Question:
My daughter has been nauseous every day for the last 3 weeks. Last week, she was admitted to the hospital and after an endoscopy they diagnosed her with celiac disease. She has been off gluten and lactose for a week and the nausea symptoms are just as bad. She has no pain, bowel problems or any other symptoms. Even on Zofran she has vomited. I am questioning if this something outside of the celiac diagnosis.
Answer:
I would recommend giving this a little bit more time. There is quite a bit of variability in terms of the length of time it takes for the GI symptoms to resolve once celiac disease patients are started on a gluten-free diet.
As you know, in celiac disease, immune system cells called lymphocytes cause damage to the villi in the small intestine. Villi are the microscopic, finger-like projections of tissue that provide the absorptive surface necessary for digestion and absorption of nutrients. The damage to the villi in celiac disease can be quite severe. However, the injury is reversible with strict adherence to the gluten-free diet. Depending on the amount of damage, though, it can sometimes take weeks for the small intestine to heal.
I would expect there to be slow improvement over the next several weeks. If this were not the case, I would first recommend an evaluation of your daughter’s diet by a registered dietitian who has experience with celiac disease. There may be hidden sources of gluten in the diet! If the diet does not seem to be the culprit, I would next recommend an evaluation for other causes of nausea and vomiting. There could certainly be more than one process causing the symptoms.
Sincerely,
The Center for Celiac Disease at The Children’s Hospital of Philadelphia
