Digestive Trac • January 2016

NON-PROFIT U.S. POSTAGE PAID SIOUX FALLS, SD PERMIT NO. 7010

Avera McKennan 1325 S. Cliff Ave. Sioux Falls, SD 57105

Hours: 8 a.m. - 5 p.m.

605-322-7797 To learn more, visit our website at AveraDigestiveDisease.org

Get your FREE mobile Digestive Trac at Avera.org/TRAC-register!

15-GAST-7060

Integrative Medicine: Easing Symptoms of Celiac Disease Dietitian Support: Key to Successful Treatment Celiac Disease: Importance of an Accurate, Conclusive Diagnosis

INSIDE THIS ISSUE: DIGESTIVE DISEASES • JANUARY 2016

DigestiveTrac

DIETITIAN SUPPORT

Key to Successful Treatment Receiving a diagnosis of celiac disease and recommendation for a gluten-free diet is often overwhelming to patients.

“A first reaction is to head to the grocery store to buy bags of expensive gluten-free products,” said Amanda Curley, MS, RD, LN, Registered Dietitian who specializes in GI care.

Yet once patients understand the shopping lists and menu plans for Amanda Curley, MS, RD, LN, gluten-free eating, it doesn’t take them Registered Dietitian long to adapt; in fact, sometimes entire families go gluten free when only one member has been diagnosed with celiac disease in order to prevent cross-contamination and make meal planning easier.

The current gluten-free fad is actually helpful for celiac disease patients, because more gluten free choices are on the market, and they are also clearly marked.

“Once patients are educated about gluten-free eating, they realize that there are a lot of foods that are naturally gluten free, and perhaps they’ve even unknowingly had gluten-free days in the past,” Curley said.

If patients “cheat” on the gluten-free diet, they either get sick, or they don’t get sick but continue damaging the intestinal tract by eating gluten. “Patients often ask, ‘is it really going to hurt me,’ and my answer in a word is ‘yes.’” So dietitian support is important in helping patients to understand the gluten-free diet, and also why it is important to remain gluten free.

GLUTEN-FREE BASICS: YES: Fresh fruit, fresh or frozen vegetables, potatoes,

fresh meats, eggs, most dairy products, potato chips, corn chips, popcorn, plain nuts and seeds, beans, rice, corn tortillas

NO: Barley, bran, durum, graham flower, rye, semolina

and wheat. Gluten is also often found in beer, luncheon meats, pasta, soup base, supplements, lipstick and candy.

Celiac disease patients and other patients with GI symptoms can benefit from integrative therapies, for example:

INTEGRATIVE MEDICINE Easing Symptoms of Celiac Disease

• Acupuncture can help normalize bowel patterns, decreasing diarrhea, urgency, pain and cramping.

• Nutritional supplements can benefit bowel flora and function.

• Dietary and health coaching helps patients make lifestyle and diet adjustments.

• Mind-body classes and mindfulness practices such as guided imagery help balance the autonomic nervous system function to normalize bowel patterns.

“Integrative therapies can help ease symptoms of celiac disease and other bowel disorders. Integrative therapies can also contribute to a healthy lifestyle, for example, stress reduction and coping with changes that come with managing a serious or chronic condition,” said Dawn Flickema, MD, of Avera Medical Group Integrative Medicine.

Contact Avera DDI through our Navigators: Liz Harden, CNP 605-322-7334 elizabeth.harden@avera.org

April Schnieder, CNP 605-322-1355 april.schnieder@avera.org

SIGNS AND SYMPTOMS

When to Suspect Celiac Disease IN CHILDREN

IN ADULTS:

• Abdominal bloating and pain

• Chronic diarrhea

Only one-third of adults with celiac disease have digestive symptoms.

