Celiac Support Association

CSA Region 5 June Meeting

Dr.Chandar Singaram, MD/GI of the Midwest Medical Care in Sioux Falls addressed the Region 5 Sioux Falls CSA Chapter on June 13, 2013.   He presented his background as an independent physician at the Sioux Falls Specialty Hospitals and is in his 28th year of practice, with his main area of interest being irritable bowel syndrome.  He felt that approximately 10-12% of his patients with irritable bowel syndrome have some other cause like celiac disease or other conditions. Questions and answers followed. 

Q:  What if you have had a surgical procedure for acid reflux and are still having heartburn?

 Even if you have had surgery done, you can you still get heartburn.   The procedure in the esophagus is where they reduce the hernia, and tighten up the opening so there isn't as much reflux.  Dr. Singaram stated reflux isn't only from acid. About 1/3 of the time it is from bile or other foods we eat.  Surgery is a way to get rid of that bile problem, since Nexium or Prilosec  only help acids.  One member noted that when she wasn't as heavy around the middle she didn't have as much reflux.

Q:  How does he treat CD in a confirmed patient?

He treats CD as aggressively as he can.   He classifies his patients into mild, moderate or severe CD.  He found in the younger age group, it’s extremely hard for them to go off gluten completely.  He puts them on some type of a steroid (usually Prednisone) for a week or 10 days as a trial period to show them what they may feel like if they treated their CD by staying off gluten.  He looks at that as being as good as they will feel if they followed the diet. 

So he then takes them off the Prednisone and works actively on their CD.  The meds he uses for patients with Crohn’s disease he sometimes gives them, if they want to stay on meds.  If they don’t get better, he looks for other things -allergies, lactose intolerance, etc.    Some behave just like CD.  If they are still struggling he takes them through several other tests or checks for lactose, grains, or maltose intolerance.  After taking those items out of the diet,  he slowly introduces them back onto them.

Q:  Does a steroid help a gluten reaction? 

  Steroids should be used in special circumstances only.   He says the symptoms for some people may be 50% less as severe.  It is only temporary.  He has found it to be helpful in his practice, but uses it only for very special circumstances.

Q:  Are you saying that Prednisone helps heal the gut?

   It’s only a temporary measure.  It does make the gut tighter, but does not heal it.  He’s not recommending we go on steroids.  It does not cure it.

Q:  Do you take children as patients? 

He is certified in both.   But he does see them.  He recommends going to a Peds doctor.

Q:  Have any patients with CD come in with light sensitivity  or dry eyes?

  He has 2 patients now who have Sjogrens.  Without Sjogrens, he has not seen any.  Sjogrens affects tear ducts, dry mouth and people have fatigue.

Q:  How do they diagnose Sjogrens?

 With a lip biopsy and blood tests.  A rheumatologist usually diagnoses this.  He recommends  Joseph Fancuillo. 

Q:  How much is a concern that the genetic testing  will affect a person's life insurance in the future? 

 It can be a concern for future coverage for life insurance.  The best way to keep testing from the insurance company is to pay it out of pocket and not run it through insurance.  He also advises going to a smaller clinic in a small town.   The information has a better chance of being protected from rejection in the future.

Q:  What is your opinion of taking various supplements or drugs imported from other countries and the chance that they contain gluten?

He advises to look where a drug is manufactured.  The ones in the U.S. have many more regulations, verses other countries like China or India, so he recommends taking only name brands and sticking with U.S. made drugs.  You have a better chance to get pure.  He wouldn’t  trust drugs from India at all.  Many companies buy generic drugs that they get at the lowest price possible.

Q:  Why are some celiacs so sensitive and others are not? 

  All patients are different.  Some have their joints affected, their stomach or skin.  The way he looks at is it -   what lymphocytes are being affected is why some people have worse symptoms.

Q:  What if a person tested positive for CD, has no obvious symptoms, -  will damage still be done to the gut? 

  Yes, absolutely.  Also many other problems may arise, like liver problems, 20-30 years down the road.

Q:  There has been some info out there saying a cure could be coming, what do you think?

  So much more research is being done and new information coming out that he believes yes,  maybe in 20-30 years there may be a cure.  How this will happen he doesn't know.

Final notes from Dr. Singaram:  He stated that he is not a total celiac specialist and confers with others in the field and recommends, both from Sanford,  Dr. George Gilbert and Dr. Lee Austin. He also uses Dr. Joseph Murray from the Mayo Clinic.

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