According to a new study, just published in the January issue of Clinical Gastroenterology and Hepatology, there is not a long term link between Celiac Disease and an increased risk for GI cancer.  In the short term, they did report a spike in cancer occurrence in the year following the diagnosis of Celiac, inflammation or latent celiac disease. While this study is no cause for alarm, if you, or someone you know has celiac, it does support the important relationship between patients with a number of gi issues and their gastroenterologist - regular visits with your physician at GI Associates will increase your chances of an early diagnosis should a cancer occur.

You should be able to talk frankly with your doctor about any concerns you have and follow their  recommendations for diet, lifestyle and medications. Our goal, as we enter the new year, is to inform, educate and give you the tools you need to take charge of your health. 

You finally have a diagnosis – celiac disease! After the initial relief, reality sets in. The big questions is “Okay, now what can I eat that is gluten-free?” Maybe you have already ventured into the grocery store only to walk out with a box of Gluten-Free Chex, bananas and a few other items. The sad thing is it took you over an hour to put those few items in your grocery cart! Yes, that first trip to the grocery store can be very overwhelming. I have had parents of newly diagnosed children with celiac disease break down in tears in my office relating their first trip to the grocery store in pursuit of gluten-free faire for their child.

There are tons of good tasting gluten-free foods readily available in a regular grocery store. Some are naturally gluten-free such as fresh fruits, vegetables, plain packaged meat, plain white or brown rice and dried beans. There are also some great tasting gluten-free new products available in most grocery stores such as the Gluten-Free Chex cereal, Nature Valley Gluten-Free Roasted Nut Crunch, Gluten-Free Bisquick and the line of Gluten-Free Betty Crocker mixes (brownies, cake and cookies).

Finding good gluten-free bread is a challenge. There are two I recommend which may be purchased online: www.udisglutenfree.com and www.canyonbakehouse.com. Nature’s Own is coming out the end of this year or beginning of next year with gluten-free breads. I have been told by the company the bread may not be available in some areas and markets.

Making an appointment with a dietitian who specializes with celiac disease may make life much easier. Not all dietitians see individuals with celiac disease on a routine basis. Therefore, they may not be well versed with both the nuances of celiac disease, nutritional needs and menu planning.

MASTOCYTIC ENTEROCOLITIS
Mastocytic enterocolitis (entero=small intestine, colitis- colon + -itis= inflammation) is a newly discovered disorder defined by the presence of increased mast cells in the intestine. Mast cells are a type of immune cell involved in allergy reactions, infection fighting and neural regulation. Mast cells contain chemicals that help regulate certain body reactions. Histamine is one of the main chemicals mast cells release when triggered. Mast cells are present in the intestinal lining in small numbers except when there are parasites, food allergies, stress or the presence of other chronic inflammatory bowel diseases such as Crohn's disease or ulcerative colitis. When mast cells release histamine a cycle of pain and gut injury results from irritation of the lining. This process can make the intestinal linining more permeable or leaky, resulting in diarrhea.

WHAT ARE THE SYMPTOMS?
The most common symptoms are diarrhea, bloating and abdominal pain. However, constipation may occur due to gut paralysis. Nausea, vomiting and various non-GI symptoms such as flushing, headaches, and fatigue may also occur. When histamine is released, it can cause leaky gut, increased contractions of the gut or decreased contractions, increased secretions and increased pain.

HOW IS IT DIAGNOSED?
When you have an endoscopic procedure at GI Associates to evaluate chronic diarrhea, your physician takes samples of tissue, biopsies, from the lining of your intestines. Our GI pathologist looks at it under the microscope with a special stain for tryptase, an enzyme present in mast cells. When excess mast cells are present in the small bowel or the colon mastocyte enterocolitis is diagnosed.

HOW IS IT TREATED?
There are medications that can reduce or block the release of chemicals by mast cells. The most common are Type I and II antihistamines. Type I antihistamines are typically used for allergies symptoms such as Zyrtec, Allegra, Claritin etc. The type II antihistamines are also acid blockers such as Zantac, Tagamet and Pepcid. Another therapy for mastocytic enterocolitis is a medication that stabilizes mast cells known as cromolyn sodium (Gastrocrom). This drug also prevents the release of chemicals including histamine from mast cells. It is typically prescribed four times a day for about 4-6 weeks. Along with these medications, the physicians of GI Associates frequently recommend allergy testing for the most common allergies. Pprobiotic supplement are also considered to have some potential benefit.