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Post by kickingfrog on Feb 2, 2011 11:48:14 GMT
Case Report: Six-Year-old Girl With Recurrent Episodes of Blue ToesRachel Kearby Suzanne Bowyer Julie Scharrer Anjali Sharathkumar, MD,MSasharathkumar@ihtc.org Abstract Pernio or chilblains is a rare condition, characterized by erythematous or violaceous painful or pruritic lesions typically distributed on parts of the body exposed to cold or humid environments. The exact etiology of pernio is uncertain; however, abnormal nerve control of blood vessel diameter and nerve sensitivity to cold exposure are suspected contributing factors, and therefore, vasodilators have been effective in treatment of pernio. Pernio is associated with variety of systemic conditions such as cryoglobulinemia and celiac disease which may require additional medical intervention. In this report we summarize the clinical course and management of a 6½-year-old girl who presented with bluish digits since the age of 2 years and recent history of joint pains. Her skin biopsy revealed the diagnosis of pernio. Work up for systemic diseases confirmed the diagnosis of celiac disease. She was successfully treated with Nifedipine and a gluten free diet. This case underscores the importance of considering pernio and associated conditions in the differential diagnosis of a child presenting with persistent or recurrent bluish discoloration of digits. cpj.sagepub.com/content/early/2010/01/28/0009922809355314.abstract***************** A 70-year-old man with chronic diarrhea and weight lossCase Report - A 70-year-old man with chronic diarrhea and weight loss Jack Alexander, MD Albany Medical Review - August 2001 A 70-year-old gentleman chronic lymphocytic leukemia presented with a four-day history of weakness and profuse, watery diarrhea .....His past medical history was significant for the aforementioned CLL, diagnosed in 1993. His disease had been well controlled until 1997 when new lymphadenopathy and increasing lymphocyte counts prompted treatment with two courses of fludaribine, after which the patient developed esophageal dysmotility. More recently, the disease was again found to be progressing and treatment with cytoxan and prednisone was instituted. The patient also has a history of hypertension, osteoarthritis, hypercholesterolemia, spinal stenosis and he is known to have had a goiter The patient has had a laminectomy in 1990, a supraclavicular lymph node biopsy in 9/00 (consistent with CLL), port-a-cath placement in fall of 2000 and past bilateral cataract surgeries. ....On hospital day nine the duodenal biopsy results returned consistent with celiac sprue. The patient was immediately placed on a gluten free diet.... . ...The patient continued on TPN in the MICU and was also started on Neupogen for a low WBC count presumably secondary to the cytoxan treatment. He was given nothing by mouth and by Day 13 stool output had begun to decrease. The bacteremia was found to be S. pneumoniae that was sensitive to vancomycin but intermediately resistant to ceftriaxone. The patient's diarrhea continued to improve over the next two days. His TPN was discontinued on day 15 and he was placed back on a gluten free diet. The vancomycin was discontinued and the patient remained on ceftriaxone. He had been afebrile since day 2 of antibiotics. At this time he was place on fluconazole for esophageal candidiasis with odynophagia. He continued to improve and was transferred back to the floor on day 17 and discharged home on day 21 with no diarrhea, a good appetite and increased energy and strength subjectively. He was to continue with a gluten free diet at home. www.amc.edu/amr/archives/200108/case02.html ************** Coeliac disease and malignancy of the duodenum: diagnosis by endoscopy, successful treatment of the malignancy, and response to a gluten free diet MJ Hall, BT Cooper, N Rooney, H Thompson and AE Read University Department of Medicine, Bristol Royal Infirmary. A patient presented with subtotal villous atrophy and a malignant duodenal tumour of uncertain histogenesis. He was successfully treated by resection and chemotherapy and the small bowel mucosa recovered on a gluten free diet. The tumour was diagnosed at upper gastrointestinal endoscopy when barium studies and abdominal computed tomography were normal, thus making this one of the earliest coeliac malignancies diagnosed. Gut, Vol 32, 90-92, Copyright © 1991 by BMJ Publishing Group *********************************
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Post by kickingfrog on Feb 2, 2011 11:50:22 GMT
He declined amputationA man aged 79, known to have peripheral vascular disease, had extensive ulcers on his legs, which failed to heal despite regular nursing care. He declined amputation. He had a gastroscopy as part of the investigation of his anaemia, and the result of a duodenal biopsy was consistent with a diagnosis of coeliac disease. He was put on a gluten free diet, and within a year the ulceration had mostly healed.--K BODGER, research registrar, St James's University Hospital, Leeds, J P MILNES, consultant physician, Airedale General Hospital, Keighley www.bmj.com/content/312/7040/1238.full?maxtoshow=&HITS=25&hits=25&********************************
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Post by kickingfrog on Feb 3, 2011 8:33:46 GMT