Other common symptoms:

• Vomiting

• Constipation

• Tingling or numbness in the hands and feet

• Fatigue

• Seizures or migraines

• Pale, foul-smelling, or fatty stool

• Missed menstrual periods

• Weight loss

• Arthritis

• Infertility or recurrent miscarriage

• Fatigue

• Bone loss or osteoporosis

• Canker sores

• Behavioral issues

• Depression or anxiety

• Itchy skin rash

• Failure to thrive

Avera Digestive Disease Multidisciplinary Team The Avera Digestive Disease Institute brings together a multidisciplinary team to address cancer and other conditions of the digestive tract, all working toward the goal of seamless care and the best possible outcomes.

• Unexplained iron-deficiency anemia

• Bone or joint pain

Gastroenterology PEDIATRICS

Avera gastroenterologists ensure that each patient affected by digestive disease is treated with the fullest extent of expertise and the latest medical technology.

A pediatric gastroenterologist provides specialty expertise for patients under age 18 impacted by celiac disease and other digestive conditions of childhood.

ENDOSCOPY Avera has a full range of endoscopy services, for the purposes of diagnosis, biopsy, removal of polyps or lesions, and specialized procedures. Biopsy via EGD (esophagogastroduodenoscopy) is the gold standard for conclusive diagnosis

NUTRITION

Be A Survivor Learn more about successfully dealing with a colorectal cancer diagnosis.

BeASurvivorAveraColon.com

A specialized dietitian works with Avera Digestive Disease patients to develop nutrition and diet recommendations that are specific for each individual patient, based on diagnosis and severity of disease.

of celiac disease.

CELIAC DISEASE Importance of an Accurate, Conclusive Diagnosis

It’s important that patients and physicians do not skip ahead to treating possible celiac disease or gluten sensitivity with a gluten-free diet without knowing for certain if celiac disease exists or if another serious condition is causing the common symptoms of stomach upset, bloating or diarrhea.

Patients with celiac disease or gluten sensitivity often feel better soon after going gluten free. Yet it can take a year and a half to three years for the small intestine to return to normal.

Celiac patients can be at higher risk for anemia, vitamin deficiencies, miscarriage and infertility, liver and pancreatic conditions, and rarely, cancer of the intestine or small bowel lymphoma. Their cases need to be followed, even if symptoms are no longer troublesome.

Celiac disease affects an estimated one in 100 individuals, and can present in childhood through adulthood. The immune system forms antibodies to gluten which then attack the intestinal lining. Resulting inflammation and damaged villi ultimately cause malnutrition because the intestine cannot absorb nutrients properly.

Symptoms might bring a patient in for evaluation, or, the condition might be found incidentally during EGD (esophagogastroduodenoscopy), or upper endoscopy.

605-322-7797

“

Patients with celiac disease are best served by a firm and accurate diagnosis, and then being connected to a knowledgeable dietitian.

“

While the gluten-free diet has gained fad popularity, it is the treatment and ultimately, the cure for celiac disease, an autoimmune disorder that results in damage to the small intestine when gluten is ingested.

- Cristina Hill Jensen, MD, board-certified Gastroenterologist

The tissue transglutaminase antibodies (tTG-IgA) blood test is approximately 97 percent accurate, but also can result in a false negative, especially if patients have switched to a gluten-free diet on their own.

Standard diagnosis for 100 percent certainty is biopsy of the small intestine through EGD while the individual is ingesting gluten. The biopsy looks for features consistent with the disease, including blunting or flattening of the intestinal villi, and increased intraepithelial lymphocytes.

Biopsy confirms the presence of celiac disease as well as the extent and stage of the disease through Marsh scoring.

First-degree relatives of patients with celiac disease should undergo blood testing, and a gastroenterologist should further evaluate family members with a positive blood test result.

“The results of a gluten-free diet are fantastic; no medications are needed. Yet accurate diagnosis is important,” said Cristina Hill Jensen, MD, board-certified Gastroenterologist. Not only is the gluten-free diet an expensive and radical change in lifestyle, accurate diagnosis is necessary to rule out other possible causes of symptoms, determine the extent of damage, and stay aware of other possible complications.

To learn more, visit our website at AveraDigestiveDisease.org