possible gluten intolerance

In July, after several weeks of various abdominal issues including pain, diarrhea, weight loss ,on and off for 2-3 weeks,then nausea later on with extreme fatigue I had a positive biopsy in the jeujeunum (sp?) for sprue and negative blood test results for sprue. I had already had loads of blood and stool tests. I know as well that I am anemiac (and have been for a while).  With a nutrionist helping me, I have been gluten and/or dairy free for the better part of 6 weeks, experimenting with different diets (gluten for a few days, No gluten/no dairy etc.)  I think my mild lactose intolerance has gotten much worse as well.  It is safe to say I have only had gluten approx. a total of 7 days out of the last 6 weeks.

My questions are:

I am constantly bloated, almost distended for the past 6 weeks.  My stomach is almost always hard and I look pregnant because of my build.  My weight was constant for 20+ years, and it dropped by 8 lbs in June and I remain at the lower weight which I do not like.  1) If I have been Gluten free, why does my stomach not deflate?
2) Does a few bites of gluten on a given day mitigate the gluten free that I had maintained, say for the past few weeks?  (I was told that by a dietician friend).
3) I have had incredible hair loss.  Is that due to malabsorption? The anemia?
I am not convinced I have celiac yet,(denial?) hence the diet experimentation.   4)  Could there be other explanations?
5) I burp after everything I ingest, usually within 10 minutes.   What causes that?
Thanks for your help.

[Kevin Pho, MD]

To answer your questions:
1) There is the possibility of a concurrent GI disease - such as irritable bowel disease, ulcers, GERD or inflammation of the upper digestive tract.

2) Typically all gluten needs to be eliminated from the diet to be effective.

3) Anemia as well as malabsorption leading to malnutrition can lead to hair loss.  A referral to a dermatologist can look for other causes.

4) As mentioned, concurrent GI diseases can be considered.  More specialized tests, such as a gastric emptying scan, can evaluate for gastroparesis (leading to your symptoms).

5) Many upper GI diseases can lead to burping - I would consider the gastric emptying scan.  Other specialized tests (assuming an upper endoscopy has already been done) can include a 24-hr pH study or esophageal motility studies.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
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