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Ask the Doc: Why am I not feeling better?

Q. 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.

A. 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

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