Celiac Disease with Dr. Prashant Krishnan [Gastroenterology]

Celiac Disease with Dr. Prashant Krishnan [Gastroenterology]


Hi, I’m Prashant Krishnan with Peak Gastroenterology Associates. I’m a gastroenterologist, and today I wanted to talk to you a little bit about Celiac Disease. [Music Playing] Celiac Disease, also known historically as Celiac Sprue, can affect a lot of people, and over 40% of Americans can be susceptible to a, to a protein called gluten, and gluten can actually cause an immune response in patients and in people so that it actually causes damage to the small intestines, resulting in malabsorption, diarrhea, and various types of symptoms. About 1% of the population actually has Celiac Disease, and up to 10 percent of people in the US can actually have non-celiac gluten sensitivity. So they don’t actually have Celiac Disease but they may be sensitive to gluten. Celiac Disease occurs because of a protein called gluten. Gluten is the main reason why people have these symptoms. So what exactly is gluten. Gluten is a protein that’s usually found in wheat, but can also be found in barley and rye. Typically you don’t find gluten in oats however, if oats are stored in an area where there’s cross contamination with either wheat, barley or rye then people may have symptoms because of the oats but it’s not because of the oats, it’s because of the cross-contamination with either the wheat, barley and rye, which have gluten in it. So what happens with gluten? Well after you ingest the gluten and it’s being digested, it’s broken down into something called Gliadin. And Gliadin is what actually triggers the immune response inside of the small intestines. So as you’re eating food and as it’s going down into your small intestines, the small intestines have finger-like projections, which really start to absorb all of these nutrients in the body. And then what happens when you have an inflammatory reaction is these finger-like projections start to get blunted, and then you have decreased surface area for absorption and that’s what really results in all of the symptoms that patients have. So what exactly happens in Celiac Disease? Like I said, the gluten is broken down into Gliadin, and that is the molecule that then triggers the immune response. This immune response creates inflammation and that’s what degrades the, the lining of the small intestines, which can lead to symptoms such as abdominal pain, nausea, vomiting, excessive gas and bloating and diarrhea, but in addition to that, because the small intestine is where iron and calcium are absorbed, you have secondary consequences, like iron deficiency anemia, and premature osteoporosis. So if any of these things are plaguing you, you may want to talk to your primary care physician, or talk to us, a gastroenterologist to see if you may have Celiac Disease. So how is Celiac Disease diagnosed? The original way that people knew about Celiac Disease was actually during World War 2, where there was a shortage of bread, and so there was a shortage of gluten, and people with symptoms, no longer had symptoms. Once the bread started coming back at the end of World War 2, people started having symptoms again. So it was actually a pediatrician that figured out the relationship between gluten and wheat and the symptoms that people were having. So how is it diagnosed? Well the gold standard is still an upper endoscopy with biopsies and what that entails, is a scope with the camera and a light at the tip of the scope, that we put down through your mouth, through the esophagus, stomach and into the small intestines, where we can take biopsies, or grab small pieces of tissue, and look at it under the microscope to see if you have inflammation, which may suggest that you have Celiac Disease. But there’s, there’s a hard diet to follow, if you actually have Celiac Disease, so we want to make sure that you actually have it. So in conjunction with the upper scope, we can actually do blood tests to see whether you may have it, and now, we also have the luxury of having genetic testing to see the likelihood of you actually being susceptible. Who gets Celiac Disease and who’s at risk for this? We have inflammatory cells that are part of our natural immune system called white blood cells, and on the surface of the white blood cells are proteins and there are two specific proteins that make us susceptible to Celiac Disease and they’re known as either HLA-DQ2 or HLA-DQ8, and if you have some combination of these two genes, then you may be susceptible to Celiac Disease. Although 40% of Americans have this in some capacity and are susceptible or at genetic risk, only a very small percentage of those people actually have Celiac Disease. One of the things that we have now found is, breastfeeding children may actually be protective against them developing Celiac Disease in the future. What should you do if you suspect you have Celiac Disease? The first thing is do not stop eating gluten. If you stopped eating gluten, then the tests that we look for, the blood testing and the upper endoscopy with the biopsies, they may be falsely negative because the inflammation is caused by gluten, when you stop ingesting the gluten the inflammation may go away so we may not be able to tell you, that you actually have Celiac Disease. So the first thing you want to do is, make sure you talk to your primary care physician, if you want to call your gastroenterologist and talk to them as well, that would be great, but one of the first things that you want to do after you see your doctor is to get a simple blood test, and you may need the upper endoscopy for the biopsies as well. Now, if both of those have been done, and both of those are coming back negative, you may want to consider getting genetic testing, because if the genetic tests are negative, there’s essentially a hundred percent likelihood you do not have Celiac Disease. It is still possible that you may have some form of non-celiac gluten sensitivity, but Celiac Disease per se can be ruled out. I hope you found today’s topic on Celiac Disease and non-celiac gluten sensitivity helpful, if you suspect that you have either one of those or you have any of the symptoms that we talked about today, please feel free to call your primary care physician, or if you want to talk to one of our gastroenterologists here at Peak Gastroenterology Associates, we’d be more than happy to help you. I’m Prashant Krishnan with Peak Gastroenterology Associates where everything revolves around you. [Music Playing]

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