0. doi: 10.1016/j.dld.2012.12.001.
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