11.07.2006, 10:14
: Am J Gastroenterol. 2003 Apr;98(4):839-43.
Comment in: Am J Gastroenterol. 2003 Apr;98(4):720-2.
High prevalence of small intestinal bacterial overgrowth in celiac patients with persistence of gastrointestinal symptoms after gluten withdrawal.
Tursi A, Brandimarte G, Giorgetti G.
Department of Emergency, "L. Bonomo" Hospital, Andria (BA), Italy.
OBJECTIVE: Celiac disease is a gluten-sensitive enteropathy with a broad spectrum of clinical manifestation, and most celiac patients respond to a gluten-free diet (GFD). However, in some rare cases celiacs continue to experience GI symptoms after GFD, despite optimal adherence to diet. The aim of our study was to evaluate the causes of persistence of GI symptoms in a series of consecutive celiac patients fully compliant to GFD. METHODS: We studied 15 celiac patients (five men, 10 women, mean age 36.5 yr, range 24-59 yr) who continued to experience GI symptoms after at least 6-8 months of GFD (even if of less severity). Antigliadin antibody (AGA) test, antiendomysial antibody (EMA) test, and sorbitol H2-breath test (H2-BT), as well as esophagogastroduodenoscopy (EGD) with histological evaluation, were performed before starting GFD. Bioptic samples were obtained from the second duodenal portion during EGD, and histopathology was expressed according to the Marsh classification. To investigate the causes of persistence of GI symptoms in these patients, we performed AGA and EMA tests, stool examination, EGD with histological examination of small bowel mucosa, and sorbitol-, lactose-, and lactulose H2-breath tests. RESULTS: Histology improved in all patients after 6-8 months of GFD; therefore, refractory celiac disease could be excluded. One patient with Marsh II lesions was fully compliant to his diet but had mistakenly taken an antibiotic containing gluten. Two patients showed lactose malabsorption, one patient showed Giardia lamblia and one patient Ascaris lumbricoides infestation, and 10 patients showed small intestinal bacterial overgrowth (SIBO) by lactulose H2-BT. We prescribed a diet without milk or fresh milk-derived foods to the patient with lactose malabsorption; we treated the patients with parasite infestation with mebendazole 500 mg/day for 3 days for 2 consecutive wk; and we treated the patients with SIBO with rifaximin 800 mg/day for 1 wk. The patients were re-evaluated 1 month after the end of drug treatment (or after starting lactose-free diet); at this visit all patients were symptom-free. CONCLUSIONS: This study showed that SIBO affects most celiacs with persistence of GI symptoms after gluten withdrawal.
PMID: 12738465 [PubMed - indexed for MEDLINE
Eine Publikation aus Italien, in der 15 Zöliakie-Patienten untersucht worden sind, deren Beschwerden trotz glutenfreier Ernährung bestehen blieben. Die histologischen Befunde waren nach 6-8 Monaten verschwunden gewesen.
2 der Pat. hatten eine LI, ein Pat. eine Lamblieninfektion , einer Ascaridenbefall.
Bei 10 Betroffenen zeigte sich im H2-Atemtest mit Laktulose .
Den LI-Patienten wurde eine milchfreie Diät empfohlen, der Parasitenbefall wurde medikamentös behandelt und die bakterielle Fehlbesiedelung mit Rifaximin ( bei uns Metronidazol). Bei der Nachuntersuchung 1 Monat nach Beendigung der medikamentösen Behandlung –oder nach Beginn der laktosefreien Diät zeigten sich alle Patienten beschwerdefrei.
Fazit: Diese Studie zeigte, dass SIBOS für Beschwerden von Zöliakiepatienten verantwortlich ist, deren Beschwerden auch nach Absetzen glutenhaltiger Nahrung anhalten.
*****
BMC Gastroenterol. 2004 May 22;4(1):10.
Partially responsive celiac disease resulting from small intestinal bacterial overgrowth and lactose intolerance.
Ghoshal UC, Ghoshal U, Misra A, Choudhuri G.
Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India. ghoshal@sgpgi.ac.in
BACKGROUND: Celiac disease is a common cause of chronic diarrhea and malabsorption syndrome all over the world. Though it was considered uncommon in India in past, it is being described frequently recently. Some patients with celiac disease do not improve despite gluten free diet (GFD). A study described 15 cases of celiac disease unresponsive to GFD in whom small intestinal bacterial overgrowth (SIBO) or lactose intolerance was the cause for unresponsiveness. CASE PRESENTATION: During a three-year period, 12 adult patients with celiac disease were seen in the Luminal Gastroenterology Clinic in a tertiary referral center in northern India. Two of these 12 patients (16.6%), who did not fully respond to GFD initially, are presented here. Unresponsiveness resulted from SIBO in one and lactose intolerance in the other. The former patient responded to antibiotics and the latter to lactose withdrawal in addition to standard GFD. CONCLUSION: In patients with celiac disease partially responsive or unresponsive to GFD, SIBO and lactose intolerance should be suspected; appropriate investigations and treatment for these may result in complete recovery.
PMID: 15154971 [PubMed - in process]
http://www.pubmedcentral.nih.gov/article...d=15154971
Und hier eine – höchst interessante- Publikation aus Indien
Der Autor schreibt eingangs, dass Zöliakie eine bekannte Ursache von Durchfall und Malabsorption weltweit ist. In der Vergangenheit in Indien aber unbekannt – wird sie nun immer häufiger beschrieben. Auch hier kann es – trotz g-freier Ernährung – zu Fällen kommen, deren Beschwerden anhalten. Oben genannte 2 Fälle: davon hatte 1 Patient Laktoseintoleranz, der andere SIBO. Nach Einhaltung der l-freien Diät und antibiotischer Behandlung waren beide Patienten ohne Beschwerden.
( ein klein wenig hilflos allerdings finde ich die Erklärung (im Originaltext) zu primärer und sekundärer LI: der Autor meint, dass primäre LI sehr selten sei.....so selten, dass ungefähr 75% der Weltbevölkerung davon betroffen sind!)
Uli
Comment in: Am J Gastroenterol. 2003 Apr;98(4):720-2.
High prevalence of small intestinal bacterial overgrowth in celiac patients with persistence of gastrointestinal symptoms after gluten withdrawal.
Tursi A, Brandimarte G, Giorgetti G.
Department of Emergency, "L. Bonomo" Hospital, Andria (BA), Italy.
OBJECTIVE: Celiac disease is a gluten-sensitive enteropathy with a broad spectrum of clinical manifestation, and most celiac patients respond to a gluten-free diet (GFD). However, in some rare cases celiacs continue to experience GI symptoms after GFD, despite optimal adherence to diet. The aim of our study was to evaluate the causes of persistence of GI symptoms in a series of consecutive celiac patients fully compliant to GFD. METHODS: We studied 15 celiac patients (five men, 10 women, mean age 36.5 yr, range 24-59 yr) who continued to experience GI symptoms after at least 6-8 months of GFD (even if of less severity). Antigliadin antibody (AGA) test, antiendomysial antibody (EMA) test, and sorbitol H2-breath test (H2-BT), as well as esophagogastroduodenoscopy (EGD) with histological evaluation, were performed before starting GFD. Bioptic samples were obtained from the second duodenal portion during EGD, and histopathology was expressed according to the Marsh classification. To investigate the causes of persistence of GI symptoms in these patients, we performed AGA and EMA tests, stool examination, EGD with histological examination of small bowel mucosa, and sorbitol-, lactose-, and lactulose H2-breath tests. RESULTS: Histology improved in all patients after 6-8 months of GFD; therefore, refractory celiac disease could be excluded. One patient with Marsh II lesions was fully compliant to his diet but had mistakenly taken an antibiotic containing gluten. Two patients showed lactose malabsorption, one patient showed Giardia lamblia and one patient Ascaris lumbricoides infestation, and 10 patients showed small intestinal bacterial overgrowth (SIBO) by lactulose H2-BT. We prescribed a diet without milk or fresh milk-derived foods to the patient with lactose malabsorption; we treated the patients with parasite infestation with mebendazole 500 mg/day for 3 days for 2 consecutive wk; and we treated the patients with SIBO with rifaximin 800 mg/day for 1 wk. The patients were re-evaluated 1 month after the end of drug treatment (or after starting lactose-free diet); at this visit all patients were symptom-free. CONCLUSIONS: This study showed that SIBO affects most celiacs with persistence of GI symptoms after gluten withdrawal.
