3.2.1 Nutrition and Common GI Disorders

Question 1

What further evaluation should the patient undergo to arrive at the diagnosis?

Answer 1

Endoscopy evaluating GI integrity

Question 2

Describe the venn diagram that compares IBS, celiac, and gluten sensitivity

Answer 2

Question 3

Based upon report of GI symptoms, how should the patient be evaluated and what is the likely diagnosis?

Answer 3

Rome III criteria (for IBS diagnosis) - any other potential evaluations????

Question 4

What dietary interventions are available to celiac patients?

Answer 4

Question 5

What are some of the non-GI symptoms of celiac?

Answer 5

iron deficiency anemia, folate (B12) deficiency, short stature, delayed puberty, recurrent feral loss, low birth weight infants, reduced fertility, persistant aphthous stomatitis, dental enamel hypoplasia, idiopathic peripheral neuropathy, nonhereditary cerebellar ataxia, recurrent migrane headaches

Question 6

Patient; “I’ve been having some tummy pain for 3 months now. I just noticed it one day, and it’s been there ever since. It’s all over the tummy, like a sort of cramping feeling, a bit like a period pain, I supposed, but I’m getting it throughout the month. It comes on most days; there doesn’t really seem to be a pattern to it. It’s usually sore for a few hours, once it’s come on. Some days it seems a bit worse than others, but as I said, there is no pattern to it.”

What are some possible, suspected diagnoses?

Answer 6

IBS-D, Celiac Dz

Question 7

What are the lecturer’s recommendations?

Answer 7

Physicians work with dieticians

Address patient misunderstanding

Restuarants that label gluten-free items aren’t as harshly regulated

Question 8

What are some of the gluten containing grains?

Answer 8

Wheat, Rye, Triticale (wheat-rye cross), Barley, Questionable Oat

Question 9

What are three tests that can help in the diagnosis of celiac?

Answer 9

Serologic evaluation (IgA - gliadin specific, anti-tissue transglutaminase tTG)

HLA DQ2/8

Histologic evaluation

Question 10

What are some of the gluten-free substitutes?

Answer 10

Corn, rice, amaranth, buck wheat, millet, montina, quinoa, sorghum, teff

Question 11

What must be remembered about the grains that can’t be consumed?

Answer 11

NO WHEAT, NO RYE, NO BARLEY!

Question 12

For Case #2

(possible IBS-D, celiac dz)

Answer 12

Have any change in stress level over the past 3 months?

What forms are your BMs, typically? Loose, formed, hard, small? Blood in stool?

Do you notice bloating?

Family history of IBS/CD/IBD?

Question 13

What is important in the treatment of celiac?

Answer 13

Gluten free (gliadin free diet mandatory)

Question 14

What three things must happen for someone to develop celiac dz?

Answer 14

1. Inherit the gene
2. Consume gluten
3. Have gene triggered

Question 15

What is questionably gluten free?

Answer 15

Oats

Question 16

Since the severity of the gluten sensitivity can be variable, celiac is described as?

Answer 16

A continuum (celiac dz to gluten-sensitive enteropathy)

Question 17

What are the two main associated conditions with celiac?

Answer 17

T1DM - 2-19%

Down Syndrome - 16%

Question 18

Where might gluten lurk within a patient’s diet?

Answer 18

Question 19

What are some of the nutritional impacts of gluten free diets?

Answer 19

Many people gain weight

Fewer servings of grains; nearly all refined

Anemia

Low in Fiber

Question 20

If testing indicates CD, how should her case be managed?

Answer 20

Primary Dietary/ Nutrition Intervention and Management

Question 21

How should said patient with suspected celiac be evaluated?

Answer 21

Question 22

What is the cue-diagnosis matrix for adominal pain scenario?

Answer 22

Question 23

What are the consequences of consuming gliadin for a patient with celiac?

Answer 23

villous atrophy, decreased surface area for nutrient absorption, chronic inflammation down-regulates transport proteins in the epithelium, atrophy leads to decreased CCK and secretin leading to pancreatic insufficiency, bacterial overgrowth

Question 24

Describe the layers of the celiac iceberg model

Answer 24

Top: typical celiac

Second: atypical celiac

Third: people who could potentially develop celiac

Bottom: Healthy individuals

Question 25

What are some of the health risks associated with celiac?

Answer 25

Dyspepsia, dirrhea, gut pain

Weight loss, weakness

Iron deficiency anemia

Metabolic bone loss

Inflammed mucosa

Question 26

What might the patient have?

Answer 26

Celiac Dz

Question 27

An adverse response to gluten storage proteins (prolamines) that triggers an immune response resulting in damage to the mucosa of the small intestine

Answer 27

Celiac Dz

Question 28

What are the celiac trifecta factors?

Answer 28

Gluten

Genetics (HLA-DQ2, HLA-DQ8)

Intestinal Permeability

Question 29

If one restricts their diet to strictly gluten free, what might they be at risk of inadequately consuming?

Answer 29

B-vitamins, iron, and fiber

Question 30

What testing is required for CD diagnosis?

Answer 30

Question 32

What is the potential diagnosis for the patient based on the EGD findings?

Answer 32

Celiac

Question 33

What are some of the gluten-free substitutes that substitute well?

Answer 33

Flax, hemp, poppy seed and sesame, nuts, salba, soy, legumes, tapioca, arrowroot, nuts

Question 34

What might cause the insufficient intake of vitamins when switching to a gluten free diet?

Answer 34

Not fortified

Question 35

What within gluten is targeted in the immune response?

Answer 35

gliadin

Question 36

What is the worldwide incidence of celiac?

Answer 36

1 in 100

Question 37

Inflammation of the mucosa causes what within the small intestine?

Answer 37

Destruction of villi in the intestine (leading to partial or complete flattening)