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.tomonari@parkway.cn Akiko Natalie Tomonari MD 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 nutrients in food

Endothelial cell

Villi

Microvilli & endothelial cells

Antibodies

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

If I am Celiac, how will I feel?

• Symptoms you

WILL feel

• Bloating/increased

gas, especially after eating

• Diarrhea
• Conditions you

WILL NOT feel

• Anemia (iron

deficiency)

• Vitamin deficiency

Bone diseases

Children may Children may

Asymptomatic

• Diarrhea
• Constipation
• Nausea or vomiting
• Weight loss/gain even

though you are eating the same amount

• Oral ulcers
• Psychiatric problems
• Dental problems
• Bone diseases

(osteoporosis)

• Elevated liver enzymes
• Thyroid disease
• Infertility

Children may show growth problems

If you have a family If you have a family member with CD, you are high risk

What’s the difference between“similar” diseases?

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

How is it diagnosed?

American College of Gastroeneterology, Celiac Disease guideline

IMPORTANT: Exam should be done on GLUTEN RICH DIET!

Exam availability

Available at Parkway Total IgA Yes AGA-IgA/G Yes AGA-IgA/G 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 diagnosed… You need to stick to GFD for life! If you have been diagnosed… You need to stick to GFD for life!

What contains gluten?

• Primary sources
• Wheat (triticale,

semolina, spelt, khorasan wheat)

• Hidden sources
• Oats
• Sauces
• Drug fillers

khorasan wheat)

• Rye
• Barley (malt)
• Drug fillers
• Shared food

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%)

USA 19% Canada 12% UK 9% China 9% Australia 10% Italy 7% Netherland 5% New Zealand 5% Sweden 5% Others 19% Country of origin

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.