Update on Celiac

Celiac is an autoimmune disease cause by a permanent sensitivity to gluten found in wheat, rye, barley in people with a genetic predisposition to the disease. There is both a genetic part and an environmental trigger necessary for celiac.

Stomach and intestinal presentations of celiac include belly pain, not wanting to eat, constipation, diarrhea, poor weight gain, weight loss and vomiting.

Other ways in which celiac may present include: anemia from lack of iron, mouth sores, swollen tender joints, behavioral problems, teeth enamel problems, depression, skin rashes, headaches, poor muscle tone, poor bone density, delay in puberty,

Celiac is associated with autoimmune liver disease, diabetes, down syndrome, Immunoglobulin A deficiency, inflamed thyroid, and turner syndrome.

For routine blood testing a tissue transglutaminase IgA level and total serum IgA level is recommended

For those who have low levels of IgA, additional tissue transglutaminase IgG should be ordered

A gluten free diet consists of eliminating foods that contain gluten and also includes avoiding barley or malt extract, bran, bulgar, coucous, durum, farina, graham flour, kamut, matzo flour or meal, orzo, panko, rye, semolina, spelt, triticale, wheat, wheat bran, wheat germ, wheat starch.

Potentially hidden sources of gluten may be found in ales, beers and lagers, breading, brown rice syrup, coating mix, communion wafers, croutons, candy, luncheon meats, broth, pasta, sauces, soup base, stuffing, self- basting poultry, imitation bacon or seafood, soy sauce, marinades, supplements, prescription medicines, over the counter medicines, vitamins and mineral supplements, lipstick, gloss and balms. Consult with the manufacturer to get all the ingredients

Gluten free grains and starches include amaranth, arrowroot, buckwheat, corn, flax, nuts, beans and seed flour, millet, potato starch, potato flour, quinoa, rice, rice bran, sago, soy, tapoica

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Lyme disease in the stomach, intestines and colon

Lyme disease is caused by the bacterium Borrelia burgdorferi and is transmitted to humans through the bite of infected ticks which may also be carrying other infections such as Bartonella, Mycoplasma etc..

Typical symptoms of Lyme include fever, headache, fatigue, and a characteristic skin rash called erythema migrans. If left untreated, infection can spread to joints, the heart, and the nervous system and the Gastrointestinal tract. Lyme disease is diagnosed based on symptoms, physical findings (e.g., rash), and the possibility of exposure to infected ticks; laboratory testing is helpful but are not a requirement to making a diagnosis Most cases of Lyme disease can be treated successfully with a few weeks of antibiotics. Steps to prevent Lyme disease include using insect repellent, removing ticks promptly, applying pesticides, and reducing tick habitat. The ticks that transmit Lyme disease can occasionally transmit other tickborne diseases including Bartonella (commonly associated with cat scratch fever), Mycoplasma ( a cause of chronic fatigue syndrome and gulf war syndrome), Ehrlichia, Babesia ( a parasite causing anemia), .

Gastrointestinal Lyme and other tick diseases may present as…

Abdominal pain (belly aches),

blood in the stool ( colitis)

Inflammatory Bowel Disease, Crohns disease, Ulcerative colitis

failure to thrive, poor gain weight, not meeting age appropriate milestones

diarrhea and/ or vomiting

heartburn, GERD

constipation with or without motility issues ( Gut issues secondary to neurologic lyme and/or bartonella)

soiling or encopresis

Irritable bowel syndrome

mouth sores

rashes may occur in patients that are not the characteristic bullseye rash and might resemble a stretch mark or be a non descript looking red earlobe or slap face or slap back appearance