Question on Celiac and Colitis

ant · Post by **ant** » Tue Mar 08, 2011 6:36 am

Dear All,

I am sure there is an easy explanation but I have been wondering........

If the colon - when working properly and not inflamed (i.e. no colitis) - absorbs moisture, how come Celiacs get D?

Put another way, by definition Celiac disease only effects the small intestines. If a Celiac's colon were not inflamed, even when they have inflamed small intestines, would not a healthy colon still absorb moisture and produce a firm BM?

If this reasoning is right, it would follow that any Celiac with D is not only suffering from Celiac but also some for of colitis (i.e. inflammation of the colon).

Of course, since I have MC I may be all "wet" (pun intended):???:

Best, ant

Joefnh · Post by **Joefnh** » Tue Mar 08, 2011 6:44 am

Ant I believe the answer lies in the 2 causes of D. One is secretory in nature i.e. people with Crohns have sores and damage to the lining of the small intestine, and this area secretes various protective fluids that can and do cause D. The fluids secreted by the small intestine such as mucus cannot be removed by the large intestine. In the colon however the osmotic balance cannot be maintained due to the inflammation which results in D. Remember its the job of the large intestine (colon) to balance the amount of water in the waste stream.

So there are 2 causes of D, secretory and osmotic

--Joe

Post by **tex** » Tue Mar 08, 2011 1:01 pm

Hi Ant,

Joe basically has it pegged. D virtually always originates in the small intestine, and because of that, the colon can't do much about it. If you look at the chemical mechanism that causes D, it is initiated when the small intestine either fails to properly absorb certain electrolytes, (particularly sodium), or it actually secretes them, and this chemical signal promotes D downstream from there. Normally, in addition to water, the colon also absorbs and recycles electrolytes, but when the level of sodium and other electrolytes in the fecal stream is significantly higher than normal, the colon discontinues absorbing electrolytes, and follows the chemical "mandate" to purge the system.

At least that's my understanding of how D typically originates.

Tex

P S Actually, there are 3 different types of D, but the other one is usually irrelevant to MC. The other type is "exudative".

TooManyHats · Post by **TooManyHats** » Tue Mar 08, 2011 1:44 pm

So is the discussion only relevant to Celiac disease? I didn't realize the small bowel was involved in MC. I'm confused, as you can tell.

Pat · Post by **Pat** » Tue Mar 08, 2011 5:55 pm

Small bowel is also involved in fructose malabsorption which causes D.

Pat

Post by **tex** » Tue Mar 08, 2011 8:40 pm

Arlene,

Many of us with MC also have small bowel involvement, and this can be proven by biopsy, except that most GI doctors never look past the colon for markers of MC, because by definition, MC can only involve the colon, (colitis refers to inflammation of the colon). IOW, the disease was improperly described initially, and so most doctors just assume that only the colon can be involved. Doh! Actually, similar to Crohn's disease, any part of the digestive tract, from mouth to anus, can be affected by MC. In fact, the most likely location to find biopsy samples that are positive for the markers of MC, is on either side of the cecum, IOW, in either the terminal ileum, or the proximal colon, (the ascending colon).

Many MC patients show lymphocytic infiltration in their small intestine, (upon small intestinal biopsy), but, of course, GI docs almost never check for the markers of MC in the small intestine, so those markers are sort of like sound in a forest if there's no ear to hear it - GI docs are not going to find those markers, if they don't look for them. Some MC patients even show Marsh I or Marsh II levels of villus atrophy, (despite the absence of postive celiac serology). So yes, the small intestine is definitely involved with MC for many of us, including myself.

Have you ever read about collagenous gastritis, or collagenous sprue? IMO, collagenous gastritis is simply collagenous colitis in the stomach, and collagenous sprue is simply collagenous colits in the small intestine, but the doctors don't realize it, and they're flummoxed by the fact that MC is misnamed, so they have to call those issues something other than CC.

Tex

irisheyes13 · Post by **irisheyes13** » Wed Mar 09, 2011 8:37 am

I was lurking on celiac.com not long ago and read an excerpt from a study on collagenous sprue published in Clinical Gastroenterology and Hepatology Jan 2010. I had never heard of it until reading several articles posted there. The researchers seem to come so close and are dancing around gluten sensitivity and MC but just won't see the forest through the trees. The article is titled "Gluten-Free Diet and Steroids Effective for Most Cases of Collagenous Sprue" and the link is here:
http://www.celiac.com/articles/22084/1/ ... Page1.html

Other common associated diseases included microscopic colitis, hypothyroidism, and autoimmune enteropathy.

Bingo.

ant · Post by **ant** » Thu Mar 10, 2011 7:44 am

Dear Tex and Irish eyes

Bingo indeed!

Tex wrote

In fact, the most likely location to find biopsy samples that are positive for the markers of MC, is on either side of the cecum,

Correct me if I am wrong, but the cecum is the nearest part of the colon to the small intestines. IMHO many celiacs (especially refractory) have inflamed colons and many diagnosed with MC have (undiagnosed) inflamed small intestines.

When is the Emperor....... (by which I mean the faceless, honorable elders who control the rules and regulations of "Established Medicine" - the laws, protocols, HR decisions, supply chains, research funds, university endowments and professorial chairs, insurance premiums, definitions of disease and all the hidden powers of a closed profession).....When is the Emperor going to be challenged by the simple observation ""But he isn't wearing anything at all!"

Why, in the naked Emperor's definition, does Celiac stop at the terminal Illium and MC start at the Cecum? Any child could point out that this is just an artificial boundary with no validity in the world of common sense.

End of rant, Best, ant

TooManyHats · Post by **TooManyHats** » Thu Mar 10, 2011 8:16 am

Have you ever read about collagenous gastritis, or collagenous sprue? IMO, collagenous gastritis is simply collagenous colitis in the stomach, and collagenous sprue is simply collagenous colits in the small intestine, but the doctors don't realize it, and they're flummoxed by the fact that MC is misnamed, so they have to call those issues something other than CC.

I wonder if this explains the pathology report of my stomach biopsy?

"Gastric mucosa showing mild reactive gastropathy. No evidence of intestinal metaplasia."

My doc did take a sample of the ascending colon, which also showed MC.

Post by **tex** » Thu Mar 10, 2011 10:40 pm

Ant wrote:Correct me if I am wrong, but the cecum is the nearest part of the colon to the small intestines. IMHO many celiacs (especially refractory) have inflamed colons and many diagnosed with MC have (undiagnosed) inflamed small intestines.

Yes, the cecum is the valve between the two.

And yes, I agree with you. Like most theoretically-constrained scientists, doctors don't like to acknowledge the existence of gray areas in science/medicine, so they pretend that everything in medicine is clearly defined, and either black or white, with nothing in between. In the real world, of course, such a position is clearly fantasy - simply wishful thinking.

Arlene wrote:I wonder if this explains the pathology report of my
stomach biopsy?

"Gastric mucosa showing mild reactive gastropathy. No evidence of intestinal metaplasia."

Maybe, that description could possibly apply to lymphocytic gastritis, also.

Tex