A case of cough, lymphocytic bronchoalveolitis and coeliac disease with improvement following a gluten free diet C E Brightling1, F A Symon1, S S Birring1, A J Wardlaw1, R Robinson2 and I D Pavord1 1 Institute for Lung Health, Department of Respiratory Medicine and Thoracic Surgery, University Hospitals of Leicester, Leicester LE3 9QP, UK 2 Department of Integrated Medicine, University Hospitals of Leicester Correspondence to: Dr C E Brightling, University Hospitals of Leicester, Groby Road, Leicester LE3 9QP, UK; "mailto:chris.brightling@uhl-tr.nhs.uk" ABSTRACT Chronic cough is a common reason for presentation to a respiratory clinic. In up to 20% of cases the cause remains unclear after investigations. We report one such case where there was bronchoscopic evidence of lymphocytic airway inflammation in association with newly diagnosed coeliac disease. All features improved markedly on a gluten free diet, suggesting a causal relationship between coeliac disease, cough, and lymphocytic bronchoalveolitis thorax.bmj.com/content/57/1/91.abstract
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Post by kickingfrog on Feb 3, 2011 14:31:27 GMT
Antibody negative coeliac disease presenting in elderly people—an easily missed diagnosis David S Sanders et al ...In May 2003 a 79 year old man with longstanding dyspepsia presented to his general practitioner with worsening indigestion, tiredness, and rapid weight loss. Blood tests arranged by the doctor showed a macrocytic anaemia with low concentrations of vitamin B-12 and folate. The patient subsequently had a negative result on endomysial antibody testing. A gastroscopy in June 2003 did not show any macroscopic abnormalities, and routine quadrantic duodenal biopsies were histologically normal. Over the following three months the patient's condition deteriorated. He developed anorexia, with a documented weight loss of 15 kg. For the first time, the patient started to complain of lower gastrointestinal symptoms. Although he did not have an increased frequency in defecation, he noted that the stool had become foul smelling, and he described abdominal bloating and increased flatus. When the patient was seen in a gastroenterology clinic his immunoglobulin concentrations, IgG and IgA gliadin antibodies, endomysial antibodies, and tissue transglutaminase activity were checked. In addition, an urgent colonoscopy yielded a macroscopically normal result. Routine terminal ileal and colonic biopsies were all normal. His blood tests were reviewed: results for endomysial antibodies and IgA gliadin were now positive; IgG gliadin was negative; and transglutaminase activity was 237 (normal range 0-10 units per millilitre). Repeat gastroscopy showed macroscopic features consistent with coeliac disease ...and duodenal biopsies showed total villous atrophy. The patient was breathless, had a haemoglobin concentration of 82 g/l, had developed ankle oedema, and had an albumin concentration of 30 (normal range 35-48) g/l. In view of this, in February 2004 he was started on both a gluten-free diet and 30 mg of prednisolone daily. He was also transfused with 2 units of packed cells. Video capsule endoscopy showed virtual pan-atrophy of the small bowel but no evidence of lymphoma.... ..........Our case is highly unusual because the patient initially had both a negative antibody profile and a normal duodenal biopsy. Perhaps at the earliest stage of presentation the patient had not developed all the immunological features of coeliac disease; this would be supported by the fact that macroscopic abnormalities were only noted at the time of the second endoscopy and video capsule endoscopy. If we had not reconsidered the possibility of coeliac disease (and repeat testing) then we would not have been able to diagnose the condition or treat it appropriately. Coeliac crisis is a rare condition, usually described as presenting with marked malabsorption and a good response to a gluten-free diet and steroids........With the arrival of serology testing for coeliac disease, fewer cases have been described in the literature. Doctors in both primary and secondary care should always consider the possibility of coeliac disease even in elderly people. Negative serology should not necessarily reassure the clinician. In the presence of a clinically deteriorating patient a duodenal biopsy should be performed.....Elderly patients following a gluten-free diet will see improvements in their symptoms and be committed to the diet despite their age. www.bmj.com/content/330/7494/775.full********************** Gut 1994;35:65-67 doi:10.1136/gut.35.1.65 ... Coeliac disease in the elderly. G L Hankey, G K Holmes ... Department of Gastroenterology, Derbyshire Royal Infirmary, Derby. Abstract Of 228 patients with adult coeliac disease, 42 (19%) were diagnosed aged 60 years or over. In this series, of 35 patients who did not have dermatitis herpetiformis, 15 had attended family doctors and hospital outpatient departments for an average of 28 years with unexplained symptoms or abnormalities in blood tests but the diagnosis of coeliac disease had been missed. This is unsatisfactory because these patients can both manage and respond to a gluten free diet. Thirty eight patients complied strictly with the diet with resolution of symptoms. Significant improvement in weight, haemoglobin, albumin, calcium, and alkaline phosphatase values after a year on the diet also occurred. Clinicians should be alert to the possibility of coeliac disease in the elderly particularly in patients with non-specific complaints in the presence of unexplained anaemia. gut.bmj.com/content/35/1/65 ************************************** ..October 2006 Cognitive Impairment and Celiac Disease William T. Hu, MD, PhD; Joseph A. Murray, MD; Melanie C. Greenaway, PhD; Joseph E. Parisi, MD; Keith A. Josephs, MST, MD Arch Neurol. 