Suggest Treatment For Celiac Disease And Mild Nighttime GERD

Posted on Mon, 29 Jun 2015

Question: This morning I underwent an endoscopy and am now recovering at home. Blood tests indicate Celiac and I know they took biopsies from my small intestines. However I was also told they took some biopsys from my stomach and am wondering why. The result recorded on my file was simply that the biopsys were taken and indications are celiac, but i have to wait. I have been on omeprazol for 18 months first on 20 and now 10mg. I tried to stop omeprazol bu taking 10mg alternaitvely but I began to suffer some nausea and put that down to rebound effect and restarted to take 10 mg daily again. Thereafter my doctor started the blood work for celiac. I have some mild nighttime GERD and next to this some issues related to loose stools etc. I am worried that they saw something they didnt ike and thats resulted in additional biopsies, however I was also told that if the doctor saw something very nasty I would have been told some more information today, which I wasn't. My anxiety is they've seen something odd in addition to the celiac biopsies.Any reassurances you can give me are welcome. Im 38 non smoker/drinker, decent health except for likley celiac disease.

Answered by Dr. Dr. Klerida Shehu (2 hours later)

Brief Answer:
The full report of endoscopy is required for specific opinion...

Detailed Answer:
Hi,

I have gone through your medical history carefully and understood your concerns.

You are reporting to have celiac disease, and running endoscopy. It is normal for your clinical symptoms and diagnosis to take biopsy samples from different parts of GI tract including duodenum; while, in the stomach biopsy will evaluate the presence of H.pylori and if any other local changes in the mucosa.

Furthermore, anxiety is an aggravating factor to your actual symptoms.

If the doctors would have noted anything unusual (e.g. tumoral mass); they would have already told to you.

However, I need to have the full report of the endoscopy you ran.

Thank you!
Dr.Klerida

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Klerida Shehu (1 hour later)

Thank you for your response. His notes were simply findings could fit to active celiac disease, several biopsies were taken.
Not a lot to go by!
I had felt ok taking 20mg omeprazol and determined by myself that I should try to come off the medicine in a progressive way. Why would I need to take ppi's for so long, is this normal. Perhaps in the end 10mg is too low a dosage and in fact my probable celiac diagnosis may be the underlying cause?

Answered by Dr. Dr. Klerida Shehu (14 hours later)

Brief Answer:
Explained below. ..

Detailed Answer:
Hi back,

PPIS can be taken :
- for years in case of GERD
- the duration of use will depend on the tests reports you did
- we advise patients to avoid gluten foods. If symptoms will get better, then PPIs will no longer use

I am sure after following a gluten free diet, your symptoms will ameliorate and you won't need to take PPIs anymore.

Hope it answered to your queries!
Dr.Klerida

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Klerida Shehu (4 days later)

Hello Doctor,

I have the results back from the lab biopsys. My partner works in the same hospital and was able to get this before my follow up consultation on Weds.
I'm in quite a panic mode at that moment and here's why.
They took 8 biopsies in total 4 from 2 seperate locations and placed in two kits. one of the kits (4 biopsies) was completely normal.
The MAJOR problem is they didn't label where/which location in the stomach/small intestine they came from!! So Im anxious now and quite angry.
So the lab report contains two sets of conclusions..unfortunately it's in Dutch so I cannot forward it to you. I try here to describe it word for word
IT says:
1. By conclusion 1 - if the biopsys came from the duodenum then there is a increase in the intra epithelial lymphocytes and could indicate celiac should serology fit. If you remember I have had 3 seperate blood tests for Celiac all of which indicate strong presence of the disease.
By conclusion 2 - if the biopsys came from stomach antrum, then findings are related to 'atrophic stomachantrum'(?) type with average chronic infection annd extended metaplasia. Their is no acute infection, no Helicobacteria no dyspasie present.

Obvioulsy I need to try to keep perspective and given the celiac serology I hope this is the conclusion, but metaplasia carries potential very serious consequences and this bothers me enourmously.
Any advice you can offer will be much appreciated and / or recommendations you maybe have before my consultation on Wednesday..
As a footnote, I continue with 10 mg omeprazol without any issues. Good appetite, weight is fine etc, is I had conclusion 2 would I have known more about it?

Thanks,

XXXX

Answered by Dr. Dr. Klerida Shehu (12 hours later)

Brief Answer:
Explained below

Detailed Answer:
Dear XXXXXXX
I’m sorry the situation you are in.
I read carefully all your reports and I can say as follow:

1.     In clinical practice I take 4-5 biopsies from duodenum to confirm celiac disease and 4 biopsies in stomach to confirm H.Pylori presence and mucosa damage.

2.     Chronic atrophic gastritis is associated with presence of H.Pylori infection since this bacter is the major cause of it. At your case you are H.pylori negative so to my opinion the 4 normal sample biopsies are from stomach mucosa.

3.     You are reporting to have serology test for celiac disease that strongly indicate the presence of the disease. Conclusion 1 of sample biopsy that shows lymphocyte presence is most probably to be from duodenal mucosa. These findings explain your clinical symptoms.

4.     I need to check by myself endoscopy report. I need to know if there is any macroscopic finding in stomach mucosa. So I can better correlate microscopic findings with macroscopic view.

5.     I am glad to know that you have good appetite and no weight loss. Atrophic gastritis is often associated with anorexia, weight loss and megaloblastic anemia.

6.     I hope your GI explains this entire situation. I hope he has ticket by number the sample biopsy kits according to endoscopy report.

7.     To my opinion you suffer only from celiac disease and gluten free diet will improve your symptoms.

Hope it was helpful to you.
wish you all the best.
Dr.Klerida

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar