Post gastroenteritis gluten intolerance

The spectrum of gluten related disorder might be much broader than currently believed. It is unknown why non-coeliac gluten sensitivity affects individuals at different ages. It is quite possible that triggering factors like infection might play an essential role in manifestation of this disorder. Similar to secondary lactose intolerance, gluten intolerance might be a common occurrence behind persistent symptoms after gastroenteritis. Presenting symptoms may depend on etiological factors and the affected portion of gastrointestinal [GI] anatomy. Therefore symptoms might be related to the upper GI tract like functional dyspepsia, or the lower GI tract like diarrhoea and constipation or a combination of both as in our patients. This case highlights that intolerance to gluten may develop in people who experience gastroenteritis and there is potential of at least partial recovery from this condition with elimination of lactose and gluten. Clinical recovery with a concomitant gluten and lactose [mainly milk] free diet over a period of time might be an effective strategy in treating these patients

Elemental diets role in treatment of high ileostomy output and other gastrointestinal disorders

Elemental diet [ED] has been used widely in the treatment of gastrointestinal disorders, especially with the management of Crohn's disease. This modality of diets provides all essential nutrients, and contains protein in the form of free amino acids that are theoretically easily absorbed. High output ileostomies are a rare but important complications of stoma formation following bowel surgery. Treatments could be challenging and include anti-diarrhoeals, octreotide and proton pump inhibitors. There is very little research regarding the use of elemental diets in the treatment of patients with post-operative high ileostomy outputs. Adequate management of high output ileostomies might prevent significant morbidity. In this case report, we describe a patient who underwent a subtotal colectomy for ulcerative colitis complicated by refractory high ileostomy output despite maximal standard medical therapy for years. The ileostomy output was dramatically reduced following the introduction of an elemental diet. This case suggests a possible role for the introduction of an elemental diet in the management of high output ileostomies. Besides presenting this case with high output ileostomy, we reviewed the role of ED in other gastrointestinal disorders

Type 1 diabetes mellitus and gluten induced disorders

Over the last five decades the association between coeliac disease and other autoimmune disorders such as autoimmune thyroid disease or diabetes mellitus type 1 has been well established through many studies and to this day is subject to on-going clinical and scientific investigation worldwide. While no link has been established between celiac disease and type-2 diabetes mellitus, coeliac disease is common in patients with type 1 diabetes. The improvement of symptoms in patients with both conditions through dietary intervention, in the form of a gluten free diet, has been widely described within the literature. Our objectives were to review and synthesise the current knowledge on the nutritional treatment for patients with both conditions

Epidemiological features of gastro-esophageal reflux disease in Iran based on general population

The aim of this study was to evaluate the epidemiology of GERD base on population study in Tehran providence. Gastro-esophageal reflux disease [GERD] is a common and chronic problem. Recent reports from developing counties indicate increment in the incidence and prevalence of the disease over the past. This study was a cross-sectional household survey conducted from May 2006 to December 2007 in Tehran province, Iran. Participants completed a valid gastro-esophageal reflux Questionnaire. The questionnaire included personal and family characteristics such as age, gender, and educational status. In addition, interviewers asked them regarding 10 GI symptoms. Altogether 18180 individuals participated in this cross-sectional study. The mean +/- SD age of participant was 38.7 +/- 17.1 and 9072 [49.9%] were women. The prevalence of GERD was 8.85 [8.43-9.26]. There was significant relationship between age, sex, marital and educational status with GERD. GERD symptoms were more common in women, older people, individuals with low education and married people. There was overlap between GERD, irritable bowel syndrome [IBS] and uninvestigated dyspepsia [UD]. According to our finding although the prevalence of GERD in our population is less than other studies, this prevalence is increasing in recent years