2006;63(10):1440-1446. doi:10.1001/archneur.63.10.1440. Text Size: A A A ... Patients Patients with the onset of progressive cognitive decline within 2 years of symptomatic onset or with a severe exacerbation of biopsy-proved adult celiac disease were identified from the Mayo Clinic medical records from January 1, 1970, to December 31, 2005. Patients were excluded if an alternate cause of their cognitive impairment was identified. Results Thirteen patients (5 women) were identified. The median age at cognitive impairment onset was 64 years (range, 45-79 years), which coincided with symptom onset or exacerbation of diarrhea, steatorrhea, and abdominal cramping in 5 patients. Amnesia, acalculia, confusion, and personality changes were the most common presenting features. The average initial Short Test of Mental Status score was 28 of a total of 38 (range, 18-34), which was in the moderately impaired range. The results of neuropsychological testing suggested a trend of a frontosubcortical pattern of impairment. Ten patients had ataxia, and 4 of them also had peripheral neuropathy. Magnetic resonance imaging of the head showed nonspecific T2 hyperintensities, and electroencephalography showed nonspecific diffuse slowing. Deficiencies in folate, vitamin B12, vitamin E, or a combination were identified in 4 patients, yet supplementation did not improve their neurological symptoms. Three patients improved or stabilized cognitively with gluten withdrawal. A detailed histological analysis revealed nonspecific gliosis. Conclusions A possible association exists between progressive cognitive impairment and celiac disease, given the temporal relationship and the relatively high frequency of ataxia and peripheral neuropathy, more commonly associated with celiac disease. Given the impact for potential treatment of similar cases, recognition of this possible association and additional studies are warranted. *****************
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Post by kickingfrog on Feb 3, 2011 15:57:56 GMT
Very late mucosal relapse in a girl with coeliac disease. Hogberg L, Stenhammar L, Wagermark J. Department of Paediatrics, Norrkoping Hospital, Sweden. Small bowel biopsy in a 4-year-old girl with symptoms suggestive of coeliac disease revealed subtotal villous atrophy. The mucosa healed on a gluten-free diet. From the age of 7 years, the girl was challenged with gluten. Annual biopsies showed normal or nearly normal mucosa specimens. At 21 years of age, after 14 years of gluten challenge, a mucosal relapse was found and a gluten-free diet was reinstituted. A biopsy one year later showed a normal mucosa. From this case report it is apparent that a patient with a past history of subtotal villous atrophy, which after a preceding period of gluten-free diet does not recur within two years of gluten challenge, must be followed carefully, so as not to miss a late relapse. Publication Types: · Case Reports PMID: 8241655 [PubMed - indexed for MEDLINE] www.ncbi.nlm.nih.gov/entrez/quer ... ds=8241655 *********************** Multiple immune disorders in unrecognized celiac disease: a case report. La Villa G, Pantaleo P, Tarquini R, Cirami L, Perfetto F, Mancuso F, Laffi G. Dipartimento di Medicina Interna, Universita degli Studi di Firenze, Firenze, Italy. We reported a female patient with unrecognized celiac disease and multiple extra intestinal manifestations, mainly related to a deranged immune function, including macroamilasemia, macrolipasemia, IgA nephropathy, thyroiditis, and anti-b2-glicoprotein-1 antibodies, that disappeared or improved after the implementation of a gluten-free diet. Publication Types: · Case Reports PMID: 12800261 [PubMed - indexed for MEDLINE] ************ Acta Paediatr Scand.1986 Mar;75(2):340-2. Late mucosal relapse in a boy with coeliac disease and cow's milk allergy. Kuitunen et al A case of coeliac disease where exceptionally long gluten challenge was needed to produce mucosal relapse is presented. An initial diagnosis of intestinal cow's milk allergy with total villous atrophy was made at the age of 3.5 months. The lesion healed after the child was put on a diet free of cow's milk and gluten. After 4.3 years on a normal diet his jejunal structure was still normal but at the age of 10.9 years, after 8.7 years of gluten ingestion, total villous atrophy was again observed. On a gluten-free diet the small intestinal structure is completely normal at the age of 17.1 years. www.ncbi.nlm.nih.gov/pubmed/3962667?dopt=Abstract***********
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Post by kickingfrog on Feb 3, 2011 19:26:27 GMT
Treatment failure in celiac disease due to coexistent exocrine pancreatic insufficiency.
Weizman Z, Hamilton JR, Kopelman HR, Cleghorn G, Durie PR.
Department of Pediatrics, University of Toronto, Canada.
