WHAT CAUSES CELIAC SPRUE?

Celiac sprue is caused by an abnormal response of the immune system. The immune system is a collection of cells and proteins that help protect the body from microorganisms that can possibly be harmful. A microorganism is a tiny organism made of one cell that is usually too small to be seen without using a microscope (a device that makes things appear larger). A cell is the smallest, most basic unit of life that is capable of existing by itself.

In people who develop celiac sprue, the body becomes sensitive to gluten and the immune system reacts to it in the same way that it would react when trying to fight off harmful substances, such as bacteria. The good thing is that this abnormal reaction does not affect the entire body, but just affects the lining of the small intestine. By affecting the lining of the small intestine, the villi (more than villus) becomes flattened. In this case, villi refers to tiny, thin, fingerlike structures with a blood supply that stick out from the surface of the lining of the small intestine. The villi help absorb, move, and distribute some of the fluids and nutrients that pass through the small intestine. But by causing flattening of the villi, this seriously impairs their ability to absorb the nutrients.

Some doctors believe that celiac sprue is due to a defect in an enzyme that results in an incomplete digestion of gluten. An enzyme is a type of protein that helps produce chemical reactions in the body. The defect in the enzyme is believed to lead to a buildup of poisonous substances that damage the parts of the lining of the small intestine. The theory as to whether a defect of enzymes cause celiac sprue is a debatable one, with many other doctors stating that there is no convincing data to show that this is the cause.

HOW MANY PEOPLE GETS CELIAC SPRUE AND WHO GETS IT?

The number of people that get celiac sprue is underestimated because many people that have the condition do not get symptoms or their symptoms are mild. Celiac sprue occurs mostly in white people, occurs in both children and adults, and tends to run in families. This last fact suggests that the disease may be inherited (passed on from one's parents). The percentage of people that get celiac sprue differ greatly in different countries and populations.

Celiac sprue is most common in Europe, especially in the country of Ireland. For example, although it is estimated that 1 in 300 people in Britain have celiac sprue, it is estimated that 1 in 150 people in Southern and Northern Ireland have this condition. Thus, twice as many people in Ireland have celiac sprue than those in Britain. It is estimated that 1 in 184 people in Italy have celiac sprue. The condition is very rare in Africa, China, and Japan. However, increasing numbers of people in North Africa are getting the condition, as are people in South America and Asia. In the United States, the amount of people that have celiac sprue is very low compared with people in Europe. Specifically, it is estimated that 1 in 4,000 people have celiac sprue in the United States.

WHAT ARE THE SIGNS AND SYMPTOMS OF CELIAC SPRUE?

When celiac sprue occurs in babies, the signs and symptoms usually occur within 6 months of the baby consuming gluten. The feces (poop) become greasy, pale, large in size, and very smelly. The poop will actually float in water because it is so high in fat. The babies lose weight, become irritable, have muscle wasting, and experience a lack of energy. They also develop lots of gas, which makes the belly become large. Vomiting can occur and the baby may suddenly develop diarrhea, have too little water in the body, and become ill.

Since there is an impairment in the ability to absorb nutrients, there is a poor absorption of iron and folic acid which both cause different forms of anemia. Anemia is a condition in which there is an abnormally low amount of hemoglobin in the blood. Hemoglobin is substance present in red blood cells that help carry oxygen to cells in the body. Red blood cells help carry oxygen in the blood. Anemia caused by too little iron (iron-deficiency anemia) leads to abnormally small red blood cells, whereas anemia caused by too little folic acid (megaloblastic anemia) causes abnormally large red blood cells.

In adults, the signs and symptoms of celiac sprue usually develop slowly over months and sometimes over years. Symptoms include loss of breath and tiredness due to anemia (see last paragraph), weight loss, diarrhea, pain in the belly, vomiting, and swelling in the legs. Some patients only suffer mild damage to the lining of the intestine, but develop a long-term rash known as dermatitis herpetiformis.

HOW IS CELIAC SPRUE DIAGNOSED?

To diagnose celiac sprue, a tissue sample is taken from the lining of the upper part of the small intestine. The tissue samples may be taken at three different times. The first time would be when the patient eats foods that contain gluten. The second time would be when the person is not eating foods that contain gluten. The third time would be when the person is again given a food that contains gluten. If the lining of the intestine changes during the second and third tissue sample, this indicates that gluten is causing the problems. Testing the blood, pee, and feces show the level in which nutrients are being absorbed.

HOW IS CELIAC SPRUE TREATED?

The only treatment that is a must for people with celiac sprue is to eat foods that do not contain gluten. This means that all foods that have wheat, rye, barley, (and for some people, oats) must be avoided. The books featured at the top of this entry discuss how to construct a diet in order to accomplish this goal. Foods are made that are free of gluten, such as breads, pasta, and flour. These foods will typically say "gluten-free" on the front of the package. Doctors usually do not tell patients to restrict their eating of fish, meat, eggs, vegetables, dairy products, rice, corn, or fruit. However, some patients also need to eliminate all milk products from the diet because they become intolerant to a type of sugar found in milk known as lactose.

Many patients respond well to a high calorie, high protein diet without gluten. After following a gluten-free diet for a few weeks, the symptoms of celiac sprue go away and the person has an excellent chance of making a full recovery. If the person does not recover after following a gluten-free diet, chances are that the he/she was diagnosed incorrectly.

WHAT ELSE IS CELIAC SPRUE KNOWN AS

Celiac sprue is also known as celiac disease, celiac syndrome, gluten enteropathy, gluten-induced enteropathy, and nontropical sprue (because it occurs to people who live away from the tropics).

WHAT IS THE ORIGIN OF THE TERM, CELIAC SPRUE

Celiac sprue comes from the Greek word "koilia" meaning "belly" and the Dutch word "sprouw" meaning "a kind of tumor." Put the words together and you have "a kind of tumor (in the) belly."