Dr. Roach: Sensitivity to gluten causes celiac disease

Dear Dr. Roach: I have several symptoms of gluten intolerance. I?ve read that there are tests to confirm celiac disease. Besides a blood test, one test is a biopsy of tissue taken from the small intestine. How does the doctor retrieve such tissue? How reliable are the results of these tests after following a gluten-free diet? ? S.S.

Celiac disease, also called celiac sprue, is caused by a sensitivity to gliadin, a component of gluten, which is found in wheat, barley, rye and oats. The major symptoms are weight loss, diarrhea and abdominal distention and bloating. The diagnosis is usually made based on a combination of blood tests and a small-intestine biopsy, which is obtained via an endoscopy of the stomach and intestine.

Neither the blood tests nor the biopsy is perfect. In people who have been on a strict gluten-free diet, it is possible the antibody blood test and the biopsy return as normal. In this case, a blood test to determine genetic risk for celiac disease can be done.

Hello, Dr. Roach: I was diagnosed with stage III kidney disease in May 2012. I had been taking HCT for more than 10 years for hypertension; apparently it did not control my blood pressure well enough to ward off kidney damage. I have been prescribed Azor once a day. After taking it with the HCT for two weeks, my GFR (glomerular filtration rate) went down 10 points, although my BP is much better, usually less than 120/80. The drastic change in my GFR concerns me greatly. Is this medication worse than the illness? A few years ago, Vioxx was taken off the market because it caused damage and fatal results in some patients. Is this a similar medication? I would appreciate any advice you can give me. ? P.E.D.

This gets a little confusing, so bear with me. Azor is a combination of two medicines: amlodipine and olmesartan. Olmesartan is in the class of ARBs (angiotensin receptor blockers, which work by opening up constricted blood vessels), and these have the effect of reducing blood flow to the kidneys. GFR (glomerular filtration rate) is a measure of kidney function, and is directly related to the blood flow to the kidneys. So a medicine like olmesartan ? or any of the ARBs or ACE inhibitors ? will very often drop GFR. A lower GFR means a higher creatinine level, since creatinine is removed from the blood by the kidneys. Since a higher creatinine means worse kidney function independent of the medication effect, it?s natural for patients to worry that the kidneys are being damaged.

DR. KEITH ROACH is a syndicated columnist with North America Syndicate Inc., P.O. Box 536475, Orlando, FL 32853-6475.

Source: http://lubbockonline.com/health/2013-06-26/dr-roach-sensitivity-gluten-causes-celiac-disease

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