My primary care doctor has referred me to a gastroenterologist for evaluation for a possible malabsorption problem. My only symptoms are unexplained weight loss of a little over 10% of my body weight over the past 6 months and somewhat frequent bowel movements (not diarrhea, just 'going' 3-4X/day, almost always in the morning). My appetite, diet and activity level remain unchanged and I feel fine. I'm too skinny as it is and very worried about losing any more weight.
For the record, I'm a 43-year-old female in otherwise good health; I do have a family history of pancreatic, prostate and colon cancer.
Has anyone else experienced similar symptoms? If so, what was your diagnosis?
I appreciate any insights. Sounds like Celiac Disease!You have all the symptoms and the family history is very telling. Be sure to ask the GI for the blood test series to test for CD. If it is CD, count your blessings! What other disease can be treated by only the gluten free diet!! No pills, no surgeries, nothing! Just don't eat gluten!! Its amazing!! I had all those symptoms as you and the family history was the same!! I had the consitpation, bloating, (diarrhea or frequent Bm's is another symptom of CD, its different for everyone). dental problems, infertility, stomach pain, bleeding, hair loss, weight loss then gain, acne, sinus problems, ovarian cysts. ALL attributed to Celiac Disease!!
here's more info below from www.csaceliacs.org
Best of luck!
Amy
Chairperson Louisiana North Shore Celiac Sprue Association
What are the symptoms
of Celiac Disease?
The symptoms of celiac disease (CD) vary so widely among patients that there is no such thing as a "typical celiac." The amount of intestinal damage that has occurred and the length of time nutrient absorption has been abnormal seem to be the factors that determine the type and severity of symptoms experienced. It is interesting to note that some people with CD report no symptoms at all.
"Celiac disease is one of the great mimics in gastroenterology in particular and medicine in general. Of 100 patients with CD, just over 10 percent present with classical overt symptoms of malabsorption such as weight loss, diarrhea and nutritional deficiencies. About 10 percent are incorrectly diagnosed for some length of time, in some cases years. Forty percent present in an atypical manner, which leads to lengthy delay in diagnosis. About 33 percent of patients have clinically silent disease and 7 percent have latent CD (no symptoms or small bowel lesion but will develop CD later, or had disease at an early age and resolved)."
C. Robert Dahl, MD, "Celiac Disease: The Great Mimic Presentation," CSA Annual Conference, September 2000,
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A. The Patient's Physical State
What are the symptoms? How long have they been present? How often do they occur?
* Abdominal cramping/bloating
* Feet (Reduced fat padding)
* Abdominal distention
* Flatus (Passing gas)
* Acidosis
* Gluten ataxia
* Appetite (Increased to the point of craving)
* Mouth sores or cracks in the corners
* Back pain (Such as a result of collapsed lumbar vertebrae)
* Muscle cramping (Especially in the hands and legs)
* Constipation
* Night blindness
* Decreased ability to clot blood
* Skin (Very dry)
* Dehydration
* Stools (Loose? Hard? Small? Large? Foul smelling? Floating? Clay, Light tan or Gray-colored? Highly rancid? Frothy?)
* Diarrhea (See Stools below)
* Tongue (Smooth or geographic - looks like different continents)
* Edema
* Tooth enamel defects
* Electrolyte depletion
* Weakness
* Energy loss
* Weight loss
* Fatigue
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B. The Patient's Emotional State
What is the patient's emotional state? Is it consistent throughout the day? When and for how long do the symptoms occur?
* Depression
* Disinterested in normal activities
* Irritable
* Mood changes
* Unable to concentrate
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C. Additional Conditions
What else is involved? Other diseases? Other organs?
* Amenorrhea
* Iron-deficiency anemia
* Bone disease
* Hyperparathyroidism
How is Celiac Disease Diagnosed?
When working with a physician to diagnose and/or confirm celiac disease (CD), three major steps are taken. First, a thorough physical examination is conducted, including a series of blood tests, sometimes referred to as the Celiac Blood Panel. Second, a duodenal biopsy is performed with multiple samples from multiple locations in the small intestine. And third, the gluten-free diet is implemented. When the patient shows a positive response to the diet - symptoms subside and the small intestine returns to its normal, healthy state - the diagnosis of CD is confirmed.
(NOTE: To ensure the most accurate and timely diagnosis, the gluten-free diet should be implemented only after the first two steps have been completed.)
1: Examination
Patient History
When reviewing a patient's medical history and symptoms with a physician, the following areas should be considered in the discussion: (The first three are applicable to adults and children. The last is specific to children.)
* What are the symptoms? How long have they been present? How often do they occur?
* What is the patient's emotional state? Is it consistent throughout the day? When and for how long do the symptoms occur?
* What else is involved? Other diseases? Other organs?
* How is the child developing?
See What are the Symptoms of Celiac Disease? for a thorough list of possible symptoms.
