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   Conditions:

      Alternative Medicine
      Barrett's Esophagus
      Biliary Tract Diseases
      Bowel Dysfunction
      Celiac Disease
      Colon Cancer
      Constipation
      Crohn's Disease
      Diarrhea
      Diet and Nutrition
      Gallstones
      Gas
      GERD
      Gluten Intolerance
      Heartburn
      Hepatitis
      Hiatus Hernia
      Irritable Bowel (IBS)
      Indigestion
      Liver Disease
      Pancreatic Diseases
      Stress Reduction
      Ulcerative Colitis  
      Ulcers
   
    Procedures:

      Colonoscopy
      Endoscopy
      Liver Biopsy
 

  Ask Dr. Aron

Jul 07



Probiotic VSL#3 for Pouchitis?


Dr. Aron, I saw you for a consult 3 years ago in regard to IBD. Most recently I'm now almost one year out post J-pouch.

When I saw you had mentioned a probiotic that I could obtain through Costco pharmacy at a reasonable price. I can not remember the name? I'm told that VSL#3, which seemes a bit expensive, has pretty much become the physician recommended standard of care in the control and prevention of pouchitis? Given my changes since I saw you last would you still recommend the probiotic that you initially told me about and if so can you recommend a dosing post J-Pouch?

Also you mentioned the Costco fish oil and again I would also be interested in appropriate dosing for that post J-Pouch if appropriate. It is now commonly available enteric coated, however I would think the regular capsule might be a better fit for me at this point?

There are other probiotics that come close to the bacterial species found in VSL#3, but have not been studied in pouchitis. They are: Flora-Q, Jarrodophilus FOS, and Primal Defense. You should take at least 3-4 capsules a day of any of these, and hope for the best. The other probiotics are just riding the coat tails of VSL. The higher cost of VSL reflects the considerable expense that the company has undertaken to prove the value of VSL in clinical trials.

Health and happiness,

Dr. Aron
, Mar 08

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Cancer risk- elevated, flat, depressed lesions.

You've performed 2 colonoscopies on me, the most recent one last year. I just read an article in the New York Times about a recent study on the cancer risk of elevated, flat & depressed lesions. Can you comment on that study, & your approach to these lesions when you perform a colonoscopy? Thank you.

Elevated, flat and depressed lesions in the colon all carry an increased risk for developing colon cancer, especially in the setting of chronic inflammatory bowel disease, such as ulcerative colitis and Crohn's disease. We can now visualize these lesions more accurately with our newer endoscopes that can magnify the image of the lesion, and give a detailed view of its surface with Narrow Band Imaging, or chromoendoscopy. At our endoscopy center-Golden Gate Endoscopy Center-this advance is utilized for colorectal cancer screening.

Health and happiness,

Dr. Aron
, Mar 08
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Trial for AT1001, a drug for leaky gut.

I heard the tail end of Dr. Aron on KGO this morning. He mentioned something about potentially needing research test subjects for Celiac, but didn't catch enough to know specifics. Can you send me information? Thanks.

Thanks for your inquiry. We need newly-diagnosed celiacs who have a positive tTG >10 units, still eating gluten to qualify for our study of AT1001, a drug that prevents leaky gut. We will need to do a biopsy at the outset of the trial, and one at the end. We will be checking on how you feel, and measuring gut leakage with a standarized urine test. You will recieve $50.00 for each visit, and get detailed nutritional counseling as well. Please let me know if you're interested; the trial will start in April.

Health and happiness,

Dr. Aron
, Mar 08

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Why am I not feeling better?

I was diagnosed with celiac disease Marsh IV three years ago. I did better for a little while but now I seem to be regressing. The doctor I had never said anything about follow ups, just stay gluten free. Am I at risk for more severe problems because it is Marsh IV? Can you regress even though you stay gluten free? I’m only 41 but have been feeling like 75.

You may be having “refractory celiac disease”, a much more likely event given your Marsh IV pre-treatment biopsy. You need to have the following: IgG and IgA anti-tTG antibodies tested, imaging of the small intestine by either barium small bowel xray, or CT enteroclysis, and a repeat biopsy. After that, a plan of further treatment can be established. If you are in Northern California, we could initiate these studies at California Pacific Medical Center. You should see a gastroenterologist in your area if not near us.

