Gluten-Free China Gastro Q&A Akiko Natalie Tomonari MD Akiko - PowerPoint PPT Presentation

Gluten-Free China Gastro Q&A Akiko Natalie Tomonari MD Akiko Natalie Tomonari MD akiko.tomonari@parkway.cn akiko.tomonari@parkway.cn Gastroenterology Specialist ParkwayHealth

Introduction (of myself) • Born in Japan, Raised in Maryland, USA • Graduated from Medical University in Japan • Has experience in US and Japan • From Hokkaido, Japan • Has been in Shanghai for almost 2 years Has been in Shanghai for almost 2 years

Introduction (of celiac disease) • What is Celiac disease?? • Having a “reaction” to eating gluten What is Gluten??

What is Celiac disease? Small Intestines Microvilli Microvilli Absorb Villi nutrients in food Endothelial cell

Antibodies Microvilli & endothelial cells & endothelial cells become damaged Malabsorption Villi become flat Increased gas Abdominal pain

If I am Celiac, how will I feel? • Symptoms you • Conditions you WILL feel WILL NOT feel Asymptomatic • Bloating/increased • Anemia (iron gas, especially after deficiency) eating • Vitamin deficiency Children may Children may Children may • Diarrhea • Diarrhea • Bone diseases Bone diseases show growth • Constipation (osteoporosis) problems • Nausea or vomiting • Elevated liver enzymes • Weight loss/gain even • Thyroid disease though you are eating • Infertility the same amount • Oral ulcers If you have a family If you have a family • Psychiatric problems member with CD, you are high risk • Dental problems

What’s the difference between“similar” diseases? Non-CD Irritable Celiac Wheat gluten bowel Disease Allergy sensitivity syndrome Hives Bloating/Gas Swollen Stomachache lips/tongue Symptoms Diarrhea/Constipation Itchiness Weight gain/loss Wheezing Nausea Anaphylaxis Gluten Not only Worse (only Worse Worse intake gluten wheat) Small intestine Abnormal Normal Normal Normal biopsy Genetic test Positive Negative Negative Negative (HLA-DQ) IgE exam Negative Negative Negative Positive Risk for other Not Not Not Elevated diseases elevated elevated elevated

How is it diagnosed? IMPORTANT: Exam should be done on GLUTEN RICH DIET! American College of Gastroeneterology, Celiac Disease guideline

Exam availability Available at Parkway Total IgA Yes AGA-IgA/G AGA-IgA/G Yes Yes TTG-IgA/G Yes EMA-IgA/G No DGP-IgA/G No HLA-DQ2/8 No Small intestine biopsy Yes

What do I do if I’m already gluten free? • Exams can be done if GF <1 month But if you’ve already been GF for a while… while… • Genetic testing can be done to try to exclude CD – If negative, no need for further testing – If positive, will need to go on “gluten challenge”

How do I treat CD? • There is no “treatment” (medication, surgery, etc) • Keeping a gluten free diet is the only “treatment” “treatment” • Having a dietician is recommended If you have been If you have been diagnosed… diagnosed… You need to stick to You need to stick to GFD for life! GFD for life!

What contains gluten? • Primary sources • Hidden sources Wheat (triticale, • Oats • semolina, spelt, • Sauces khorasan wheat) khorasan wheat) • Drug fillers • Drug fillers Rye • • Shared food Barley (malt) • preparations • Processed meats

What are the other things I need to be careful about? • Higher risk for… 1. Lymphoma (cancer of blood) 2. Small intestine cancer 2. Small intestine cancer 3. Liver disease (PBC) 4. Autoimmune disease 1. Type I diabetes 2. Autoimmune thyroid disorder

How should I follow up? • When newly diagnosed, nutritional deficiencies should be screened (iron, vitamins, folic acid) • If deficiencies are detected, need to follow • If deficiencies are detected, need to follow up to confirm it is back to normal • If GFD does not improve symptoms, endoscopy follow up is needed • If able to keep a strict GFD, follow up is necessary only once a year

Survey: Living with Celiac Disease/Gluten sensitivity in Asia: How difficult is it? Survey conducted in November, 2016 to CD or gluten free patients in • China, with cooperation from Gluten-free China Age Range: Under 19 (9.52%), 20’s (38.1%), 30’s (26.19%), 40’s • (16.67%), 50’s (4.76%), Over 60 (4.76%) Country of origin USA Others 19% 19% Sweden 5% Canada New Zealand 12% 5% Netherland UK 5% Italy 9% 7% Australia China 10% 9%

Prevalence of Celiac Disease Autoimmunity Among Adolescents and Young Adults in China • Yuan et al, April, 2017 • 19,778 undiagnosed Chinese young adults (16–25 years old) were tested for CD related blood markers years old) were tested for CD related blood markers • About 2% tested positive for CD autoimmunity • In China, the occurrence of CD may be more common than previously recognized Yuan J, Zhou C, et al, Prevalence of Celiac Disease Autoimmunity Among Adolescents and Young Adults in China, Clinical Gastroenterology and Hepatology (2017), Doi: 10.1016/j.cgh.2017.04.025

Thank you. Thank you.