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Celiac disease - sprue

Sprue; Nontropical sprue; Gluten intolerance; Gluten-sensitive enteropathy; Gluten-free diet celiac disease

 

Celiac disease is a condition caused by damage to the lining of the small intestine. This damage comes from a reaction to eating gluten. This is a substance that is found in wheat, rye, barley, and possibly oats. It is also found in food made from these ingredients.

The damaged intestine does not absorb needed components of food.

Causes

 

The exact cause of celiac disease is unknown. The lining of the intestines have small areas called villi which project outward into the opening of the intestine. These structures help absorb nutrients.

  • When people with celiac disease eat foods with gluten, their immune system reacts by damaging the villi.
  • Because of the damage, the villi are unable to properly absorb iron, vitamins, and other nutrients.
  • As a result, a number of symptoms and health problems may occur.

The disease can develop at any point in life, from infancy to late adulthood.

People who have a family member with celiac disease are at greater risk of developing the disease. The disorder is most common in Caucasians and persons of European ancestry. Women are affected more often than men.

People with celiac disease are more likely to have:

  • Autoimmune disorders such as rheumatoid arthritis, systemic lupus erythematosus , and Sjogren syndrome
  • Addison disease
  • Down syndrome
  • Intestinal cancer
  • Intestinal lymphoma
  • Lactose intolerance
  • Thyroid disease
  • Type 1 diabetes

 

Symptoms

 

The symptoms of celiac disease can be different from person to person. This can make diagnosis difficult. For example, one person may have constipation, a second may have diarrhea, and a third may have no problem with stools.

Gastrointestinal symptoms include:

  • Abdominal pain , bloating, gas, or indigestion
  • Constipation
  • Decreased appetite (may also be increased or unchanged)
  • Diarrhea , either constant or off and on
  • Lactose intolerance (common when the person is diagnosed, often goes away after treatment)
  • Nausea and vomiting
  • Stools that are foul smelling, oily, or stick to the toilet when flushed
  • Unexplained weight loss (although people can be overweight or of normal weight)

Other problems that can develop over time because the intestines do not absorb key nutrients include:

  • Easy bruising
  • Depression or anxiety
  • Fatigue
  • Growth delay in children
  • Hair loss
  • Itchy skin with a rash ( dermatitis herpetiformis )
  • Missed menstrual periods
  • Mouth ulcers
  • Muscle cramps and joint pain
  • Nosebleeds
  • Seizures
  • Tingling or numbness in the hands or feet
  • Unexplained short height

Children with celiac disease may have:

  • Defects in the tooth enamel and changes in tooth color
  • Delayed puberty
  • Diarrhea, constipation, fatty or foul-smelling stools, nausea, or vomiting
  • Irritable and fussy behavior
  • Poor weight gain
  • Slowed growth and shorter than normal height for their age

 

Exams and Tests

 

The following tests may be performed:

  • Bone density
  • Cholesterol (may be low)
  • Complete blood count ( CBC - test for anemia)
  • Comprehensive metabolic panel
  • Folate level (serum)
  • Iron level (serum)
  • Prothrombin time
  • Vitamin B12 level (serum)
  • Vitamin D level

Blood tests can detect antibodies, called antitissue transglutaminase antibodies (tTGA) or anti-endomysial antibodies (EMA) which may help detect the condition. The health care provider will order these antibody tests if celiac disease is suspected.

If the tests are positive, upper endoscopy is often performed to sample a piece of tissue (biopsy) from the first part of the small intestine (duodenum). The biopsy may show a flattening of the villi in the parts of the intestine below the duodenum.

Genetic testing of the blood can also be done to help determine who may be at risk for celiac disease.

A follow-up biopsy or blood test may be ordered several months after the diagnosis and treatment. These tests assess how well treatment is working. Normal results mean that you have responded to treatment. This confirms the diagnosis. However, this does not mean that the disease has been cured.

 

Treatment

 

Celiac disease cannot be cured. Your symptoms will go away and the villi in the lining of the intestines will heal if you follow a lifelong gluten-free diet . Do not eat foods, drink beverages, or take medicines that contain wheat, barley, rye, and possibly oats.

You must read food and drug labels carefully to look ingredients that may include these grains. It may be hard to stick to a gluten-free diet because wheat and barley grains are common in the American diet. Over time, most people are able to adapt and get better. You should NOT begin the gluten-free diet before you are diagnosed. Starting the diet will affect testing for the disease.

In most cases, following a well-balanced, gluten-free diet is the only treatment you need to stay well. Your health care provider may need to prescribe vitamin and mineral supplements.

Sometimes, short-term use of corticosteroids (such as prednisone) may be needed if sprue does not respond to treatment.

When you are diagnosed, get help from a registered dietitian who specializes in celiac disease and the gluten-free diet. A support group may also help you cope with the disease and diet.

 

Outlook (Prognosis)

 

Following a gluten-free diet heals the damage to the intestines and prevents further damage. This healing most often occurs within 3 to 6 months in children. Recovery may take 2 to 3 years in adults.

Rarely, long-term damage will be done to the lining of the intestines before the diagnosis is made.

Some problems caused by celiac disease may not improve, such as a shorter than expected height and damage to the teeth.

 

Possible Complications

 

You must carefully continue to follow the gluten-free diet. When untreated, the disease can cause life-threatening complications.

