Question: My wife has been tested and shows some intolerance for glutens, eggs, milk products, and soy. She has been suffering from stomach problems since she had an ulcer in the lower stomach two years ago. She has had appointments with a cross section of doctors with no real analysis.
She has been on a diet with no gluten, soy, egg, or milk for two weeks with no relief. She has nausea, dry heaves, and, in the evening, she seems to throw up anything she has eaten. She’s lost at least 20 pounds in the past two months. What should she do next?
Dr. Hibberd's Answer:
I see that you have sensibly worked though an elimination of dietary precipitants, but I see no mention of any systematic investigation of your wife’s symptoms.
Celiac disease affects 2 million people in the United States alone, and is a genetic disorder where gluten intolerance is prominent. Not all people with celiac disease have symptoms.
Treatment with gluten elimination will stop symptoms within several days, but the small intestine usually takes three to six months in children, and up to several years in adults to heal sufficiently to fully absorb nutrients from food into the bloodstream.
Celiac disease is often misdiagnosed since its symptoms are easily confused with irritable bowel syndrome, inflammatory bowel diseases, intestinal infection, and chronic fatigue syndrome.
Diagnosis rates are increased now that effective blood tests are available (tTGA anti-tissue transglutaminase or EMA anti-endomysium antibodies). These tests are best performed while eating gluten, because the tests may be negative if a person stops eating foods with gluten before being tested.
Once the blood tests suggest celiac disease, a small intestinal biopsy is usually performed by scope to confirm the diagnosis and to check for damage to the villi. Celiac disease can be triggered by surgery, pregnancy, viral infection, or even severe emotional distress. It seems to affect its victims differently and is often associated with other immune-mediated diseases.
Gluten is a protein in wheat, rye, and barley, and is often contained in many medications, vitamins, and lip balms. When patients with celiac disease eat gluten, their immune system responds by damaging or destroying the villous lining of the small intestine resulting in malabsorption and diarrhea, cramps, abdominal pain, bloating, and sometimes vomiting, etc., and eventually malnutrition and weight loss.
Weight loss with recurring nausea and vomiting is extremely concerning and needs to be investigated and evaluated by a medical professional without delay.
Usual baseline investigations will include a CBC (complete blood count) as well as a CMP (comprehensive medical profile). Your physical examination will guide your doctor's choice of imaging. At the very least, it will involve a noncontrast CTT (cat scan) of the abdomen and pelvis to ascertain site(s) of inflammation, infection, abscess, or mass/obstruction(s). If no surgical condition exists, you can expect endoscopic evaluations of the upper and lower digestive tracts to be in order.
Despite all studies, I want to emphasize that recurring vomiting is extremely stressful on our bodies, and it doesn't take too much, even over a short period of time, to induce internal organ failure and even cardiac arrest and coma when electrolyte balances are sufficiently disturbed.
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