A Test for Celiac Sufferers
Dear Dr. Roach: I have to take levothyroxine in order to obtain an acceptable TSH number. I have read that some doctors are stating that there is a relationship between hypothyroidism and gluten intolerance, possibly even celiac disease. Is this proven to the point that a patient should alter his or her diet and give up the basic foods of bread and cereal? — R.K.
Answer: People with celiac disease have a much higher risk of autoimmune thyroid disease (especially Hashimoto’s, the most common cause of low thyroid) than expected, to the point where everyone with celiac disease should have a blood test to look at thyroid levels. Celiac disease, or intolerance of gluten in general, may have few or subtle symptoms, and it might be worthwhile to consider testing for celiac disease in people with autoimmune thyroid disease. However, I would not recommend a drastic change in diet for people with thyroid disease if there are no symptoms.
Dear Dr. Roach: I have had stomach pain on my lower left side for several months. Other symptoms include occasional heartburn, bloating and almost constant burping. My doctor is treating it with metronidazole, clarithromycin and omeprazole. Could these be symptoms of stomach cancer? — D.W.
Answer: Abdominal pain, heartburn and belching are nonspecific symptoms that can be associated with many conditions. The most common would be GERD (gastro-esophageal reflux disease), gastritis and stomach ulcer. The combination of medications your doctor is treating you with is for the bacteria H. pylori, which can cause gastritis and ulcers. Eradication of the infection, which is very common, can heal ulcers and relieve symptoms. H. pylori can be diagnosed definitively by a breath test or a stool test, or by biopsy of the stomach. A blood test shows evidence of old infection, but it isn’t completely accurate.
Stomach cancer has vague symptoms as well, and requires a high degree of suspicion. Stomach symptoms that don’t improve with treatment, or that have worrisome features like weight loss, early satiety (the feeling of being full after eating only a small amount of food) or bleeding should cause the doctor to consider an endoscopy to look at the stomach. New onset of symptoms in someone over 55 also should be considered for endoscopy.
Treatment of H. pylori may reduce future risk of gastric cancer (that’s stomach cancer).
Dear Dr. Roach: I am a veteran and have had digestive problems (GERD and gastritis) since I came back from Vietnam in 1968. How closely related are these disorders? — J.R.O.
Answer: GERD (gastroesophageal reflux disease) is very, very common, and refers to the passage of food and acid backward — from the stomach into the esophagus. The general cause of GERD is a relative weakness in the lower esophageal sphincter, the muscular, valvelike structure at the bottom of the esophagus. Gastritis is an inflammation of the lining of the stomach.
Both of these terms often are used imprecisely, as a guess at what might be causing nonspecific stomach pains. With such a prolonged course, it would be wise to make sure of your diagnosis, as your symptoms actually might be caused a different condition, such as an ulcer or infection by the bacteria H. pylori, which would require different treatment.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or write to P.O. Box 536475, Orlando, FL 32853- 6475.