PMID: 12738465 [PubMed - indexed for MEDLINE
Eine Publikation aus Italien, in der 15 Zöliakie-Patienten untersucht worden sind, deren Beschwerden trotz glutenfreier Ernährung bestehen blieben. Die histologischen Befunde waren nach 6-8 Monaten verschwunden gewesen.
2 der Pat. hatten eine LI, ein Pat. eine Lamblieninfektion , einer Ascaridenbefall.
Bei 10 Betroffenen zeigte sich im H2-Atemtest mit Laktulose .
Den LI-Patienten wurde eine milchfreie Diät empfohlen, der Parasitenbefall wurde medikamentös behandelt und die bakterielle Fehlbesiedelung mit Rifaximin ( bei uns Metronidazol). Bei der Nachuntersuchung 1 Monat nach Beendigung der medikamentösen Behandlung –oder nach Beginn der laktosefreien Diät zeigten sich alle Patienten beschwerdefrei.
Fazit: Diese Studie zeigte, dass SIBOS für Beschwerden von Zöliakiepatienten verantwortlich ist, deren Beschwerden auch nach Absetzen glutenhaltiger Nahrung anhalten.
*****
BMC Gastroenterol. 2004 May 22;4(1):10.
Partially responsive celiac disease resulting from small intestinal bacterial overgrowth and lactose intolerance.
Ghoshal UC, Ghoshal U, Misra A, Choudhuri G.
Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India. ghoshal@sgpgi.ac.in
BACKGROUND: Celiac disease is a common cause of chronic diarrhea and malabsorption syndrome all over the world. Though it was considered uncommon in India in past, it is being described frequently recently. Some patients with celiac disease do not improve despite gluten free diet (GFD). A study described 15 cases of celiac disease unresponsive to GFD in whom small intestinal bacterial overgrowth (SIBO) or lactose intolerance was the cause for unresponsiveness. CASE PRESENTATION: During a three-year period, 12 adult patients with celiac disease were seen in the Luminal Gastroenterology Clinic in a tertiary referral center in northern India. Two of these 12 patients (16.6%), who did not fully respond to GFD initially, are presented here. Unresponsiveness resulted from SIBO in one and lactose intolerance in the other. The former patient responded to antibiotics and the latter to lactose withdrawal in addition to standard GFD. CONCLUSION: In patients with celiac disease partially responsive or unresponsive to GFD, SIBO and lactose intolerance should be suspected; appropriate investigations and treatment for these may result in complete recovery.
PMID: 15154971 [PubMed - in process]
http://www.pubmedcentral.nih.gov/article...d=15154971
Und hier eine – höchst interessante- Publikation aus Indien
Der Autor schreibt eingangs, dass Zöliakie eine bekannte Ursache von Durchfall und Malabsorption weltweit ist. In der Vergangenheit in Indien aber unbekannt – wird sie nun immer häufiger beschrieben. Auch hier kann es – trotz g-freier Ernährung – zu Fällen kommen, deren Beschwerden anhalten. Oben genannte 2 Fälle: davon hatte 1 Patient Laktoseintoleranz, der andere SIBO. Nach Einhaltung der l-freien Diät und antibiotischer Behandlung waren beide Patienten ohne Beschwerden.
( ein klein wenig hilflos allerdings finde ich die Erklärung (im Originaltext) zu primärer und sekundärer LI: der Autor meint, dass primäre LI sehr selten sei.....so selten, dass ungefähr 75% der Weltbevölkerung davon betroffen sind!)
Uli