A 17-year-old white adolescent had a history of chronic diarrhea, delayed puberty, and growth failure. Investigations excluded cystic fibrosis, Shwachman syndrome, and endocrine causes of growth failure. Severe steatorrhea was diagnosed from fecal fat studies, and a jejunal suction biopsy showed total villus atrophy, consistent with a diagnosis of celiac disease. Following introduction of a gluten-free diet, his appetite and growth improved, but he continued to have abdominal discomfort and loose offensive bowel motions. One year later, severe steatorrhea was present. A repeat jejunal biopsy showed partial recovery of villus architecture. Serum immuno-reactive trypsinogen level was low, which was highly suggestive of exocrine pancreatic failure. Results of quantitative pancreatic stimulation test confirmed the presence of primary pancreatic insufficiency. After introduction of oral pancreatic enzyme supplements with meals, his gastrointestinal symptoms resolved and growth velocity accelerated. Previously, primary pancreatic insufficiency has only been described in elderly patients with long-standing untreated celiac disease. This case, however, emphasizes that pancreatic failure can occur with celiac disease at any age. Determination of a serum immunoreactive trypsinogen level should be considered a useful screening tool for pancreatic insufficiency in patients with celiac disease who have not responded to a gluten-free diet.
Publication Types: · Case Reports
PMID: 3684405 [PubMed - indexed for MEDLINE]
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Post by kickingfrog on Feb 4, 2011 9:39:49 GMT
*1: Helv Paediatr Acta. 1987 Jun;42(1):45-8. Obesity in a child with untreated coeliac disease. Conti Nibali S, Magazzu G, De Luca F. Istituto di Clinica Pediatrica, University Hospital, Messina, Italy. This is the first report of obesity in an untreated coeliac patient diagnosed at the age of 5.1 years according to the criteria of the European Society for Paediatric Gastroenterology. Diagnosis of coeliac disease was suspected on the basis of recurrent episodes of abdominal pain and of family history. Gluten-free diet induced evident acceleration of both length and weight velocity and increase of weight excess, apart from resolution of the abdominal symptoms. The present case report demonstrates that obesity in a child does not exclude the diagnosis of coeliac disease. Publication Types: · Case Reports PMID: 3667333 [PubMed - indexed for MEDLINE] www.ncbi.nlm.nih.gov/pubmed/3667333?dopt=Abstract
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Post by kickingfrog on Feb 4, 2011 10:11:02 GMT
Coeliac crisis in adults: report of two cases.
European Journal of Emergency Medicine. 11(6):363-365, December 2004.
Ozaslan, Ersan; Koseoglu, Tankut; Kayhan, Burcak
Abstract: Adult coeliac disease, in contrast to its childhood counterpart, almost always has an indolent course with a wider spectrum of clinical manifestations. Approximately half of the patients have no overt gastrointestinal symptoms and many are asymptomatic. A rare and life-threatening complication, affecting mainly children younger than 2 years of age, is the so-called coeliac crisis, a term that applies to profuse diarrhoea leading to dehydration, hypokalemia, and acidosis. We report here two cases of adult coeliac disease that presented as coeliac crisis. Coeliac disease should be a differential diagnosis in adult patients with severe acute diarrhoea and acidosis, although a rare presentation.
(C) 2004 Lippincott Williams & Wilkins, Inc.
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Post by kickingfrog on Feb 4, 2011 13:17:24 GMT
Ichthyosis revealing coeliac disease.Menni S, Boccardi D, Brusasco A. IV Department of Dermatology, Pediatric Dermatology, University of Milan, Ospedale S. Paolo, Via A. di Rudini 8, 20142 Milano, Italy. We describe the case of a twenty-nine year-old woman presenting a lamellar desquamation on the abdomen, submammary folds and on the limbs. During recent years the patient suffered neither from bowel disorders, nor from dryness of the skin. Laboratory tests revealed high values of parathormone and a high level of antiendomysial antibodies. The total bone-mineral density was about 78% of normal levels. A duodenal mucous membrane specimen showed total atrophy of the villi. Skin biopsy revealed an acquired ichthyosis mimicking an ichthyosis vulgaris. The patient underwent a gluten-free diet, supported by folic acid and vitamin D and six months later, after the regression of secondary hyperparathyroidism, a remarkable improvement of the cutaneous symptoms was obtained. Publication Types: · Case Reports PMID: 10882952 [PubMed - indexed for MEDLINE] www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10882952&dopt=Abstract****************
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Post by kickingfrog on Feb 4, 2011 13:49:05 GMT
Living Well: Celiac disease needs to be taken seriously Posted by Jackie Mum of twins on 25/7/2004 GF board Quote: When Eric Oemig's father died in late 2000, at age 67, doctors hadn't figured out the type of cancer that killed him, despite locating a "large mass of tumors" in his abdomen. What the physicians discovered after the older Oemig's death is he suffered from celiac disease...... www.seattlepi.com/health/182472_condor19.html
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Post by kickingfrog on Feb 4, 2011 15:19:51 GMT
A case of cough, lymphocytic bronchoalveolitis and coeliac disease with improvement following a gluten free diet
C E Brightling1, F A Symon1, S S Birring1, A J Wardlaw1, R Robinson2 and I D Pavord1 1 Institute for Lung Health, Department of Respiratory Medicine and Thoracic Surgery, University Hospitals of Leicester, Leicester LE3 9QP, UK 2 Department of Integrated Medicine, University Hospitals of Leicester Correspondence to: Dr C E Brightling, University Hospitals of Leicester, Groby Road, Leicester LE3 9QP, UK; "mailto:chris.brightling@uhl-tr.nhs.uk"
ABSTRACT Chronic cough is a common reason for presentation to a respiratory clinic. In up to 20% of cases the cause remains unclear after investigations. We report one such case where there was bronchoscopic evidence of lymphocytic airway inflammation in association with newly diagnosed coeliac disease. All features improved markedly on a gluten free diet, suggesting a causal relationship between coeliac disease, cough, and lymphocytic bronchoalveolitis.
