Celiac Sprue (CS) is a disease of the lining of the small intestine. This part of the bowel lies between the stomach and colon or large bowel. It is about 20 feet long and is where nutrients, calories, vitamins and minerals are absorbed into the blood. The inside lining of the small bowel has tiny, microscopic, finger-like projections called villi. It is through these villi that nutrients are absorbed.
CS us a genetic disorder meaning that it can be passed through the genes from parent to child. It only occurs when the grain protein called gluten comes in contact with these villi. Gluten is present in wheat and all wheat products, barley, rye and, to a lesser extent, oats. In celiac sprue, the gluten protein severely damages these delicate villi. In fact, the damaged villi are actually destroyed so that absorption of nutrients may be severely affected.
CS tends to be most common in people of northern European extraction. It can occur in infants or those of older ages. The body's immune and antibody systems are, in some as yet undefined way, important. Certain protein antibodies occur in the blood of patients and even their close relatives. CS is also known as celiac disease, non-tropical sprue and gluten enteropathy or intolerance.
What
are the Symptoms?
In children, there may be irritability, diarrhea, nausea, vomiting and
failure to thrive or grow. The same symptoms may occur in adults
along with abdominal pain, weight loss, anemia or low red blood cell
count, mood changes, joint and muscle pain, fatigue, skin rashes and
menstrual irregularity. Remarkably, some people may have no
symptoms at all. Even with the damage to the small bowel, they
seem to absorb enough nutrients to remain reasonably healthy.
The Diagnosis
The physician may suspect the disorder by the medical history and
abnormal blood tests such as a low red blood cell count. A more
specific test for the disease is the endomysial antibody test. A
biopsy of the lining of the small intestine is always needed. This
is done by endoscopy, where, under light sedation, a thin endoscope is
passed through the mouth and into the small bowel where biopsies can be
taken. When damage to the inside lining of the bowel is seen, the
diagnosis is usually confirmed.
The Gluten Free Diet
The treatment of CS is simple yet difficult. CS is treated through
dietary modification - avoid the gluten protein. This is, however,
easier said than done.
Wheat, rye, barley and perhaps oats are the culprits. These grains, especially wheat, are part of almost every meal. They are present in many canned and prepared foods. The patient must become a label-reader to see if wheat in any form has been used. Further, the patient, and especially, the preparer of the patient's food, must understand the treatment goals. Instead of wheat flour, potato, rice, soy or even bean flour may be used. Specialty stores (and many grocery stores) now sell gluten free breads, pasta and other gluten-free products. Meat, fish, poultry, fruits and vegetables do not contain gluten and are good choices.
Patients with CS and their food preparer should see a registered dietician for several sessions to learn more about this complicated diet. Another source of information is the Internet where there are many support groups and forums, as well as professional organizations that provide good information about this disease (see Support Links section).
Eating out can be a challenge, as sauces and gravies are often made with wheat-based products. However, once known and understood, the diet can be fairly easy to follow, especially when a patient sees improvement in their condition after dietary changes are undertaken.
The Response
Most patients have a good response to the elimination of gluten from
their diet. A few are called non-responders and do not respond.
Further testing and medications may then be indicated.
Celiac Sprue and Other Disorders
Since CS
is a disorder of the immune system and the genes, it is not surprising to
find that it is associated with other diseases that have similar links.
These include:
- dermatitis herpetiformis
- lupus
- diabetes occurring in childhood or requiring insulin
- rheumatoid arthritis and other immune related disorders, often called collagen-vascular diseases
Complications
There are certain complications known to develop with CS. Usually,
these can be prevented by staying on a strict gluten-free diet. These
include:
- malignancies of intestines
- osteoporosis
- failure to grow in height or weight
- deficiencies of minerals (iron) and vitamins which, in turn, can lead to convulsions when inadequate folic acid is absorbed
Summary
Celiac Sprue is a disorder which can be difficult to diagnose
because of the many different symptoms it may produce. It can
occur at almost any age. Making the diagnosis is fairly
straightforward. The treatment of avoiding gluten protein in
wheat, barley, rye and perhaps oats is the difficult part.
However, once mastered, it becomes a fairly easy diet to follow.
Further, the response to dietary treatment is usually so good that
patients have no problem staying on this eating program.
Support Links
Patients with Celiac Sprue can receive support and information about
their disease through the following contacts:
Related Diets
Gluten Free Diet
Related Procedures
Upper GI Endoscopy (EGD)
This material does not cover all information and is not intended as a subsitute for professional care. Please consult with your physician on any matters regarding your health.
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