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Celiac Sprue
Celiac sprue is an uncommon, long-term disorder, in
which the lining of the small intestine wastes away,
becomes inflamed, and is damaged by a protein known
as gluten. This protein is found in wheat, rye, barley,
and other cereals. The intestine is a tube shaped
structure that is part of the digestive tract. It stretches
from an opening in the stomach to the anus (rear end)
and occupies most of the lower parts of the belly. The
small intestine is a part of the intestine that takes in all
of the nutrients that the body needs.
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The damage to the lining of the small intestine causes a failure to absorb nutrients in
food. This causes weight loss, a lack of vitamins and minerals in the body, and the
passage of a large amount of fat in the feces (poop), which will be large and smell very
bad. Weight loss and a lack of vitamins and minerals can cause skin problems and
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.
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.
"Where Medical Information is Easy to Understand"™
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. People must remember coffee isn't always gluten free. 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.
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."