Physical Examination
Depending on the presentation of symptoms, the physician will check for some of the following items:
* emaciation
* pallor (due to anemia)
* hypotension (low blood pressure)
* edema (due to low levels of protein, [albumin] in the blood)
* dermatitis herpetiformis (skin lesions)
* easy bruising (lack of vitamin K)
* bone or skin and mucosa membrane changes due to vitamin deficiencies
* protruding or distended abdomen (intestine dysmotility)
* loss of various sensations in extremities including vibration, position and light touch (vitamin deficiency)
* signs of severe vitamin/mineral deficiencies which may include:
* -diminished deep tendon reflexes
* muscle spasms (magnesium and/or calcium deficiency)
* bone tenderness and bone pain (due to osteomalacia)
Blood Tests
A number of tests, sometimes collectively referred to as the Celiac Blood Panel, will aid the physician in diagnosis. The tests may include, but are not limited to:
*
Serologic Tests
1. EMA (Immunoglobulin A anti-endomysium antibodies)
2. AGA (IgA anti-gliadin antibodies)
3. AGG (IgG anti-gliadin antibodies)
4. tTGA (IgA anti-tissue transglutaminase)
* Tolerance or Measure of Digestion/Absorption Tests
1. Lactose tolerance test.
2. D-Xylose test.
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2: Biopsy
In the event that clinical signs and laboratory tests indicate probable malabsorption, a biopsy of the small intestine [jejunal] is called for. In this test, a small flexible biopsy instrument is passed through a tube, down the throat, through the stomach and into the upper end of the small intestine where patchy, multiple snippets of tissue are gathered. The tube is removed and the tissue samples are examined under a microscope for signs of injury.
CD DiagnosisThe difference between tissue in a normal small intestine and that found in a celiac patient is remarkable. The normal finger-like projections (villi), which increase the absorptive surface area of the small intestine, are partially or totally flattened in a person with celiac disease. Enzymes located on the brush border are also drastically reduced. Lactase, the enzyme responsible for splitting milk sugar (lactose) so it can be absorbed, is an example of one of these brush border enzymes. This decrease in lactase explains why some untreated celiac patients may not be able to tolerate milk products and will have developed lactose intolerance. Elevated numbers of T-cell lymphocytes (white blood cells) are also present. The small bowel biopsy samples of persons with dermatitis herpetiformis often show similar damage.
To view a color-coded illustration of a single villus, visit MEDLINEplus.
NOTE: At this time there is no standardization in either serological testing or intestinal biopsies.
To view a chart showing typical test results for someone with celiac disease
Click Here
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3: Diet
The diagnosis of celiac disease is complete when the health of the patient improves following implementation of the gluten-free (GF) diet. When gluten is removed from the diet, most of the damage that was done to the small intestine (the jejunum) is repaired. It takes only three to six days for the intestinal lining (the mucosa) to show improvement. Within three to six months, most symptoms subside as the mucosa returns to its normal (or nearly normal) state.
For an explanation of the gluten-free diet, see:
* How is Celiac Disease Treated?
* Gluten-Free Diet: Basic Diet Choices
* Gluten-Free Diet: Grains and Flours
If, after six months on the GF diet, symptoms still persist, the following need to be considered:
* Has gluten been removed from every area of your diet and life?
(See How is Celiac Disease Treated? for information on where gluten can "hide" in food and other products.)
* Do unrelated conditions exist that are causing the continued discomfort?
(See How is Celiac Disease Treated? for information on additional conditions that may be present.)
The GF diet is a risk-free diet! Gluten, as a protein, is not essential to the diet and its amino acid components are replaced many times over by other foods. Adopting the GF diet can only result in improved health and well-being.
The medical information on this page was last reviewed/updated on January 1, 2004. Best of luck to you! Amy Report It
Malabsorption refers to a number of disorders in which nutrients from food are not absorbed properly in the small intestine.
Normally, foods are digested and nutrients are absorbed into the bloodstream mainly in the small intestine. Malabsorption may occur if a disorder interferes with the digestion of food or if a disorder interferes directly with the absorption of nutrients.
Digestion can be affected by disorders that prevent adequate mixing of food with digestive enzymes and acid from the stomach. Inadequate mixing may occur in a person who has had part of the stomach surgically removed. In some disorders, the body produces inadequate amounts or types of digestive enzymes, which are necessary for the breakdown of food. For example, a common cause of malabsorption is insufficient production of digestive enzymes by the pancreas, as occurs with some pancreatic diseases, or by the small intestine, as occurs in lactase deficiency. Decreased production of bile, too much acid in the stomach, or too many of the wrong kinds of bacteria growing in the small intestine may also interfere with digestion.
Absorption of nutrients into the bloodstream can be affected by disorders that injure the lining of the small intestine. The normal lining consists of small projections called villi and even smaller projections called microvilli, which create an enormous surface area for absorption. Surgical removal of a large section of the small intestine substantially reduces the surface area for absorption (short bowel syndrome). Infections (bacterial, viral, or parasitic), drugs such as neomycin and alcohol, celiac disease, and Crohn's disease all may injure the intestinal lining. Disorders that affect the remaining layers of the intestinal wall, such as blockage of the lymph vessels by lymphoma (cancer of the lymphatic system) or poor blood supply to the small intestine, also reduce absorption.
Symptoms
Symptoms of malabsorption are caused by the increased passage of unabsorbed nutrients through the digestive tract or by the nutritional deficiencies that result from inadequate absorption.
The inadequate absorption of fats in the digestive tract results in stool that is light-colored, soft, bulky, and unusually foul smelling (such stool is called steatorrhea). The stool may float or stick to the side of the toilet bowl and be difficult to flush away. The inadequate absorption of certain sugars can cause explosive diarrhea, abdominal bloating, and flatulence.
Malabsorption can cause deficiencies of all nutrients or selective deficiencies of proteins, fats, sugars, vitamins, or minerals. People with malabsorption usually lose weight. The symptoms vary depending on the specific deficiencies. For example, a protein deficiency can cause swelling (edema) anywhere throughout the body, dry skin, and hair loss.
hope this would help, take care! |
