STUDIES SUMMARIZED



Source (00:20)


Capsule Endoscopy Findings

Capsule endoscopy offers a detailed view of the entire digestive tract (see sample above). A Mayo Clinic study using capsule endoscopy showed that damage in the small intestine due to untreated celiac disease can vary significantly from patient to patient and not heal completely even after a year or more on a gluten-free diet. The degree of damage "did not explain differences in clinical presentation." (Clinical Gastroenterology and Hepatology, CNNMoney.com)


Oral Manifestations

A meta-study found:

Dental enamel defects are the oral lesions most closely related to CD. There are conflicting data on the association between CD and recurrent aphthous stomatitis. A correlation of CD with atrophic glossitis has been reported, although robust evidence in support of it is lacking. Patients with CD have caries indexes seemingly lower than healthy individuals, but they may experience delay in tooth eruption. Occurrence of other oral mucosal lesions in CD subjects is likely occasional.

and concluded that

Patients with systematic dental enamel defects should be screened for CD even in the absence of gastrointestinal symptoms. CD screening tests for patients with oral aphthae or idiopathic atrophic glossitis should be selectively considered during a medical evaluation that focuses on all aspects of the patient's status. (Journal of Clinical Gastroenterology)

Seniors

Israeli researchers identified a group of seven people with celiac disease who had been diagnosed after age 60 and saw signs of improvement in cognitive decline (previously attributed to Alzheimer's Disease) as well as other symptoms:

The most common presenting findings were weight loss, iron deficiency anemia, and diarrhea. Two patients suffered from severe early osteoperosis and 2 additional patients had elevated liver function tests. Neurologic manifestation was suspected in 3 cases. Two female patients presented with cognitive decline that was attributed to Alzheimer dementia but ameliorated after the initiation of gluten-free diet. The third patient had peripheral neuropathy that completely resolved after the initiation of gluten-free diet. Median lag in diagnosis was 8 years. Diet treatment led to complete resolution of symptoms in most cases and a significant weight gain.... (Journal of Clinical Gastroenterology, NewsRx)

Thanks to Michael Thorn

OSTEOPOROSIS DRUG ALERT

Adults diagnosed with untreated celiac disease should have their bone density checked because many—men included—have low bone density. After adopting a gluten-free diet, such people often show dramatic improvement without taking osteoporosis medication such as bisphosphonates. However, physicians may still consider prescribing bisphosphonates to improve bone density.

Although many people appear to use bisphosphonates safely, concerns about the medication have come up periodically. Necrosis has received some attention, though I have been told that it is very rare. Jane Brody at The New York Times (July 5, 2005) reported on a possibile association of slow-healing non-traumatic stress fractures with the use of bisphosphonates for more than five years.

And now the FDA has issued an alert about severe bone, joint, and/or muscle pain while taking a bisphophonate:

FDA is highlighting the possibility of severe and sometimes incapacitating bone, joint, and/or muscle (musculoskeletal) pain in patients taking bisphosphonates. Although severe musculoskeletal pain is included in the prescribing information for all bisphosphonates, the association between bisphosphonates and severe musculoskeletal pain may be overlooked by healthcare professionals, delaying diagnosis, prolonging pain and/or impairment, and necessitating the use of analgesics.

The severe musculoskeletal pain may occur within days, months, or years after starting a bisphosphonate. Some patients have reported complete relief of symptoms after discontinuing the bisphosphonate, whereas others have reported slow or incomplete resolution. The risk factors for and incidence of severe musculoskeletal pain associated with bisphosphonates are unknown.

This severe musculoskeletal pain is in contrast to the acute phase response characterized by fever, chills, bone pain, myalgias, and arthralgias that sometimes accompanies initial administration of intravenous bisphosphonates and may occur with initial exposure to once-weekly or once-monthly doses of oral bisphosphonates. The symptoms related to the acute phase response tend to resolve within several days with continued drug use.

Healthcare professionals should consider whether bisphosphonate use might be responsible for severe musculoskeletal pain in patients who present with these symptoms and consider temporary or permanent discontinuation of the drug.

Bisphosphonates are marketed as Actonel, Actonel+Ca, Aredia, Boniva, Didronel, Fosamax, Fosamax+D, Reclast, Skelid, and Zometa.