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Suggest treatment for celiac disease

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Posted on Wed, 9 Jul 2014
Question: Hi I am 60yrs old and 6 months ago discovered I have Celiac Disease (+ gene markers-HLA-DQ8 and many IEL's on small bowel biopsy's) after 30+ yrs of PUD, duodenal ulcers ,IBS, colitis and ulcerative colitis--causing sigmoid abscess and a sigmoid colectomy 8 months ago, the many ulcers caused stricture of my pyloris which Ive'd had balloon dilated and botoxed at intervals over the last 6 yrs. I'm at the point ,now that my moderately stenosed pyloris is not able to be dialated . I've discussed w a general surgeon--who wants to do a Roux en y procedure---I would prefer not to have a gastric bypass, opting instead for pyelolotomy and vagotomy--my surgean instead, says that the gastrin in the antrum is what caused my ulcer disease and my proposed procedure would not correct that issue. However couldn' t the years of undiagnosed celiac disease and its inflammatory property's been responsible for my ulcer disease. since being gluten free, my colitis is 75% resolved, GERD is non existant. reflux esophagitis is still an ongoing problem, though.
FYI--+ HIDA scan shows Gallbladder EF at 18%. Having a laparoscopic cholecystectomy next week, by same gen. surgeon. Hoping this resolves some of my symptoms. Though still have the issue of the strictured pyeloris, that needs a permanent solution
doctor
Answered by Dr. Ajit Naniksingh Kukreja (1 hour later)
Brief Answer:
Cholecystectomy & Roux en Y Should Help

Detailed Answer:
Hi

Thanks for writing in

Have gone through your endoscopy report and your detailed medical history

It needs a strong lady like you to bear all the pathology mentioned

Here is my impression :

Roux en Y will definitely be a better procedure

Instead of Zofran I would prefer a combination of a Proton Pump Inhibitor and a prokinetic like Pantoprazole and Domperidone twice a day before meals

Though not documented coincidence of celiac disease and associated ulcers is observed in some cases

For reflux my tips are as follows :

1] Avoid spicy, fermented meals
2] Do not have heavy meals
3] Avoid smoking and alcohol
4] Wear loose clothes
5] Do not stoop
6] Do not lift heavy weights
7] Raise the head end of your bed
8] If Obese lose weight
9] If under stress - Manage stress levels by meditation and exercise

Gall bladder disease is known to cause acid peptic symptoms and the removal of the same may resolve your symptoms

Hope this helps
Do write back in case of concern
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Ajit Naniksingh Kukreja (8 hours later)
Thank you so much for your rapid response. I didn't mention that I do take omeprazole (PPI) and on prn basis Pepcid (H2 Blocker). I have lost 75 lbs in the last 8 months, BMI 28, currently. I am concerned about the nutritional malabsorption issues associated with roux en y procedure. Especially since celiac disease (and incidently I have hemochromatosis gene (not activated) and have ferritin levels checked annually) also has nutritional absorbtion issues. Have been chronically anemic most of my life, with Hgb around 10. Although since going Gluten free 8 months ago, my hgb (resulted a week ago) is up to 13.2, the highest its ever been.
However I do trust my Doctors involved, just wanted confirmation that I was doing the right thing for my situation.
Since going gluten free, I've had the best energy of my life--I've become a competitive swimmer, training for the state level XXXXXXX Olympics in Aug 2014 to qualify for nationals in 2015, and training for Triathelon in Sept 2014.
Any additional information/resources that you could refer me to better educate myself on managing my nutritional status, post op roux en y.
Respectfully,XXXX
doctor
Answered by Dr. Ajit Naniksingh Kukreja (2 hours later)
Brief Answer:
Great .... XXXXXXX

Detailed Answer:
Hi XXXXXXX

I am impressed the way you have been fighting the tough times

I have respect for people who do not surrender to health issues

With your type of strong will am sure you will not have the malabsorption issues after the procedure as you are well educated about your disease so would be able to take a balanced supplement

My good wishes for the XXXXXXX olympics, Nationals and Triathelon

Wishing you a very healthy life ahead
You may drop in a line once you are done with the procedures to keep me updated about your health
Regards

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Ajit Naniksingh Kukreja (1 hour later)
Your information and kindness have been very helpful. I would be honored to keep you updated. Will be scheduling Roux en y in the fall. ( will let you know when I qualify for nationals)
Again Thank you kindly
Respectfully,XXXX
doctor
Answered by Dr. Ajit Naniksingh Kukreja (18 minutes later)
Brief Answer:
Three Cheers for the brave lady

Detailed Answer:
Hi

I will for sure remember you in my prayers and pray Almighty to give you enough strength and energy to come out of the issues with a big smile on your face

Do keep me informed

Regards
Above answer was peer-reviewed by : Dr. Prasad
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Answered by
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Dr. Ajit Naniksingh Kukreja

Gastroenterologist, Surgical

Practicing since :1984

Answered : 923 Questions

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Suggest treatment for celiac disease

Brief Answer: Cholecystectomy & Roux en Y Should Help Detailed Answer: Hi Thanks for writing in Have gone through your endoscopy report and your detailed medical history It needs a strong lady like you to bear all the pathology mentioned Here is my impression : Roux en Y will definitely be a better procedure Instead of Zofran I would prefer a combination of a Proton Pump Inhibitor and a prokinetic like Pantoprazole and Domperidone twice a day before meals Though not documented coincidence of celiac disease and associated ulcers is observed in some cases For reflux my tips are as follows : 1] Avoid spicy, fermented meals 2] Do not have heavy meals 3] Avoid smoking and alcohol 4] Wear loose clothes 5] Do not stoop 6] Do not lift heavy weights 7] Raise the head end of your bed 8] If Obese lose weight 9] If under stress - Manage stress levels by meditation and exercise Gall bladder disease is known to cause acid peptic symptoms and the removal of the same may resolve your symptoms Hope this helps Do write back in case of concern