From BMJ
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Post by kickingfrog on Feb 6, 2011 9:26:33 GMT
Endocr Pract. 2007 Jul-Aug;13(4):403-7 Hypocalcemia after alendronate therapy in a patient with celiac disease. Meek SE, Nix K. Division of Endocrinology, Mayo Clinic College of Medicine, Jacksonville, Florida 32224-1865, USA. OBJECTIVE: To describe a patient with osteoporosis who was treated with alendronate and developed hypocalcemia, which ultimately led to the diagnosis of celiac sprue. METHODS: We present the clinical and laboratory findings in a patient with osteoporosis, in whom hypocalcemia developed after treatment with alendronate. This patient was subsequently diagnosed with celiac sprue. The pertinent literature regarding orally administered bisphosphonate-induced hypocalcemia is reviewed. RESULTS: A 79-year-old man who was diagnosed with osteoporosis was treated with alendronate. He was subsequently found to have asymptomatic hypocalcemia (serum calcium concentration, 8.3 mg/dL), which resolved after alendronate therapy was discontinued. He was then treated with calcium, vitamin D, and calcitonin nasal spray, which did not cause hypocalcemia. Because of his reduced bone density, however, he was subsequently referred for endocrine consultation. Evaluation at that time showed normal levels of serum calcium, phosphorus, creatinine, alkaline phosphatase, 25-hydroxyvitamin D, thyrotropin, and parathyroid hormone as well as 24-hour urine calcium excretion. An endomysial antibody titer was dramatically elevated. Upper endoscopy showed villous atrophy, and small bowel biopsy confirmed the presence of villous blunting and chronic inflammation, consistent with celiac sprue. He was treated with a gluten-free diet and then subsequently treated with orally administered risedronate, which he tolerated well without evidence of hypocalcemia. CONCLUSION: To the best of our knowledge, this is the first report of orally administered bisphosphonate-induced hypocalcemia, which subsequently led to the diagnosis of previously unrecognized, otherwise asymptomatic celiac sprue. Patients with unexplained hypocalcemia should be screened for celiac sprue, even in the absence of gastrointestinal symptoms. www.ncbi.nlm.nih.gov/pubmed/17669718 ******************
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Post by kickingfrog on Feb 6, 2011 9:32:30 GMT
Celiac disease (CD), ulcerative colitis (UC), and primary sclerosing cholangitis (PSC) in one patient: a family study.
[Article in English, Spanish]
Cadahía V, Rodrigo L, Fuentes D, Riestra S, de Francisco R, Fernández M. Service of Digestive Diseases, Hospital Universitario Central de Asturias, Oviedo, Spain. vallecadahia@terra.es
We discuss the case of a 17-year-old male who at the age of 7 was diagnosed with celiac disease (CD) together with ulcerative colitis (UC) and primary sclerosing cholangitis (PSC). The patient was treated with gluten-free diet and immunosuppressive drugs (azathioprine), and currently remains asymptomatic. The patient's younger, 12-year-old sister was diagnosed with CD when she was 1.5 years old, and at 7 years she developed type-I diabetes mellitus, which was difficult to control.
A family study was made, and both parents were found to be affected with silent CD. All were DQ2 (+).
In relation to the case and family study, we provide a series of comments related to CD and its complications.
PMID: 16454610 [PubMed - indexed for MEDLINE]
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Post by kickingfrog on Feb 6, 2011 9:38:58 GMT
From Frank
Gluten Free and Multiple Sclerosis
MULTIPLE SCLEROSIS -- ENCOURAGING PROGRESS
... A man from Cornwall, Great Britain, who has been confined to a wheelchair with multiple sclerosis for the past four years, claims a gluten- (flour) and fat-free diet he has developed is helping him defeat the disease and walk again.
Jess Thomas, 52, a former fisherman and farmer who now lives in Hayle, was diagnosed as suffering from MS in 1992 and slid, he says, into almost immediate decline.