Delaying diagnosis or not following the diet puts you at risk for related conditions such as:

  • Autoimmune disorders
  • Bone disease ( osteoporosis , kyphoscoliosis , fractures)
  • Certain types of intestinal cancer
  • Low blood count ( anemia )
  • Infertility or repeated miscarriage
  • Liver disease

 

When to Contact a Medical Professional

 

Call your provider if you have symptoms of celiac disease.

 

Prevention

 

Because the exact cause is unknown, there is no known way to prevent the development of celiac disease. However, being aware of the risk factors (such as having a family member with the disorder) may increase your chances of early diagnosis, treatment, and a long, healthy life.

 

 

Open References

References

Hogenauer C, Hammer HF. Maldigestion and malabsorption. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 104.

Rubio-Tapia A, Hill ID, Kelly CP, Calderwood AH, Murray JA; American College of Gastroenterology. ACG clinical guidelines: diagnosis and management of celiac disease. Am J Gastroenterol . 2013;108(5):656-676 PMID: 23609613 www.ncbi.nlm.nih.gov/pubmed/23609613 .

Semrad CE. Approach to the patient with diarrhea and malabsorption. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 140.

 
  • Digestive system

    Digestive system - illustration

    The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

    Digestive system

    illustration

  • Celiac sprue - foods to avoid

    Celiac sprue - foods to avoid - illustration

    Celiac disease causes inflammation in the small intestine and damage in the lining. This prevents the body from properly absorbing the nutrients in food. The damage to the lining of the intestine comes from a reaction to eating gluten, which is found in wheat, rye, barley, and possibly oats, and in food made from these ingredients. The inability to absorb nutrients can lead to weight loss, fatigue, malnourishment, and other health problems. Gluten may be found in many foods, especially processed foods and baked goods. Breads, cakes, desserts, alcoholic beverages (except wine), cereals, and pastas may all contain gluten. Eating a gluten-free diet heals the intestines and prevents further damage.

    Celiac sprue - foods to avoid

    illustration

  • Dermatitis, herpetiformis on the knee

    Dermatitis, herpetiformis on the knee - illustration

    This picture shows the knee of a person with a chronic inflammatory disease known as dermatitis herpetiformis. It produces red, raised (papular), small or large blisters (vesicles or bullae) that burn and itch intensely. Dermatitis herpetiformis develops suddenly, lasts for weeks to months, and may be associated with digestive diseases (such as Celiac disease).

    Dermatitis, herpetiformis on the knee

    illustration

  • Dermatitis, herpetiformis on the arm and legs

    Dermatitis, herpetiformis on the arm and legs - illustration

    This picture shows a chronic inflammatory disease (dermatitis herpetiformis) that produces red (erythematous), raised (papular), small or large blisters (vesicles or bullae) that burn and itch intensely. Dermatitis herpetiformis develops suddenly, lasts for weeks to months, and may be associated with digestive diseases (such as Celiac disease).

    Dermatitis, herpetiformis on the arm and legs

    illustration

  • Digestive system organs

    Digestive system organs - illustration

    The digestive system organs in the abdominal cavity include the liver, gallbladder, stomach, small intestine and large intestine.

    Digestive system organs

    illustration

    • Digestive system

      Digestive system - illustration

      The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

      Digestive system

      illustration

    • Celiac sprue - foods to avoid

      Celiac sprue - foods to avoid - illustration

      Celiac disease causes inflammation in the small intestine and damage in the lining. This prevents the body from properly absorbing the nutrients in food. The damage to the lining of the intestine comes from a reaction to eating gluten, which is found in wheat, rye, barley, and possibly oats, and in food made from these ingredients. The inability to absorb nutrients can lead to weight loss, fatigue, malnourishment, and other health problems. Gluten may be found in many foods, especially processed foods and baked goods. Breads, cakes, desserts, alcoholic beverages (except wine), cereals, and pastas may all contain gluten. Eating a gluten-free diet heals the intestines and prevents further damage.

      Celiac sprue - foods to avoid

      illustration

    • Dermatitis, herpetiformis on the knee

      Dermatitis, herpetiformis on the knee - illustration

      This picture shows the knee of a person with a chronic inflammatory disease known as dermatitis herpetiformis. It produces red, raised (papular), small or large blisters (vesicles or bullae) that burn and itch intensely. Dermatitis herpetiformis develops suddenly, lasts for weeks to months, and may be associated with digestive diseases (such as Celiac disease).

      Dermatitis, herpetiformis on the knee

      illustration

    • Dermatitis, herpetiformis on the arm and legs

      Dermatitis, herpetiformis on the arm and legs - illustration

      This picture shows a chronic inflammatory disease (dermatitis herpetiformis) that produces red (erythematous), raised (papular), small or large blisters (vesicles or bullae) that burn and itch intensely. Dermatitis herpetiformis develops suddenly, lasts for weeks to months, and may be associated with digestive diseases (such as Celiac disease).

      Dermatitis, herpetiformis on the arm and legs

      illustration

    • Digestive system organs

      Digestive system organs - illustration

      The digestive system organs in the abdominal cavity include the liver, gallbladder, stomach, small intestine and large intestine.

      Digestive system organs

      illustration

    A Closer Look

     

    Talking to your MD

     

      Self Care

       

        Tests for Celiac disease - sprue

         
         

        Review Date: 1/28/2016

        Reviewed By: Subodh K. Lal, MD, gastroenterologist with Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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