Mesenteric Panniculitis is a rare inflammatory disease that affects the subcutaneous adipose tissue of the mesentery or the small bowel area that is characterized by blockage to the small intestine; it can be associated with other immune disorders, like celiac disease. However, celiac disease does not contribute to mesenteric panniculitis, but rather that the inflammation in the intestine could affect inflammation in the mesentery, as they are so closely related.
With regard to neuropathy, celiac disease could be one of the leading factors for peripheral neuropathy, but its association with other neurological disorders is not clear, and requires more research.
Blood tests for celiac disease are usually accurate, but what does it mean when there is a discrepancy between biopsies suggesting celiac disease, but blood tests are negative?
In response to a question from a Mayo Clinic Connect member, Dr. Joseph Murray, M.D., explains that there may be other conditions that can cause changes in the intestinal biopsy that are characteristic of celiac disease. Tropical sprue, certain medications, or infections can cause damage to the intestinal wall.
Other reasons could be IgA deficiency; people with this disorder have absent levels of a blood protein called immunoglobulin A (IgA), which protects against infections of the mucous membranes lining the mouth, airways and digestive tract.
Why is it important to investigate and identify intestinal damage when test discrepancies occur? They may have alternate causes and subsequently alternate treatment, Dr. Murray emphasizes.
The only current treatment for celiac disease is a strict, lifelong gluten-free diet. The Internet can be a great help, but can also be a source of confusion and misinformation. In this Q and A discussion, Dr. Joseph Murray, M.D., and Jacalyn See, clinical dietitian, talk about the benefits of medical nutrition advice provided by a registered dietitian, and strongly recommended it for individuals with celiac disease.
In response to numerous queries concerning the use of oats in various products, the North American Society for the Study of Celiac Disease (NASSCD) has developed this statement: “Based on the available scientific evidence, the use of oats uncontaminated by wheat, barley or rye by individuals with celiac disease and dermatitis herpetiformis in North America has been endorsed by most experts. Oats can add diversity and offer many nutritional benefits to the gluten-free diet.”
Oats do not naturally contain gluten. The main problem with oats in gluten-free eating is contamination during harvest and storage. Many commercial oats are processed in facilities that also process wheat, barley, and rye. The gluten in these ingredients can contaminate oats, and with most gluten intolerances, even a trace amount of gluten can cause severe discomfort. Therefore, it has been stressed that the oats be certified as pure.
Oats contain a protein called “avenin” that has the same properties as gluten. However, adverse reactions to this oat protein are very rare. More commonly, some patients may react to the fiber content or the fermentable carbohydrates in oats, both of which can cause gas, bloating and diarrhea.
There have been extensive studies done in adults and children, and clinical reports now provide strong evidence that pure oats very rarely cause damage to the gut mucosa in people with celiac disease.
Jacalyn See urges patients to check with their doctor and dietitian before introducing oats, and to start very slowly. It is important to ensure the oats are labelled gluten-free, but if there is suspicion of contamination, See advises patients to contact the FDA’s MedWatch; save all packaging so that the source of contamination can be traced.
Oats are a great source of nutrients that are often lacking in the gluten-free diet, such as iron and fiber. Dr. Murray concludes that, “There is renewed hope and new opportunity for celiac disease patients to expand their diet to an area of the past where they felt uncomfortable doing so before.”
Read more about the oats statement by NASSCD, here
Celiac disease primarily affects the small intestine, which is about 25 feet long. When celiac disease affects the duodenal bulb, the topmost part of the duodenum, it is diagnosed as ultra-short celiac disease. A recent study, published in Gastroenterology, found that a single biopsy of the duodenal bulb significantly increases the diagnostic yield for celiac disease. Dr. Joseph Murray, M.D., explains the prevalence and clinical implications of ultra-short celiac disease.
So far, treatment for celiac disease has been limited to a gluten-free diet, but as clinicians and researchers understand more about the causes of this disease, it has opened up many avenues for development of new treatment. There are at least 3 drugs that have shown hints of promise in small clinical trials, and larazotide acetate is the first one that will soon advance to the final stage of testing. Researchers observed that the compound reduces the permeability of the gut, and found that the combination of the drug with a gluten-free diet reduces the symptoms of celiac disease better than a gluten-free diet on its own. Dr. Joseph Murray, M.D., provides some insight into this exciting development that may hold the key to a better future for patients living with celiac disease.
Although celiac disease primarily affects the gut, the clinical spectrum of celiac disease is remarkably varied, and the disease can affect many extraintestinal organs, including the liver. Dr. Joseph Murray, M.D., reviews a study published in the World Journal of Gastroenterology, which identifies strategies for the diagnosis and treatment of these disorders in childhood.
Celiac disease is increasingly reported in children who are symptomless or present atypical symptoms and signs. As the medical community learns more about the far reaches of celiac disease, its association with liver ailments is receiving greater attention. Liver abnormalities can range from mild hepatic injury to severe liver disease. Although rarely, celiac disease may be also associated with severe liver involvement requiring liver transplant. All of these findings confirm the importance of early diagnosis and treatment of celiac disease-associated liver diseases.