"My back collapsed, I could feel nothing in my legs and feet and my hands clutched themselves into useless claws," he said. "I was wheelchair-bound within six months. I thought 'this is it, this is the end,' and wondered where I would end up and who would care for me."
Now, four years later, he claims not to be in a period of remission, a common trait of this unpredictable disease, but to be well on the way to a total cure. "My hands have uncurled, I have feeling back in my legs and body and I can stand and take four steps before I have to sit again," he said. "I have strength back in my arms and can lift my own wheelchair to chest height. I am con vinced that within months I will be able to walk again."
Other MS sufferers, he says, who have written to him for details of the fat- and gluten-free diet he has developed, have witnessed equally dramatic improvements. The MS Society should follow up on these cases, but has not, as far as I know.
Doctors, however, remain skeptical, as they should. A spokesman for the MS Society, which has 85,000 members, said: "We encourage anyone to try anything which relieves the symptoms or makes them feel better, but there is no scientific evidence to support Mr. Thomas's claims that a gluten- and fat-free diet can effect any kind of improvement, let alone a total cure."
Thomas's GP, he says, refers to him as "the silly man who takes no drugs." But, he says, he does not care. "I am the one stuck with this disease, and doctors although I don't want to criticize them - do not currently have any long- term solutions."
It's hard to argue with that.
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Post by kickingfrog on Feb 8, 2011 14:37:00 GMT
Digestion. 2003 [Epub ahead of print]. Epub 2003 Aug 29. Related Articles, Links Rapid Regression of Psoriasis in a Coeliac Patient after Gluten-Free Diet. A Case Report and Review of the Literature. Addolorato G, Parente A, De Lorenzi G, D'angelo Di Paola ME, Abenavoli L, Leggio L, Capristo E, De Simone C, Rotoli M, Rapaccini GL, Gasbarrini G. Institute of Internal Medicine, Universita Cattolica del Sacro Cuore, Rome, Italy. BACKGROUND: Several skin disorders are present in patients affected by coeliac disease (CD) - among them, psoriasis has been described. However, at present the relationship between CD and psoriasis remains controversial since there are few and contrasting data on this topic. METHOD: Here we describe a case of psoriasis in a CD patient not responding to specific therapies for psoriasis. RESULT: The regression of skin lesions after gluten-free diet (GFD) was evident in a short time. CONCLUSION: The present case supports the association between CD and psoriasis and the concept that psoriasis in CD patients can be improved by GFD. Future studies are needed to clarify the possible mechanisms involved in this association. Copyright 2003 S. Karger AG, Basel www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12949434&dopt=Abstract**************
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Post by kickingfrog on Feb 8, 2011 14:59:44 GMT
Reversible hypertension following coeliac disease treatment: the role of moderate hyperhomocysteinaemia and vascular endothelial dysfunction. Lim PO, Tzemos N, Farquharson CA, Anderson JE, Deegan P, MacWalter RS, Struthers AD, MacDonald TM.
Hypertension Research Centre, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK. limpo@cf.ac.uk
The vascular endothelium maintains a relatively vasodilated state via the release of nitric oxide (NO), a process that could be disrupted by hyperhomocysteinaemia. Since endothelial dysfunction is associated with increased systemic vascular resistance that is the hallmark of sustained arterial hypertension, we hypothesised that in patients with both hypertension and coeliac disease with hyperhomocysteinaemia (via malabsorption of essential cofactors), treatment of the latter disease could improve blood pressure (BP) control. A single patient with proven sustained hypertension and newly-diagnosed coeliac disease had baseline and post-treatment BP and endothelial function assessed by ambulatory BP monitoring (ABPM) and brachial artery forearm occlusion plethysmography respectively. This 49 year-old woman had uncomplicated sustained hypertension proven on repeated ABPM carried out 6 weeks apart (daytime mean 151/92 mm Hg and 155/95 mm Hg), and sub-clinical coeliac disease (gluten-sensitive enteropathy). Initial assessments revealed raised homocysteine levels with low normal vitamin B(12) level. It was likely that she had impaired absorption of essential cofactors for normal homocysteine metabolism. She adhered to a gluten-free diet and was given oral iron, folate and B(6) supplementations as well as B(12) injections for 3 months. Her BP had improved by 6 months and normalised by 15 months (daytime ABPM mean 128/80 mm Hg). There was parallel restoration of normal endothelial function with normalisation of her homocysteine levels.
These observations suggest that sub-clinical coeliac disease related hyperhomocysteinaemia might cause endothelial dysfunction, potentially giving rise to a reversible form of hypertension.
In addition, this case study supports the notion that irrespective of aetiology, endothelial dysfunction may be the precursor of hypertension. This highlights the need to resolve co-existing vascular risk factors in patients with hypertension.
