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Monday, March 17, 2014

Celiac Sprue






Gluten enteropathy or celiac disease

  • Celiac Disease is characterized by damage to part of the small intestine, interfering with the body's natural ability to absorb food and nutrients properly.  The actual cause is not known, but there appears to be a genetic component.  In addition, an autoimmune phenomenon (the body's immune system mistakenly attacks the intestines) probably is a major factor.
  • Though the actual cause is unknown, the elimination of gluten from the diet often resolves the symptoms, and causes the small intestine to heal in nearly all cases.  Gluten is the protein portion of wheat, rye, barley, and oats.  Wheat flour, the major component in bread and most baked goods, must be eliminated.

  • Abdominal bloating
  • Flatulence ("Gas")
  • Large, bulky, greasy stool
  • Weight loss
  • Weakness
  • Constant hunger
  • Easy bruising
  • Diarrhea
  • Failure to Thrive
  • Vomiting
  • Anorexia
  • Clingy, irritable
  • Pallor
  • Digital clubbing

  • Genetic predisposition
  • Probably autoimmune (see above)

  • Examination:
  1. Loss of muscle mass
  2. Loss of body fat
  3. Itching blisters
  • Laboratory:
  1. Complete blood count
  2. Serum iron, folate, vitamin B12, calcium, alkaline phosphatase, albumin, beta-carotene
  3. Prothrombin time
  4. Stool test for fat in stool
  5. D-xylose test -- not commonly done any more, a check for malabsorption
  6. IgG and IgA anti-gliadin antibodies
  7. IgA endomysial antibody
  • Testing: Intestinal biopsy (can be done with endoscopy -- passing scope through the esophagus)

  • Remove all gluten-containing products from the diet -- wheat, rye, barley, and oat products. 
  • Carefully read ingredients on the package of all baked goods and processed foods, as they often contain gluten in one form or another.  Gluten is not only the primary ingredient in breads, crackers, and pastries, but it is often added to many manufactured foods.
  • Rice, corn, potato, and soybean flours are safe to use.
  • Expect improvement in about 2-4 weeks.
  • Rare individuals who fail diet restrictions may need corticosteroids or cyclosporine (both treat autoimmune diseases).
  • Vitamin and iron supplementation

  • 10% of individuals with celiac sprue develop intestinal lymphoma (a form of cancer).  If symptoms recur after elimination of gluten from the diet, then intestinal lymphoma should be suspected.

  • Expect improvement within about 2-4 weeks of starting therapy.

  • Pancreatic insufficiency
  • Chronic pancreatitis
  • Whipple's disease
  • Eosinophilic Gastroenteritis
  • Crohn's disease
  • Intestinal lymphoma

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