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Celiac sprue

Also listed as: Sprue; Nontropical sprue; Gluten intolerance; Gluten-sensitive enteropathy


Celiac disease, also called celiac sprue, is an inherited disease that damages the small intestine and interferes with digestion. People with this disease cannot tolerate a protein called gluten, and as a result, they have trouble absorbing nutrients from food. Gluten is found in wheat, barley, rye, and possibly oat products. Some vitamins and medicines also contain gluten.

The small intestine is lined with fingerlike projections called villi, which help absorb nutrients. In celiac disease, these villi become flattened, so they don't work as well and the person becomes malnourished.  

The disease can develop at any age. 


Signs and Symptoms

The symptoms of celiac disease can vary significantly from person to person. For example, one person may have constipation, another may have diarrhea, and yet a third may have no intestinal problems at all.

A partial listing of gastrointestinal symptoms:

A partial listing of non-intestinal symptoms:


Causes

Researchers don’t know the exact cause of celiac disease. Once thought rare, recent research suggests that an estimated 1 of every 133 Americans has celiac disease. However, in the United States, only a small fraction of people living with the disease are diagnosed.

People who have a family history of celiac disease are at greater risk for developing the condition. It is most common in Caucasians and those of European ancestry. Women are affected more commonly than men.


Risk Factors

Celiac disease occurs in 5 - 15% of the children and siblings of a person with celiac disease. The disease can be triggered for the first time after surgery, viral infection, severe emotional stress, pregnancy, or childbirth.


Diagnosis

People with celiac disease have abnormally high amounts of auto-antibodies. (Antibodies are proteins produced by the immune system that attack harmful substances in the body. Auto-antibodies, on the other hand, attack the body's own healthy tissues.) Therefore, several antibody blood tests are useful in diagnosing celiac sprue disease.

Other tests that may be done include:

Your doctor may order a follow-up biopsy or blood work several months after the diagnosis and treatment. These serve as a final confirmation of the disease.


Preventive Care

Since researchers are unsure of the exact cause of celiac disease, there is no known way to prevent the disease. However, being aware of your risk factors (such as a family member with the disorder) may increase the chance of early diagnosis and treatment.

Routine screening for celiac disease in people without symptoms is not done in the U.S. Antibody screening tests may not be reliable in young children.


Treatment Approach

A life-long gluten-free diet is required. This allows the intestinal villi to heal.

Completely eliminate foods, beverages, and medications that contain wheat, barley, rye, and possibly oats. 

Read food and medication labels carefully to look for "hidden" sources of these grains and their by-products. Since wheat and barley grains are found abundantly in the American diet, the treatment is challenging but can be done with education and planning.

Do NOT begin the gluten-free diet before being diagnosed with celiac disease. Doing so will alter future testing for the disease.

To correct nutritional deficiencies, doctors may prescribe vitamin and mineral supplements. Occasionally, doctors may prescribe corticosteroids (such as prednisone) for short-term use or if you have refractory sprue.

Following a well-balanced, gluten-free diet is generally the only treatment required for achieving wellness and eliminating symptoms. Several studies have also found that sticking to such a diet helps reduce the risk of intestinal lymphoma .

Upon diagnosis, seek consultation from a registered dietitian with a specialty in celiac disease and the gluten-free diet. Joining a local and national support group can also be invaluable in helping one to cope with the disease and diet. See also: Nutrition .


Prognosis/Possible Complications

Removing all damaging grains ("triggers" to the immune system) from the diet is the most important measure one can take to become healthy. One who follows the diet strictly can expect to lead a long, healthy life (as long as permanent damage did not occur before diagnosis).

Depending on the degree of intestinal damage prior to diagnosis, the improvement in symptoms may vary in duration once treatment begins. The gluten-free diet must be carefully and continuously followed. When untreated, the disease can cause life-threatening complications. A delayed diagnosis or failure to follow the diet places one at risk for developing other conditions.

There are numerous diseases and conditions associated with celiac disease. Some of these include:


Other Considerations

Since nutrients may not be absorbed properly, miscarriage, and birth defects such as neural tube defects may occur in untreated pregnant women with celiac disease.


Supporting Research

Rostom A, Dubé C, Cranney A, et al. Celiac Disease .  Rockville, MD: Agency for Healthcare Research and Quality, US Dept of Health and Human Services; June 2004. AHRQ Publication Number 04-E029-1. Available at http://www.ahrq.gov/clinic/epcsums/celiacsum.htm . Accessed December 1, 2005.

Hellekson K. AHRQ Releases Practice Guidelines for Celiac Disease Screening .  Am Fam Physician. May 1, 2005; 71(9); 1814-1819.

Rossi T. Celiac disease.  Adolesc Med Clin . Feb 2004; 15(1): 91-103, ix.

Feldman M, Friedman LS, Sleisenger MH, eds. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease. 7th ed. Philadelphia, Pa: WB Saunders; 2002: 466.

Goldman L, Ausiello D. Cecil Textbook of Medicine , 22nd ed. Philadelphia, PA: WB Saunders; 2004:852-854.


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