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No “window of opportunity” for celiac disease prevention

Uma Pisharody, MD, FAAP

Uma Pisharody, MD, FAAP
Pediatric Gastroenterologist

As a pediatric gastroenterologist, I’m often asked whether there is any way to prevent a child from developing celiac disease. Based on what I knew regarding how food allergies develop, I used to counsel families that there might be a “window of opportunity”, between four and six months, when it’s possible to introduce grains and other gluten-containing foods that could potentially “teach” the immune system to tolerate gluten and thus lower the risk of developing celiac disease.

However, my “window theory” recently got thrown out the window when the results of two important scientific studies were published in the New England Journal of Medicine.

Over the counter medications to avoid for gastrointestinal health

LuLu Iles-Shih, MD

LuLu Iles-Shih, MD
Gastroenterologist

Non-steroidal anti-inflammatory drugs (NSAIDs) are medications frequently used to treat general aches and pains like headaches, musculoskeletal, and joint pains. NSAIDs include Celebrex, Aspirin, Ibuprofen, Excedrin, Alleve, Advil, Diclofenac, and Naproxen.

However, these medications may cause harm to the gastrointestinal system: possible bleeding risks, ulcer formation, ischemia, or decreased blood flow to certain areas of the gastrointestinal system which can lead to increased bleeding, vomiting of blood, or blood in the stool. These medications should be ...

How to deal with gas and bloating

Margaret Gorham, ARNP
We all have occasional gas, usually from something we have eaten, but many people feel that they pass too much gas or burp too frequently. Intestinal gas can result in abdominal pain, bloating and embarrassment.
 
The amount of gas produced by the body depends upon your diet and other factors. Most people with symptoms of excessive gas do not produce more gas than the average person, but are more aware of normal amounts of gas.
 
Where does the gas come from?

Bellyaches in Kids (and the “Und Here” Syndrome)

Uma Pisharody, MD, FAAP

Uma Pisharody, MD, FAAP
Pediatric Gastroenterologist

Bellyaches, stomachaches, or belly pain in school-age children are a common occurrence.  At least half of the children that get referred to pediatric gastroenterologists like me come for treatment of their chronic, recurrent abdominal pain.  Parents often feel frustrated because despite multiple visits to physicians, even emergency rooms, they are left with more questions than answers all whilst their child continues to suffer.

A typical scenario is a child whose pain seems worst in the mornings after awakening and towards the evening, especially after dinner or before bedtime.  Often the child doesn’t want to eat breakfast and if forced, tells his parents he feels nauseated.   When asked where the pain is, the child most often points to the area around his belly button.

More often than not, depending on a few other factors, the diagnosis ends up being ...

Kids and lactose intolerance

Uma Pisharody, MD, FAAP

Uma Pisharody, MD, FAAP
Pediatric Gastroenterologist

Do you wonder if your child might have “lactose intolerance”?    Have you ever thought of removing dairy from your child’s diet?  If the answer to either of these questions is yes, here are a few things to remember when it comes to lactose intolerance in kids:

  • Lactose is broken down by lactase.

While lactose is the carbohydrate (sugar) found in milk, lactase is the enzyme that digests the sugar. This enzyme is found in the lining of the small intestine, breaks down lactose into simpler molecules that are easier to absorb.  When there isn’t enough lactase, the sugar isn’t properly absorbed, which leads to the symptoms of “intolerance”, which include gas, bloating, pain and diarrhea.

  • True lactose intolerance is rare in young children.

Although children as young as infants can “transiently” have less lactase in their digestive tracts (most often, this happens for a week or two after an infection), lactase production remains ...

Gluten intolerance or low FODMAPs?

Uma Pisharody, MD, FAAP

Uma Pisharody, MD, FAAP
Pediatric Gastroenterologist

Despite test results that show no evidence of their children having neither any detectable allergies to wheat nor any signs of celiac disease, many parents choose to have their children follow a gluten-free diet.  This is because of convincing stories of how gluten (a protein found in wheat and other grains) seems to cause their kids to have belly aches, nausea, bloating and a variety of other symptoms.  

For years, this was hard to explain without a scientific explanation.   Gastroenterologists like me had a hard time supporting families who wanted to follow gluten free diets, without a good “medical reason”.  Then, in 2011, researchers from Australia conducted a double-blind, randomized, placebo-controlled, rechallenge trial in nearly 3 dozen patients (none of whom had celiac disease or wheat allergy), all of whom described worsening symptoms when unknowingly ingesting small amounts of gluten.  The results of this study described a condition termed, “Non-celiac gluten intolerance”.    It was after reading this landmark study that many physicians, including myself, began to validate parents’ concerns about gluten being the culprit behind their children’s gastrointestinal (GI) problems.

But then in 2013, just as word of non-celiac gluten intolerance was gaining popularity amongst physicians like me, the exact same group of researchers from Australia published a follow-up study on a similar set of about 3 dozen patients.  The findings of this 2nd study showed that instead...

Does your child have a food allergy or food sensitivity?

Uma Pisharody, MD, FAAP

Uma Pisharody, MD, FAAP
Pediatric Gastroenterologist

“Every time my child eats, his belly hurts. I think he must have a food allergy. Can you help us?”

Countless times have I heard this from parents of children worried about foods being the cause of their child’s gastrointestinal (GI) complaints. Some families wonder whether their child should start a “gluten-free” or other type of dietary change. More often than not, families have already tried a few diets before meeting with me.

Parents considering these types of elimination diets need to be aware of a few key points:
The difference between “food allergy” and “food sensitivity”:

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