Celiac disease (sprue)

It is a hereditary disease, autoimmune disease in which the lining of the small intestine is damaged from eating gluten and other proteins found in wheat, barley, rye and possibly oats.




Causes, incidence and risk factors

It is unknown the exact cause of celiac disease. The intestines contain projections (called villi) that absorb nutrients, but in people with undiagnosed or untreated celiac disease, these villi become flattened, which affects their ability to absorb nutrients properly.



This disease can occur at any time of life from infancy to late adulthood.



Those with a family member with celiac disease are at greater risk. This disorder is more common in Caucasians and European origin. Also, women are affected more commonly than men.



There are many diseases and conditions associated with celiac disease, including:



Anemia

Autoimmune disorders such as rheumatoid arthritis and systemic lupus erythematosus

Certain types of intestinal cancer

Dermatitis herpetiformis

Down Syndrome

Lactose intolerance

Spontaneous abortion or unexplained infertility

Neurological diseases

Osteoporosis or osteopenia

Thyroid Disease

Diabetes Type I

Symptoms

The symptoms of celiac disease can vary significantly from person to person. This is part of the reason the diagnosis is frequently delayed. For example, a person may have constipation, another third have diarrhea, and no irregularity in stools.



The following is a partial list of gastrointestinal symptoms:



Abdominal pain

Abdominal distension, bloating, gas, indigestion

Constipation

Decreased appetite (may also be increased or unchanged)

Diarrhea, chronic or occasional

Lactose intolerance (common upon diagnosis, usually goes away following treatment)

Nausea and vomiting

Floating stools, bloody, offensive or "fatty"

Unexplained weight loss (although people can be overweight or at the time of diagnosis)

The following is a partial list of non-gastrointestinal symptoms:



Anemia (low blood count)

Pain in bones and joints

Bone disease (osteoporosis, kyphoscoliosis, fracture)

Shortness of breath due to anemia

Tendency to bruising

Defects and discoloration of tooth enamel

Depression

Fatigue

Stunting of children

Hair Loss

Hypoglycaemia (low blood sugar)

Irritability and behavioral changes

Malnutrition

Mouth ulcers

Muscle cramps

Nosebleeds

Seizures

Short stature, unexplained

Skin disorders (dermatitis herpetiformis)

Swelling, general or abdominal

Vitamin or mineral deficiency, single or multiple nutrient (eg iron, folate, vitamin K)

Exams and Tests

A complete blood count (CBC) may show signs of anemia and it is important to determine the cause if it is found.

An increase in alkaline phosphatase level may indicate bone loss.

Low levels of cholesterol and albumin may be signs of malabsorption and malnutrition.

Similarly, one can notice slightly elevated liver enzymes and abnormal blood clotting.

Blood tests can detect some special antibodies. Your doctor will order these antibody tests if celiac disease is suspected. If tests are positive, usually carried out an upper GI endoscopy to obtain a sample of a piece of tissue (biopsy) of the first part of the small intestine (duodenum).



Also availability of genetic blood tests to help determine who may be at risk for celiac disease.



An endoscopy (EGD) with enteroscopy, particularly of the lower sections of the intestine most commonly affected, will show a flattening of the villi.



You can order a biopsy or blood test several months after diagnosis and treatment, confirming the disease. Normal results mean that the person has responded to treatment, thereby confirming the diagnosis. However, this does not suggest that the disease has been cured.



Treatment

The person must follow a gluten-free diet for life, allowing the recovery of intestinal villi. We must eliminate foods, beverages and medications that contain wheat, rye, barley and possibly oats.



You must read food labels carefully and drugs for hidden sources of these grains and their derivatives. Since wheat and barley are found abundantly in the American diet, the treatment is a challenge, you will achieve the goal of healing with education and planning.



Gluten-free diet should NOT begin before the diagnosis, as do so will affect future testing for the disease.



Your doctor may prescribe vitamin and mineral supplements to correct nutritional deficiencies. Occasionally, may also be prescribed corticosteroids (like prednisone) for use for a short time or if you have refractory sprue. Follow a balanced diet free of gluten, is generally the only treatment needed to stay well.



After diagnosis, consult with a registered dietitian who specializes in celiac disease and gluten-free diet. Similarly, a support group can help a person to manage the disease and diet.



Support Groups

For additional information and support, it is recommended to see the list of organizations in the article: celiac disease resources.



Expectations (prognosis)

Removing all damaging grains from the diet is the most important step you can take to stay healthy. If you follow the strict diet can expect to lead a long and healthy life, unless that has experienced a permanent injury before the diagnosis.



Complications

You must follow the gluten-free diet carefully and continuously. When this disease is left untreated, can cause life-threatening complications.



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



Autoimmune disorders

Certain types of intestinal cancer

Fractures

Infertility

Spontaneous abortion

Osteoporosis

Calling your health care

Call your doctor if you have symptoms of celiac disease.



Prevention

Since the exact cause is unknown, there is no known way to prevent the development of celiac disease. However, knowledge of risk factors (such as having a family member suffering from this disorder) may increase the chances of early diagnosis, treatment, like having a long and healthy life.



Alternative Names

Gluten sensitive enteropathy, sprue, Celiac disease, gluten intolerance