Greetings, Dr. Roach I was 62 years old when I received a diagnosis of silent celiac disease, but I most likely had it for decades. (My severe osteoporosis might have resulted from that.) Villi were completely flattened upon biopsy.
Since I’m gluten-free, I’ll be receiving routine test work on celiac-antibody, nutrients, and other topics. However, according to my doctors, no more scopes are required until my blood work indicates an issue or I experience symptoms while following a gluten-free diet. However, blood work does not reveal if the small intestine has physically healed, and there are no signs for asymptomatic people like me. I never got a response when I attempted to ask my doctor this follow-up question.
Do you think I should obtain another opinion? Other individuals have told me that their doctors scheduled a follow-up scope to assess physical healing one to two years following the diagnosis. Is it wise to perform a follow-up scope on elderly patients who can handle one and have significant villi destruction? — W.C.S.
ANSWER: Individuals who develop osteoporosis without warning should be evaluated for celiac disease. Gliadin sensitivity causes damage to the small intestine in celiac disease. Gluten, wheat, and other grains contain gliadin, a protein that is believed to cause direct harm to the intestinal lining. The small intestine’s absorptive surface, the villi, flattens as a result. Celiac illness can only be cured by strictly avoiding gluten in one’s diet.
Although symptoms like diarrhea and weight loss can result from an inability to absorb nutrients, they can also be quite mild. After eating, some people have mild stomach pain, but once they switch to a gluten-free diet, the symptoms normally go away.
In addition to direct calcium malabsorption, people with celiac disease frequently have low calcium levels for complicated causes that include parathyroid hormone and vitamin D. After preparing for yet another colonoscopy, one of my coworkers with undiagnosed celiac disease woke up with low blood calcium levels that prevented her from moving her muscles. Since the bone is the body’s main calcium store, calcium is extracted from it to maintain blood calcium levels, but over time, this can cause severe osteoporosis.
Although small intestinal biopsies are still the most reliable method of diagnosing celiac disease, blood testing can be very predictive of a diagnosis. Blood tests must be performed while a person is eating gluten because if they are on a gluten-free diet, the results may be negative.
It’s debatable whether you should get another biopsy after following a gluten-free diet. To confirm the initial diagnosis and prove that the diet has allowed the bowel to heal, patients with severe celiac disease like you should have another biopsy within a year, according to the American Gastroenterological Association’s consensus of opinion.
In your instance, maintaining your bone density and closely monitoring your calcium, vitamin D, and parathyroid hormone levels will be crucial strategies to ensure that your medication is working. Since bone changes slowly, it will take years before bone density testing can confirm that your osteoporosis is getting better.
More information about celiac disease can be found at celiac.org.
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