Publication Types: · Case Reports
PMID: 12037696 [PubMed - indexed for MEDLINE]
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Post by kickingfrog on Feb 8, 2011 17:29:59 GMT
Manifestation of adult celiac disease during the puerperium[Article in Hungarian] Bajor J, Lomb Z, Anga B, Bero T. Baranya Megyei Korhaz, Belgyogyaszati es Gasztroenterologiai Osztaly, Pecs. The coeliac disease is a T cell mediated autoimmune enteropathy, presents in genetically susceptible person exposed to gluten. It can manifest in any age group but it is becoming more commonly diagnosed in adulthood. Very rarely it manifests during pregnancy or after childbirth, possibly due to hormonal and immunological changes. In authors' case a young female developed severe diarrhoea resulting in malabsorption following both of her pregnancies. On the first presentation the gluten sensitive enteropathy was not diagnosed despite detailed gastroenterological and endocrine workup. Following her first pregnancy she remained free of symptoms for years on a normal diet. After the birth of her second child her symptoms flared up and she was admitted to authors' department. The diagnosis of coeliac disease was confirmed by the histological finding from a small bowel biopsy. The coeliac specific serologic markers were also positive (antibodies to gliadin, endomysium and tissue transglutaminase). Significant improvement was achieved with supportive therapy and gluten-free diet. Despite the fact that authors' patient's symptoms were transient, the diagnosis of latent coeliac disease seems to be evident. Lifelong gluten-free diet is mandatory to prevent the late complications. Publication Types: · Case Reports · Review · Review of Reported Cases PMID: 15005066 [PubMed - indexed for MEDLINE] www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15005066**************************************
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Post by kickingfrog on Feb 8, 2011 17:32:51 GMT
Trichobezoar in a child with concomitant coeliac disease: a case report. Larsson LT, Nivenius K, Wettrell G. Department of Paediatric Surgery, Children's Hospital, Lund, Sweden. lars-torsten.larsson@skane.se We report on a case of childhood coeliac disease presenting with tricophagia and trichobezoar. The combination of obstructive symptoms, severe hypoalbuminaemia and a large abdominal mass detected on CT scan warranted diagnostic gastroscopy and laparotomy, resulting in removal of a large gastric trichobezoar. Surgical recovery was uneventful although serologic studies for coeliac disease were abnormal. Coeliac disease was confirmed by subsequent biopsy. CONCLUSION: Concomitant trichobezoar and coeliac disease in a child is reported for the first time. It is postulated that the trichobezoar was a result of coeliac disease-induced pica. Publication Types: · Case Reports PMID: 15046290 [PubMed - indexed for MEDLINE] www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15046290************************
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Post by kickingfrog on Feb 8, 2011 17:35:10 GMT
Mov Disord. 2004 Apr;19(4):478-82. Choreic syndrome and coeliac disease: a hitherto unrecognised association.Pereira AC, Edwards MJ, Buttery PC, Hawkes CH, Quinn NP, Giovannoni G, Hadjivassiliou M, Bhatia KP. Sobell Dept of Motor Neuroscience and Movement Disorders, Institute of Neurology, United Kingdom. Coeliac disease has been associated with a variety of neurological conditions, most frequently cerebellar ataxia and peripheral neuropathy. To date, chorea has not been associated with coeliac disease. We present the case histories of 4 individuals with coeliac disease and chorea (4 women, average age of onset of chorea 61 years). Unexpectedly, most of these patients showed a notable improvement in their motor symptoms after the introduction of a gluten-free diet. Copyright 2003 Movement Disorder Society Publication Types: · Case Reports PMID: 15077250 [PubMed - indexed for MEDLINE] www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15077250
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Post by kickingfrog on Feb 8, 2011 18:47:33 GMT
From BMJ
Carbohydrate restriction can disturb glucose metabolism, and this may be interpreted falsely as food allergy Case 2 A 47 year old man was referred with a 3 year history of diarrhoea, dizziness, abdominal pain, myalgia, and weight loss of 7 kg. He had been investigated extensively by several doctors, had seen a psychiatrist, and had consulted numerous alternative therapists. He believed that he was allergic to carbohydrate and had adopted a low carbohydrate diet. This resulted in further weight loss; his body mass index fell to 17. The patient's symptoms of dizziness and weakness were reproduced by meals rich in carbohydrate, reinforcing his belief that food allergy was his problem. A diagnosis of coeliac disease was made after the patient was found to be positive for IgA anti-endomysial antibodies, and this was confirmed by histological findings from a jejunal biopsy specimen. He was given advice about eating a gluten free diet. The patient combined the gluten free diet with restricted carbohydrates but found that the symptoms he had been experiencing after eating meals containing carbohydrate (gluten free) persisted. A prolonged oral glucose tolerance test resulted in symptomatic hypoglycaemia, and his venous glucose concentration was 1.5 mmol/l at 3 hours. The patient was advised to continue the gluten free diet and to incorporate carbohydrate regularly. He now eats a gluten free diet with normal amounts of carbohydrate; his symptoms have resolved and his weight has returned to normal.
