Gluten-Free China Gastro Q&A 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
Introduction (of celiac disease) What is Celiac disease?? Having a reaction to eating gluten What is Gluten??
What is Celiac disease? Small Intestines Villi Microvilli Absorb nutrients in food Endothelial cell
Antibodies Microvilli & 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 Constipation Nausea or vomiting Asymptomatic Weight loss/gain even though you are eating the same amount Oral ulcers Psychiatric problems Dental problems Children may show growth problems Conditions you WILL NOT feel Anemia(iron deficiency) Vitamin deficiency Bone diseases (osteoporosis) Elevated liver enzymes Thyroid disease Infertility 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 Genetic test (HLA-DQ) Abnormal Normal Normal Normal Positive Negative Negative Negative IgE exam Negative Negative Negative Positive Riskfor other diseases Elevated Not elevated Not elevated Not 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 AGA-IgA/G TTG-IgA/G EMA-IgA/G DGP-IgA/G HLA-DQ2/8 Small intestine biopsy Yes Yes Yes No No No 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 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 Having a dietician is recommended If you have been diagnosed You need to stick to GFD for life!
What contains gluten? Primary sources Wheat (triticale, semolina, spelt, khorasan wheat) Rye Barley (malt) Hidden sources Oats Sauces 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 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 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 Others 19% USA 19% Sweden 5% New Zealand 5% Canada 12% Netherland 5% Italy 7% Australia 10% China 9% UK 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 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.