ASGE Annual GI Advanced Practice Provider Course (Virtual) - Clinical Case-based Learning (Day Two) | March 2025-Clinical Vignettes: Approach to Bloating Small Bowel Diseases Incl Celiac and SIBO

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The presentation focuses on the evaluation and management of bloating, celiac disease, and small bowel disorders, primarily presented by Jill Olmstead from Providence Health System, Fullerton, California. It highlights delayed diagnosis in celiac disease, which can be up to 10 years post-symptom onset. The presentation emphasizes the integration of gluten into the diet before testing if a patient has self-initiated a gluten-free diet, recommending 3 slices of wheat bread daily for 1-3 months for accurate results.<br /><br />A comprehensive approach to bloating includes differential diagnoses that can stem from various etiologies like lactase or fructose intolerance, celiac disease, SIBO, or mechanical obstructions. Bloating can be influenced by both normal and abnormal viscerosomatic reflexes, affecting the diaphragm and abdominal wall musculature.<br /><br />Celiac disease, an autoimmune disorder, results in small intestine damage due to gluten ingestion. It is prevalent in about 1.4% of the population, with genetic predispositions linked to certain HLA genes. Classical symptoms include weight loss, diarrhea, and malabsorption, while non-classical symptoms might show anemia and osteoporosis.<br /><br />Diagnosis of celiac disease is done through serology and possibly a duodenal biopsy, particularly if the patient has been consuming gluten. Management involves a lifelong gluten-free diet, nutritional guidance from a dietitian, and regular follow-up to manage symptoms and nutritional deficiencies. Refractory celiac disease and concurrent disorders like IBS or lactose intolerance could impede recovery and symptom management.<br /><br />Small Bowel Bacterial Overgrowth (SIBO) leads to bloating, diarrhea, constipation, and abdominal pain. It’s diagnosed using breath tests measuring hydrogen, methane, and hydrogen sulfide, and treated with antibiotics like Rifaximin alongside dietary changes.<br /><br />Patient education and adherence to prescribed dietary and lifestyle changes are essential in managing these conditions effectively. Regular monitoring and follow-up appointments are necessary to ensure treatment efficacy and to manage any persisting or new symptoms.

Asset Subtitle

Jill Olmstead, DNP, ANP-BC, FAANP

Keywords

bloating

celiac disease

small bowel disorders

gluten-free diet

Jill Olmstead

SIBO

diagnosis

HLA genes

dietary management

breath tests