BMJ 1999;319:304-305 (Published 31 July 1999)
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Post by kickingfrog on Feb 8, 2011 18:53:53 GMT
Danger of stereotyping in suspected osteomalaciaA 21 year old English woman, whose parents had emigrated from Pakistan, presented to an accident and emergency department with fatigue and a painful, swollen leg. A venogram was negative. Investigations showed iron deficiency anaemia (haemoglobin 87 g/l, mean cell volume 69 fl), and she was treated with ferrous sulphate. She continued to have pains in the wrist and knee. She was not a vegetarian and ate a balanced diet that included fewer than three pieces of unleavened bread a week. She worked full time outside the home and wore dress that did not shade her face or always cover her arms. Serum levels of calcium (2.38 mmol/l), phosphate (0.91 mmol/l), and alkaline phosphatase (160 IU/l) were in the normal range, but a 25-hydroxycholecalciferol level was 6 µg/l (reference range 7-50). At a hospital outpatient clinic "Asian osteomalacia" was diagnosed. She was discharged to the Jericho Health Centre in Oxford with the recommendation to prescribe ergocalciferol and calcium. Her pains improved, but she continued to complain of fatigue and developed a new problem of frequent loose stools. She was referred to a gastroenterologist, and a duodenal biopsy showed partial villous atrophy, consistent with coeliac disease. The epidemiological identification of an increased risk of osteomalacia has been important for improving public health and clinical care in south Asian communities in the United Kingdom. An epidemiological risk factor, however, is not the same as a disease entity. We could find no evidence to confirm or refute whether British Asians face a greater current risk than any other population group. Together with our recent clinical experience, this leads us to question the value of Asian osteomalacia as a clinical diagnosis. The diagnostic evaluation for suspected osteomalacia should be driven by the clinical findings not the patient's ethnic origin. Clinicians must be alert to the limitations of diagnoses based on stereotypical pattern recognition. bmj.bmjjournals.com/cgi/content/full/323/7305/149************************
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Post by kickingfrog on Mar 13, 2013 15:55:20 GMT
Fatal Intestinal Bleeding in an 80-Year-Old WomanAUTHOR(S)Aalaei, Sophie; Jakate, Shriram PUB. DATE June 2005 SOURCE Archives of Pathology & Laboratory Medicine;Jun2005, Vol. 129 Issue 6, p803 SOURCE TYPE Academic Journal DOC. TYPE Article This article presents the case report of an 80-year-old white woman presented with a 9-kg weight loss that occurred during a period of 6 months. Physical and gynecologic examinations, preliminary imaging, and blood and serologic studies did not reveal the cause of weight loss. Upper endoscopy showed atrophic duodenal mucosa, and random biopsies from the second part of the duodenum showed severely shortened villi, increased intraepithelial lymphocytes, and chronic duodenitis. Histologically, these features were suggestive of celiac disease (CD) or gluten-sensitive enteropathy. Celiac disease is a genetically determined, immune-mediated disease triggered by the ingestion of gluten-containing grains. Both ulcerative jejunoileitis and enteropathy-associated T-cell lymphoma are rare but well-documented and related complications of CD. connection.ebscohost.com/c/articles/17199615/fatal-intestinal-bleeding-80-year-old-woman
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Post by kickingfrog on May 16, 2013 7:48:29 GMT
Osteoporosis Associated with Neutralizing Autoantibodies against Osteoprotegerin
Philip L. Riches, M.R.C.P., Euan McRorie, F.R.C.P., William D. Fraser, Ph.D., F.R.C.Path., Catherine Determann, B.Med.Sci., Rob van’t Hof, Ph.D., and Stuart H. Ralston, M.D. Autoantibodies against osteoprotegerin, which block the inhibitory effect of osteoprotegerin on signaling by the receptor activator of nuclear factor (NF)-êB (RANK), were identified in a man with celiac disease who presented with severe osteoporosis and high bone turnover.The osteoporosis did not respond to the treatment of his celiac disease but was completely reversed by bisphosphonate therapy. ] Autoantibodies against osteoprotegerin were detected in three additional patients with celiac disease. Such autoantibodies may be associated with the development of high-turnover osteoporosis, but whether autoantibodies against osteoprotegerin commonly contribute to the pathogenesis of osteoporosis in patients with celiac disease remains to be determined... From the Rheumatic Diseases Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh (P.L.R., E.M., C.D., R.H., S.H.R.); and the Unit of Clinical Chemistry, School of Clinical Sciences, University of Liverpool, Liverpool (W.D.F.) — both in the United Kingdom. Address reprint requests to Dr. Ralston at the Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU, United Kingdom, or at stuart.ralston@ ed.ac.uk. N Engl J Med 2009;361:1459-65. Copyright © 2009 Massachusetts Medical Society. www.nejm.org/doi/pdf/10.1056/NEJMoa0810925Read more: coeliac.proboards.com/index.cgi?board=othercon&action=display&thread=309#ixzz2TRJFFSw4
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