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 Ask
Dr. Aron
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 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?
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 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.
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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.
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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.
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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?
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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.
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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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