Microscopic Enteritis; clinical features and correlations with symptoms

To assess the clinical characteristic of CD as well as correlation of symptoms and the degrees of intestinal mucosal lesions in Iranian children. Microscopic Enteritis [Marsh 0-II] is associated with malabsorption. From August 2005 to September 2009, 111 cases with malabsorption and classical gastrointestinal symptoms were evaluated. The mean [ +/- SD] age of children with CD was 4.9 +/- 3.5 years [range, 6 month-16 years] and the mean duration of symptoms was 8 +/- 20.5 months. 50 cases [45%] were female and 61 cases [55%] were male. The most common clinical presentation was failure to thrive in 72%, chronic diarrhea in 65.8% and Iron deficiency anemia in 59.5%. Sensitivity of EMA was 100% in patients with Marsh IIIb and Marsh IIIc. EMA was also positive in 77% of cases with Marsh 0, 18% in Marsh I, 44% in Marsh II and 81.8% in patients with Marsh IIIa. Histopathology did not reflect the severity of gluten sensitivity. This would suggest that the degree of intestinal mucosal damage might not be a reliable prognostic factor. Significant symptoms can be present with minor histological change on biopsy

Clinical and histological presentation of helicobacter pylori and gluten related gastroenteropathy

Celiac disease has been reported to be associated with gastric abnormalities. The aim of this study was to assess the relationship between the prevalence of celiac disease and Helicobacter pylori infection in an Iranian population of 250 patients. Biopsies were taken from the gastric antrum and duodenum. Morphology and histology were evaluated using the updated Sydney system and modified Marsh criteria, respectively. To simplify the interpretation of gastric lesions we classified gastritis in macroscopic and microscopic stages. Serology for anti-tissue transglutaminase antibody was performed to determine the presence of celiac disease. Among 250 patients, 232 [93%] had histological evidence of Helicobacter pylori infection. Histological abnormalities [Marsh I to IIIc] were present in 24 [10%]. Of 24 patients, 20 [83%] with histological abnormalities were infected with Helicobacter pylori. Of 250 patients, 25 [10%] had a positive anti-tissue transglutaminase antibody. Of 25 anti-tissue transglutaminase antibody positive patients, 9 [3.6%] had microscopic and macroscopic enteritis [Marsh I to IIIc]. Clinical presentation of celiac disease was not distinguishable from cases infected with Helicobacter pylori. Histology, even in patients with positive serology, was non-specific and unhelpful. We found a high prevalence of Helicobacter pylori infection and chronic gastritis, but neither was associated with celiac disease, in agreement with studies in Western populations

Rotavirus and coeliac autoimmunity among adults with non-specific gastrointestinal symptoms

To determine celiac disease [CD] serology and rotavirus [RV] by polymerase reaction [PCR] in adults with non-specific gastrointestinal complaints. The study comprised 5176 randomly selected individuals living in Tehran, Iran between September 2006 and September 2007. Six hundred and seventy individuals with GI symptoms were identified with a questionnaire and invited for a further study including stool sampling and blood tests. Stool samples were examined for detection of RV by amplification of specific gene [VP6] and by light microscopy and formalin-ether concentration methods for parasite detection. The subjects also tested for CD including anti-transglutaminase [tTG] antibodies and total immunoglobulin A [IgA]. The study was carried out in the Research Center of Gastroentrology and Liver Disease, Taleghani Hospital, Tehran, Iran. The VP6 gene was detected in 150 [22.3%] individuals. Anti-tissue transglutaminase [tTG-IgA] was positive in 22 individuals [95% CI 2.3-5.1] and IgG-tTG antibody in 3 individuals who were IgA deficient. Amplification of VP6 gene was positive in 8/25 [32%] with positive CD serology and in 142/645 [22%] with negative CD serology. This difference was not statistically significant [p=0.2]. This study shows that RV infection is common among Iranian patients with non-specific gastrointestinal symptoms. However, in contrast to studies in children, this study shows that the prevalence of active RV infection was not statistically significantly different between individuals who were tTG antibody positive and those who were tTG antibody negative