Celiac Sprue 

Introduction

Celiac sprue is an inherited disease that affects the way nutrients are absorbed in the small intestine. It occurs when people with the genetic condition eat foods that contain gluten and other proteins.

Gluten is contained in wheat, barley, rye, and some oat products. The gluten causes an autoimmune reaction that damages the inner lining of the small intestine and impedes its role with nutrient absorption. Because of this, celiac sprue is termed a malabsorption condition.

Symptoms of celiac sprue vary from person to person. Symptoms may include abdominal pain and changes in bowel habits. Numerous non-gastrointestinal symptoms may occur as well including joint pain, bone fractures, and complications from nutritional deficiencies.

The treatment for celiac sprue is to not consume gluten products. If celiac sprue is not treated, it can lead to serious medical complications including an increased risk for developing cancer.

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Anatomy
Whenever you eat and drink, food travels through your digestive system for processing. Your body absorbs nutrients and removes waste products via your digestive system. When you eat, your tongue moves chewed food to the back of your throat. When you swallow, the food moves into the opening of the esophagus. Your esophagus is a tube that moves food from your throat to your stomach.
 
Your stomach produces acids to break down food for digestion. Your stomach processes the food you eat into a liquid form. The processed liquid travels from your stomach to your small intestine.
 
The small intestine is a tube that is about 20-22 feet long and 1 ½ to 2 inches around.  The duodenum is the first part of the small intestine. It is a short C-shaped structure that extends off of the stomach. The jejunum and the ileum are the middle and final sections of the small intestine.
 
Your small intestine breaks down the liquid from your stomach even further so that your body can absorb the nutrients. Your small intestine is lined with villi. Villi are tiny projections that absorb nutrients. Their finger-like shape increases the surface area of absorption in the small intestine. The villi are more dense in the first part of the small intestine and are sparse or absent in the last section of the small intestine.
 
The remaining waste products from the small intestine travel to the large intestine. The liquid solidifies as it moves through the large intestine, forming a stool. The stool is eliminated from your body when you have a bowel movement.

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Causes

Celiac sprue is a chronic autoimmune disease of the digestive tract. People with celiac sprue have an inherited genetic disorder. The condition results when people with the genetic condition eat foods that contain gluten and other proteins.

Gluten is contained in wheat, barley, rye, and some oat products. The gluten causes an autoimmune reaction that damages the inner lining of the small intestine. When the intestinal lining is damaged, it is unable to produce the enzymes necessary for digestion and nutrient absorption. 

Further, the villi in the small intestine become flattened, which further impedes the absorption process. Because of this, celiac sprue is termed a malabsorption disorder. The function of other body organs may be affected when malabsorption occurs.

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Symptoms
Symptoms of celiac sprue can vary from person to person. Symptoms may be gastrointestinal or non-gastrointestinal. You may experience diarrhea, constipation, vomiting, gas, and bloating. You may have pain in your abdomen and feel nauseated. Your stools may be “fatty,” float, contain blood, or have a foul smell. You may lose your appetite and lose weight.
 
Non-gastrointestinal symptoms include muscle cramps, joint pain, bone pain, and bone conditions such as osteoporosis and fractures. You may experience skin disorders, hair loss, and bruise easily. Your teeth may become discolored and develop enamel problems. Sores may appear in your mouth.
 
You may feel depressed, irritable, and tired. It may be difficult for you to breathe, or you may feel fatigued if you develop anemia, a shortage of red blood cells. Malnutrition and vitamin deficiencies can occur, particularly of iron, folate, and vitamin K.
 
Women may experience hormonal changes, infertility, and miscarriage. Men may experience hormonal changes, infertility, and impotence. Additionally, you may experience low blood sugar levels, nosebleeds, seizures, and general or abdominal swelling.
 
Symptoms in children develop when they begin to eat cereal. Childhood symptoms include abdominal pain, vomiting, diarrhea, depression, irritability, and behavior problems. Because celiac sprue interferes with nutrient absorption, children may have impaired growth and be short.

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Diagnosis

Your doctor can start to diagnose celiac sprue by reviewing your medical history and conducting a physical examination. You should tell your doctor about your symptoms, what you typically eat, and your risk factors for celiac sprue. 

Your doctor will test your blood for the antibodies associated with celiac sprue. Your doctor will also test your blood and stool for signs of malabsorption and related complications. If your antibody tests indicate that you have celiac sprue, your doctor may take a biopsy of your small intestine. 

A biopsy involves the removal of a very small piece of your small intestine for examination with an upper gastrointestinal (GI) endoscopy. This test is also called an esophagogastroduodenoscopy (EGD).
 
An upper GI endoscopy uses an endoscope to view the esophagus, stomach, and upper duodenum, the first part of the small intestine. An endoscope is a long thin tube with a light and a viewing instrument that sends images to monitor. After you receive relaxing medication, the endoscope is inserted through your mouth. The endoscope allows a doctor to examine the inside of the upper gastrointestinal tract for bleeding, tumors, polyps, and other abnormal conditions. 
 
For celiac sprue, the doctor will look at the villi for structural and functional changes. The condition of the villi may show mild, moderate, or severe damage. A tissue sample or biopsy can be taken with the endoscope for examination.

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Treatment
Treatment for celiac sprue is to remove gluten products from your diet. You will need to follow a gluten-free diet for the rest of your life. Your doctor may refer you to a dietician that can educate you about reading product labels and menu planning.
 
Your doctor may prescribe vitamins and mineral supplements to help correct nutritional imbalances. A small percentage of people with celiac sprue may fail to respond to a gluten-free diet. These people are typically treated with corticosteroid medications.
 
Symptoms of celiac sprue improve quickly, in just a few days, for most people who follow a gluten-free diet. It usually takes three to six months for the small intestine to heal. In older adults, it may take up to two years to heal.

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Prevention
It is helpful to become educated about gluten-free eating. Learn how to read product labels to detect gluten. A registered dietician can help you identify products and substitutes for your recipes. 

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Am I at Risk

Researchers believe that celiac sprue is greatly under diagnosed. Previously believed to be rare, it appears that it may actually be a common condition.

Celiac sprue is more common in Western Europe, North America, and Australia. Celiac sprue occurs most frequently in Caucasians and people of Northern European ancestry.  It is more common in women than men and generally begins in people between the ages of 30 and 50 years old.

Celiac sprue can develop in children when they begin to eat cereal. Lactose intolerance appears to be common in people with celiac sprue. Because it is inherited genetically, your risk of developing celiac sprue is greater if other members of your family have the condition.

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Complications
If untreated, celiac sprue can lead to life-threatening medical complications including an increased risk for cancer. If you do not follow a strict gluten-free diet, you have an increased risk for developing associated medical conditions including infertility, miscarriage, and bone fractures. 

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Advancements
Improvements in antibody testing have led to an increased diagnosis of celiac sprue.  Further, gluten-free product labeling and gluten-free baking products are becoming more common on grocery store shelves.

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.