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Why Does My Irritable Bowel Flare Up
After Eating Bread?
(Celiac Disease)

By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

This article originally appeared on page 11 in the September 20-21, 2003 issue of
The Mississauga News under the feature: Health & Wellness, Doctor's Corner.
Dr K

There is an entity that is difficult to diagnose but might explain this problem. It is called Celiac Disease. This is a genetically inherited condition that allows gluten to damage the mucosa in the small intestine through an autoimmune mechanism. Gluten is present in grains such as barley, wheat and rye. The small intestine is the major absorptive area in the gut. In addition to nutrients, it absorbs vitamins and minerals such as iron. In time, this may result in iron-deficiency anemia. One in 300 persons may have Celiac Disease, with a high prevalence in persons of Irish descent. When the gut starts to lose absorption ability, you may notice loose stools, bloating and a smelly stool. This in time could lead to weight loss.

The problem is that non-specific abdominal symptoms such as diarrhea, cramps, pain, etc. could be associated with numerous other entities such as Crohn's Disease, Ulcerative Colitis, Irritable Bowel Disease and others. Drinking milk can also cause symptoms in some people leading to a misdiagnosis of lactose deficiency. If you are having symptoms and are preparing to see your doctor, start by compiling a food log. Keep a two-week log of all food substance ingested, time of consumption as well as your symptoms. This forms a database for your physician, which is vital for diagnosis. Allergy testing is of little value in this condition. I usually work up bowel problems by examining this log, along with the patient. This may be followed with some blood and stool tests. The results of these dictate the next step, be it a referral to a gastroenterologist for direct visualization or special bowel x-rays. The most reliable test for Celiac Disease involves obtaining a direct sample from the small intestine for examination under the microscope. There is a new blood test that also helps with the diagnosis. It is called the Serum Immunoglobulin A Antiendomysial Antibody Titre. The best treatment is to avoid all gluten containing foods. Strive for soy, corn, rice and potato products. This is easier said than done, since grain products and by-products are far reaching in the North American food chain. Symptoms disappear in a few weeks in those afflicted who can avoid gluten.

Related resources:

Celiac Disease from MedlinePlus
Celiac Disease Facts from University of Maryland Center for Celiac Research
Coeliac disease, also spelled celiac disease is an autoimmune disorder of the small bowel that occurs in genetically predisposed people of all ages from middle infancy, from Wikipedia, the free encyclopedia.
Celiac Disease from National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health (NIH)
Irritable Bowel / Crohn's Disease - Facts and Fallacies About Digestive Diseases - Celiac Disease from About.com.

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