Gluten-Free China

Gastro Q&A

Akiko Natalie Tomonari MDakiko.tomonari@parkway.cnAkiko Natalie Tomonari MD

akiko.tomonari@parkway.cn

Gastroenterology SpecialistParkwayHealth

Introduction (of myself)

• Born in Japan, Raised in Maryland, USA

• Graduated from Medical University in Japan

• Has experience in US and Japan

• From Hokkaido, Japan

• Has been in Shanghai for almost 2 years• Has been in Shanghai for almost 2 years

Introduction (of celiac disease)

• What is Celiac disease??

• Having a “reaction” to eating gluten

What is Gluten??

What is Celiac disease?

Small Intestines

MicrovilliMicrovilli

Absorb

nutrients

in food Endothelialcell

Villi

Microvilli& endothelial cells

Antibodies

& endothelial cellsbecome damaged

Villi become flatMalabsorptionIncreased gasAbdominal

pain

If I am Celiac, how will I feel?

• Symptoms you

WILL feel• Bloating/increased

gas, especially after

eating

• Diarrhea

• Conditions you

WILL NOT feel• Anemia (iron

deficiency)

• Vitamin deficiency

Bone diseases Children may Children may

Asymptomatic

• Diarrhea

• Constipation

• Nausea or vomiting

• Weight loss/gain even

though you are eating

the same amount

• Oral ulcers

• Psychiatric problems

• Dental problems

• Bone diseases

(osteoporosis)

• Elevated liver enzymes

• Thyroid disease

• Infertility

Children may

show growth

problems

If you have a family If you have a family

member with CD, you

are high risk

What’s the difference between“similar” diseases?

CeliacDisease

Non-CD gluten

sensitivity

Irritablebowel

syndrome

Wheat Allergy

Symptoms

Bloating/GasStomachache

Diarrhea/ConstipationWeight gain/loss

Nausea

HivesSwollen

lips/tongueItchiness

WheezingAnaphylaxis

Gluten intake

Worse WorseNot onlygluten

Worse (only wheat)

Smallintestine biopsy

Abnormal Normal Normal Normal

Genetic test (HLA-DQ)

Positive Negative Negative Negative

IgE exam Negative Negative Negative Positive

Risk for other diseases

ElevatedNot

elevatedNot

elevatedNot

elevated

How is it diagnosed?

American College of Gastroeneterology, Celiac Disease guideline

IMPORTANT:

Exam should be

done on GLUTEN

RICH DIET!

Exam availability

Available at Parkway

Total IgA Yes

AGA-IgA/G YesAGA-IgA/G Yes

TTG-IgA/G Yes

EMA-IgA/G No

DGP-IgA/G No

HLA-DQ2/8 No

Small intestine biopsy Yes

What do I do if I’m already gluten free?

• Exams can be done if GF <1 month

But if you’ve already been GF for a while…while…

• Genetic testing can be done to try to

exclude CD

– If negative, no need for further testing

– If positive, will need to go on “gluten

challenge”

How do I treat CD?

• There is no “treatment” (medication,

surgery, etc)

• Keeping a gluten free diet is the only

“treatment”“treatment”

• Having a dietician is recommended

If you have been

diagnosed…

You need to stick to

GFD for life!

If you have been

diagnosed…

You need to stick to

GFD for life!

What contains gluten?

• Primary sources

• Wheat (triticale,

semolina, spelt,

khorasan wheat)

• Hidden sources

• Oats

• Sauces

• Drug fillerskhorasan wheat)

• Rye

• Barley (malt)

• Drug fillers

• Shared food

preparations

• Processed meats

What are the other things I need to be careful about?

• Higher risk for…

1. Lymphoma (cancer of blood)

2. Small intestine cancer2. Small intestine cancer

3. Liver disease (PBC)

4. Autoimmune disease

1. Type I diabetes

2. Autoimmune thyroid disorder

How should I follow up?

• When newly diagnosed, nutritional

deficiencies should be screened

(iron, vitamins, folic acid)

• If deficiencies are detected, need to follow • If deficiencies are detected, need to follow

up to confirm it is back to normal

• If GFD does not improve symptoms,

endoscopy follow up is needed

• If able to keep a strict GFD, follow up is

necessary only once a year

Survey: Living with Celiac Disease/Gluten sensitivity in Asia: How

difficult is it?• Survey conducted in November, 2016 to CD or gluten free patients in

China, with cooperation from Gluten-free China

• Age Range: Under 19 (9.52%), 20’s (38.1%), 30’s (26.19%), 40’s

(16.67%), 50’s (4.76%), Over 60 (4.76%)

USA

19%

Canada

12%

UK

9%

China

9%

Australia

10%

Italy

7%

Netherland

5%

New Zealand

5%

Sweden

5%

Others

19%

Country of origin

Prevalence of Celiac Disease Autoimmunity

Among Adolescents and Young Adults in

China

• Yuan et al, April, 2017

• 19,778 undiagnosed Chinese young adults (16–25

years old) were tested for CD related blood markersyears old) were tested for CD related blood markers

• About 2% tested positive for CD autoimmunity

• In China, the occurrence of CD may be more

common than previously recognized

Yuan J, Zhou C, et al, Prevalence of Celiac Disease Autoimmunity

Among Adolescents and Young Adults in China, Clinical Gastroenterology and Hepatology (2017),

Doi:10.1016/j.cgh.2017.04.025

Thank you.Thank you.