Health and happiness,

Dr. Aron
, Mar 2008
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Causes of positive Transglutaminase?

I had a positive transglutaminase and I am having an endoscopy done to confirm that I have celiac sprue. I am just wondering what other autoimmune inflammatory diseases would cause a positive transglutaminase result?

Undiagnosed and untreated celiac disease is often associated with other autoimmune diseases, and thus a positive tTG antibody test may indicate the presence of other autoimmune diseases. That said, no one will diagnose you with an autoimmune disease based solely on the positive tTG; you’ll need to be tested for ANA, RA, and a host of others. The good news is that many of the associated autoimmune diseases with celiac disease can be reversed with a gluten-free diet.

Health and happiness,

Dr. Aron
, Mar 08
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Blood test and stool test differ?

I am concerned that my 2 1/2 year old daughter may have celiac. I am 37 and my 1st cousin on my father’s side has celiac disease, and my aunt (not her mother) on my father’s side had lupus (she has been dead over 30 years).

My daughter is about 33 inches tall and weighs 28 pounds. She is a very picky eater to begin with. She has about 3 to 5 bowel movements a day; these are all over the map in terms of consistency and size. She doesn’t stool at night and the colors of these BMs range from green to brown (never red, black, grey, or white). Sometimes I can see what she had eaten in them (i.e., grape skins) but she also doesn’t always chew her food in the first place!

We are going to see a pediatric gastroenterologist in our area. She has already had some labs done. I read another posting and will ask for the Prometheus Celiac-Plus panel to be done.

Here are the results from some blood work from Quest:

IgA Serum - = 51
Gliadin AB (IgA) = <3
TTG Ab IgA = <3

These are all in the normal range according to Quest.

We also did stool testing through Enterolab in Dallas.

Gluten Sensitivity Stool and Gene Panel Complete
Fecal Antigliadin IgA 222 (Normal Range <10 Units)

Fecal Antitissue Transglutaminase IgA 163 Units (Normal Range <10 Units)

Quantitative Microscopic Fecal Fat Score <300 Units (Normal Range <300 Units)

Fecal anti-casein (cow’s milk) IgA antibody 155 Units (Normal Range <10 Units)

HLA-DQB1 Molecular analysis, Allele 1 0201

HLA-DQB1 Molecular analysis, Allele 2 0301

Serologic equivalent: HLA-DQ 2,3 (Subtype 2,7)

These tests indicate that there is a definite problem - I guess gluten sensitivity and casein sensitivity. I don’t understand how 2 tests can be so different and the results came in within a week of each other; she has been on gluten and dairy the whole time and will continue to be until we meet with this pediatric gastroenterologist.

What is your thought on stool testing? I have not seen much positive response to it within the medical community online.

What should we specifically ask for when we meet? I guess a biopsy is needed to make a definitive diagnosis but I really, really don’t want to be so invasive with her. Any advice is much appreciated.


You should know that your daughter’s blood IgA levels are low, and that would make the IgA based antibody tests falsely normal.

Secondly, commercial lab blood testing can be notoriously inaccurate, with sensitivity as low as 40% in some instances.

The stool tests need to be validated in large scale trials with biopsy as the end point before they can be generally accepted.

In your daughter’s instance, the tests strongly suggest celiac disease, but are confounded by the casein data: she needs an intestinal biopsy. My pediatric colleagues at California Pacific Medical Center are skilled and expert in this problem, and I’m sure that they can satisfy the situation. Please let me know how things are going, and I can arrange a consult with them for you.

Follow-up Question: You mentioned that the “casein intolerance confounds the issue.” I’m confused on that - does that mean that she MAY have only a casein problem? Do we need to eliminate one before the other? (casein before gluten, or whatever).

Follow-up Answer: Milk protein (casein) allergy can mimic the symptoms of celiac disease, but does not cause the same pathologic changes in the intestine as celiac. Therefore, an intestinal biopsy will resolve the issue.

Health and happiness,

Dr. Aron
, Mar 08  

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