Celiac Disease in a Patient With Morbid Obesity

Owen, David A.; Thorlakson, T. Kenneth; Walli, J. Eric

doi:10.1001/archinte.1980.00330210128039

Cited by 12 publications

(11 citation statements)

References 7 publications

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“…There have been few reports of CD diagnosed in obese individuals after bariatric procedures [4,7,14]. We report three further patients undergoing bariatric procedures which led to unmasking of CD.…”

Section: Introductionmentioning

confidence: 82%

“…The initial reports of CD developing after bariatric procedures were two patients who were diagnosed following jejunoileal bypass. One was diagnosed when severe malabsorption developed nine months later [14]. The other was diagnosed when villous atrophy was identified in an operative specimen [7].…”

Section: Discussionmentioning

confidence: 99%

“…Subsequent evaluation then leads to the diagnosis, termed "unmasking" [6]. Initial reports of this phenomenon occurred following upper gastrointestinal procedures such as fundoplication and gastrectomy [6]; however, unmasking has been subsequently described following a variety of intraabdominal and extraabdominal procedures [7][8][9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

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Bariatric Procedures Unmasking Celiac Disease

2014

J Obes Bariatr Surg

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Celiac disease is being recognized more frequently but often remains undiagnosed. Celiac disease patients are increasingly obese. Major operation in patients with celiac disease may cause symptoms which lead to the diagnosis, termed "unmasking." We report three patients undergoing bariatric procedures which led to unmasking.Three patients undergoing bariatric procedures for morbid obesity were subsequently diagnosed with celiac disease. A 42-yearold female underwent gastric bypass. Her body mass index was 77 preoperatively and open gastric bypass with a 150 cm Roux Limb was performed. At 18 months her body mass index was 51 and she had no diarrhea. A malabsorptive revision moved the Roux Limb connection to 60 cm proximal to the cecum. One year later she had a body mass index of 36 and diarrhea. Persistent diarrhea and weight loss in the following two years led to serologic diagnosis of celiac disease. On a gluten-free diether diarrhea improved and her weight increased 6 kg. A 30-year-old female underwent gastric band. Her body mass index was 46 preoperatively. After multiple adjustments a band slip repair was performed at two years and the band was removed at four years. Body mass index was 42 at that time. Within a few months she developed early satiety, abdominal pain and distension, and hepatomegaly. Serology and histology diagnosed celiac disease and a gluten-free diet was instituted. A 36-year-old female underwent biliopancreatic diversion. Her body mass index was 48 preoperatively and decreased to 22 in two years. Persistent diarrhea led to serologic evaluation for celiac disease. She was started on a gluten-free diet and her body mass index increased to 27 at five years and 30 at ten years postoperatively.Celiac disease should be suspected and evaluated in patients who develop suggestive symptoms after bariatric procedures, including those associated with malabsorption.

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Section: Introductionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Bariatric Procedures Unmasking Celiac Disease

2014

J Obes Bariatr Surg

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“…There have been reports of mortality and significant morbidity after bariatric surgery in such patients. [6,7] Performing bariatric surgery in a case of celiac disease therefore involves significant risk and invites special precautions. We here report a case of a patient who is a known case of celiac disease and thalassemia minor who underwent laparoscopic sleeve gastrectomy without worsening of her symptoms of celiac disease.…”

Section: Introductionmentioning

confidence: 99%

Sleeve Gastrectomy in a Patient With Celiac Disease and Thallesemia Minor Is Safe

N¹,

Chamany²,

Ramesh³

2014

jemds

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Celiac disease is a chronic small intestinal immune-mediated enteropathy precipitated by exposure to dietary gluten in genetically predisposed individuals. Classical celiac disease presents with signs and symptoms of mal absorption. The true prevalence of the disease is not known. Up to 13% of patients with celiac disease are overweight. Any abdominal surgery can trigger the disease in a previously normal patient or aggravate the disease. OBJECTIVE: To show that simpler bariatric procedures like sleeve gastrectomy can be performed safely in patients with celiac disease. METHODS: A 53 year old female, a known case of Type II Diabetes mellitus, hypertension, OSA on treatment & who was diagnosed to have thalassemia minor 24 years back and celiac disease 7 years back, having a BMI of 43.5 kg/m 2 & HbA1c of 7.3% underwent laparoscopic sleeve gastrectomy. RESULTS: Patient has had 45 % excess weight loss at one year follow up with complete remission of diabetes (HbA1c of 5.4%), without any aggravation of celiac disease. CONCLUSION: Sleeve gastrectomy appears to be safe and well tolerated in patients with celiac disease.

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“…Despite the description of obesity in patients with CD (3)(4)(5)(6)(17)(18)(19)(20)(21)(22), the role of adiposity on stature in prepubertal children with CD is unknown. In general, obese or overweight children are taller than normal-weight children (23).…”

Section: Introductionmentioning

confidence: 99%