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'Gastroenterology' posts

FDA finally defines gluten free

On August 5th, 2013, the U.S. Food and Drug Administration (FDA) at long last published a formal rule regulating the use of the term "gluten free" on foods and beverages.  Even though this came with a big sigh of relief to the millions of people with celiac disease living in the US, consumers should be aware that the law gives manufacturers one year to be in full compliance (and goes into effect August 5, 2014).

As we head into the final months before the law’s final compliance date, I thought I’d highlight a few other key points about this brand new law:

1. No symbols needed.  The law does not require or recommend manufacturers use any particular symbol or food label, but if a label should include any of the following phrases, compliance must be ensured:
    •    “Gluten-free”
    •    “Free of gluten”
    •    “No gluten”
    •    “Without gluten”

2.  It’s voluntary.  A manufacturer may produce gluten-free foods, but just choose not to label them as such.   

3.  “Gluten-free” does not mean “zero gluten”. The new law defines "gluten-free" to mean that a food contains less than 20 parts per million (20 ppm) of gluten.  (This tiny amount can be visualized as less than a tenth of a grain of salt on a slice of bread, and is acceptable as the standard for people with celiac disease).

4.  As with any rule, there are exceptions.  Although ...

Pivotal time for chronic hepatitis C treatment

An estimated 2.7-3.9 million people in the US are chronically infected with hepatitis C.*  Patients are often diagnosed incidentally, when they donate blood, get life insurance or get a routine physical exam with blood tests showing normal or abnormal liver enzymes.  They may have been diagnosed many years ago with non-A, non-B hepatitis, but forgot about it, never followed up, or did not mention it to their regular health care provider.  In 2012, the Centers for Disease Control (CDC) issued additional recommendations to start screening “Baby Boomers,” those born between 1945-1965.  Though Baby Boomers account for 3.25% of the US population, they account for 3/4 of the hepatitis C infections.*

Patients may have seen a health care provider in the past and told that there is no treatment, that treatments were not effective, or not worthwhile due to side effects.  Patients have been reluctant to seek treatment because they have heard about the terrible side effects associated with treatment, including flu-like symptoms, fatigue, depression, muscle aches, rashes, etc, lasting up to a year. 

However, this is a pivotal time for hepatitis C patients because treatment has improved by leaps and bounds.  In late 2013, two ...

Troubles swallowing food or liquids – what does it mean?

Dysphagia refers to the sensation of food or liquid being delayed or hindered from the mouth to the stomach.  This abnormality is increasingly recognized as an important concern that requires attention and study.  There are many causes of impaired swallowing, which are categorized into two types, mechanical, a structural barrier to food bolus movement, and motility disorders, involving abnormal muscle movement.  There are also two major anatomical sites, oropharyngeal and esophageal. 
 
Oropharyngeal dysphagia is related to problems with the initiation of the swallows and clearing the food bolus from the mouth to the esophagus.  This usually occurs within a second of swallowing and you may feel that you cannot initiate a swallow or food hangs up in the neck region.  A test that is commonly used to evaluate this is a modified barium swallow or videofluoroscopic swallowing study.  This study provides critical information on inability or excessive delay in initiation of swallowing, unintentional inhalation of food, unintentional expulsion of food from the nose or mouth, and/or abnormal retention of food in the back of the throat after swallowing.  Most ...

Gluten allergy: myth or fact?

Gluten is a hot topic these days, and is hitting the headlines again. Why? At the American College of Allergy, Asthma, and Immunology annual meeting, Dr. David Stukus (a pediatric allergist) set out to clarify frequent myths that he encounters in his practice.  So, why is he saying that gluten allergies do not exist?

Gluten is a protein found in foods processed from wheat and related grain products.  In celiac sprue (affecting up to 1% of adults), gluten intake leads to damage of the small intestine, impairing its ability to absorb nutrients.  I like to imagine that a healthy small intestine is like a shag carpet, and small intestine affected by active celiac sprue is more like a tile floor.  Celiac sprue is not a gluten allergy, but rather an autoimmune condition where the gluten is triggering an inflammatory response in the body.

Studies find that ...

What causes constipation and how is it treated?

People often fear the worst about constipation.  Constipation is very common and only rarely signifies something serious.  Just because the average person has a bowel movement daily doesn’t mean you have to—if normal for you is every 3, 5, or 7 days that is okay so long as it’s not adversely affecting your life. In many cases, people with constipation struggle with it all their lives and are looking to be certain nothing more serious is going on and for a way to treat their symptoms.  Even in people with relatively new onset of constipation, there usually is a simple solution.  It is certainly reasonable to have your constipation assessed but in the absence of other warning signs for more serious disease, additional testing related to constipation is not always essential.

What are the causes of constipation?

Colonic inertia

  • Most cases of constipation are caused by colonic inertia, which is simply a slow moving colon.  Different people are made differently, and the muscles and nerves that are supposed to act in concert to push stool along just work a little slower in people with constipation.  In such cases, if we could look at the colon under the microscope it would look normal but if we took an x-ray of how quickly it pushed stool through, it would on average move things along more slowly.

Pelvic floor dysfunction

  • If ...

Is the FODMAP diet right for you?

FODMAPs is an acronym, coined by two Australian researchers, that refers to Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols.  These are small chain sugars, fibers, and sugar alcohols that are poorly digested by humans, but are easily digested by the bacteria in your intestine and colon.  When the bacteria consume FODMAPs, they produce gas, which leads to symptoms of gas, bloating, abdominal discomfort, and changes in bowel movements.  The FODMAP diet is used to alleviate the impact these types of foods have on your gastrointestinal tract. 

A diet low in FODMAPs food was designed to help minimize symptoms in individuals that suffer from irritable bowel syndrome (IBS) and functional bloating.  You should discuss your symptoms with your physician prior to starting this diet since other gastrointestinal related disorders need to be excluded first (i.e., celiac disease, thyroid disease, inflammatory bowel disease, and others). 

If a diet low in FODMAP is recommended for you ...

Swedish Digestive Health Network – call 1-855-411-MYGI (6944)

In the fall of 2011, Swedish opened the largest, most advanced endoscopy center in the Pacific Northwest. This state-of-the-art unit serves as the procedural space for a broad range of minimally invasive cases performed by gastroenterologists, colorectal specialists, thoracic and bariatric surgeons and pulmonologists on patients with a broad range of digestive and respiratory diseases.  As we celebrated this accomplishment, we were reminded of the complexity of digestive disease and that many times, patients and possibly even referring physicians aren’t sure of what type of specialist is best suited to a particular digestive problem.

There is nothing more distressing as a health care professional than hearing patient horror stories about trying to access care. A chronic illness can cause depression and discouragement; an acute illness or a cancer diagnosis can overwhelm the patient and the patient’s family with plenty of unknowns. 

To address these challenges, a group of 50+ specialists came together and created the Swedish Digestive Health Network.

The Swedish Digestive Health Network focuses on collaboration to ease the way for ...

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