May Is Celiac Disease Month

By Dr. Glenn Pang
Interviewed by Melissa Moniz
Wednesday - May 19, 2010
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Dr. Glenn Pang
Gastroenterologist

Where did you receive your schooling and training?

I was a pharmacist, then went back to school in 1972. I attended University of Hawaii School of Medicine and graduated in 1976. I did a two-year residency at UH, which included both medicine and surgery, then went to Tulane Medical Center, where I did my internal medicine residency. I stayed in New Orleans and completed my gastroenterology fellowship there at LSU. I came back in 1982 to practice as a gastroenterologist. My office has been here at Hawaii Medical Center since then.

What are the most common diseases or disorders that you see and treat?

The most common GI problems are gastroesophageal reflux disease (GERD), constipation, irritable bowel syndrome, colonic polyps, inflammatory bowel disease such as ulcerative colitis and Crohn’s disease, abnormal liver enzymes mostly due to steatosis or fatty liver and hepatitis, and peptic ulcer disease. Other lesser GI problems I see are pancreatitis, gallstones, GI cancers and GI bleeding.


What is irritable bowel syndrome, what are its symptoms and how is it treated?

IBS is a very common GI problem, occurring in 9-20 percent of the population, mostly women. The diagnosis is suggested if the patient has abdominal pain, altered bowel habits, such as diarrhea, constipation or both, and bloating for a period of greater than three months, and can often interfere with work or daily activities. The physical exam is somewhat unre-markable except for clammy hands and mild abdominal tenderness. So IBS is a diagnosis of exclusion, and the patient will undergo a battery of tests to eliminate other possible causes of the GI symptoms. Treatment usually consists of bulking agents to regulate the consistency of the stools, antispasmodics to control the irritability, simethicone to control the gaseousness, medications to manage and control the constipation or diarrhea, probiotics to replenish the normal flora, and antianxiety or antidepressant medications to control anxiety and depression.

Can you talk about food allergies that cause problems with digestion?

Food allergy is rare and occurs in only 2 percent of the population. A person with a food allergy will develop GI symptoms such as abdominal pain, nausea and diarrhea about an hour after eating the inciting food. To determine what a person is allergic to, we have them maintain a food diary. We try to isolate the food that made them have these GI problems. The patient could then be sent to an allergist. Also an endoscopy would often reveal eosinophils, a type of white blood cell that suggests an allergic reaction. If an allergy to a specific food is suggested, then the patient would be told to avoid that type of food.

May is Celiac Disease Month. Can you explain what celiac disease is?

Celiac disease also is called non-tropical sprue. It’s a condition that is characterized by the damage of the small intestines, when there is an adverse reaction to gluten in wheat and the prolamins in rye, barley and oats. There is a generic predisposition to this disease and development of antibodies in the intestines that react to the gluten and prolamin in rye, barley and oats. Classic symptoms include diarrhea, abdominal pain and distension, anorexia, gaseousness, irritability and weight loss. In children, there is often failure to thrive and impaired growth and maturation. Since there is damage of the absorptive surface of the small intestines, there is malabsorbtion of many nutrients, including vitamins, resulting in several abnormalities including anemia osteoporosis, bleeding, neuropathy and low calcium, magnesium and proteins. Diagnosis is made with antibody blood tests and with biopsies of the small bowel during endoscopy.

What types of treatments are available?

Treatment of celiac disease includes a gluten-free diet, which means avoiding foods that consist of wheat, barley, rye and oats. This is challenging since there are so many foods that contain gluten. There are many booklets that describe a gluten-free diet and many companies offer gluten-free products. It is often wise to use the expertise of a registered dietitian. The patient also often needs nutritional supplementation of vitamins D, K and B12 as well as folic acid, calcium, magnesium and iron. The majority of patients, about 70-75 percent, improve after two weeks on a gluten-free diet.


How common is celiac disease?

The incidence of celiac disease is about 1 percent of the Western world. We’re finding it and diagnosing it with more frequency because there is a blood test that we can do to make that diagnosis. The incidence is getting more significant.

Do you foresee a pill or some kind of treatment beyond avoiding gluten?

There may be a way to desensitize a person to gluten.

 

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