Celiac sprue
Celiac sprue, also known as celiac disease or gluten-sensitive enteropathy, is a chronic autoimmune condition characterized by inflammation of the small intestine triggered by the ingestion of gluten, a protein found in wheat, rye, oats, and barley. This inflammation leads to damage of the intestinal villi, decreasing nutrient absorption and resulting in symptoms such as diarrhea, weight loss, anemia, and bone disease. While the condition often manifests in childhood, some individuals may develop it later in life, with factors such as stress, infections, or surgery potentially triggering its onset. Treatment primarily involves a strict lifelong gluten-free diet, which helps alleviate symptoms and allows the intestinal lining to heal. Additional support, including dietary counseling and vitamin supplementation, may be necessary. Celiac sprue has a genetic component, and approximately 1% of the global population is affected, with certain groups, such as those with other autoimmune conditions or a family history of the disease, being at higher risk. Understanding celiac sprue is crucial for those affected, as managing the condition requires significant lifestyle adjustments.
Celiac sprue
ALSO KNOWN AS: Nontropical sprue, gluten-sensitive enteropathy, gluten intolerance
ANATOMY OR SYSTEM AFFECTED: Intestines, joints
DEFINITION: Inflammation of the small intestine resulting from an abnormal response to gluten in the diet.
CAUSES: Inflammation of small intestine from gluten in diet
SYMPTOMS: Diarrhea, weight loss, anemia, bone disease
DURATION: Chronic, with acute episodes lasting two weeks
TREATMENTS: Elimination of gluten from diet, folic acid supplementation
Causes and Symptoms
The most common symptoms of celiac sprue, also called celiac disease, are and weight loss. Patients develop an inflammatory reaction to gluten, a protein found in wheat, rye, oats, and barley. This causes flattening of the fingerlike projections in the known as "villi," thereby decreasing the surface area available for nutrient and absorption. Thus, patients often have (from malabsorption of iron and folic acid) and bone disease (from of calcium and vitamin D). Other symptoms of celiac sprue can include muscle weakness, infertility, epilepsy, and psychiatric illnesses, although the mechanisms underlying these manifestations are less clear. Some patients develop a blistering, on the skin known as " herpetiformis." Most patients come to medical attention at two years of age, after wheat is introduced into the diet. A small number of people develop the disease as adults. Research suggests that stress can trigger celiac sprue reactions, including extreme emotional stress, pregnancy, surgery, and infections.
Treatment and Therapy
The mainstay of therapy is elimination of gluten from the diet, which calms the inflammation and eventually allows the flattened to grow back. Symptoms usually improve within two weeks. Lack of improvement is most often the result of incomplete elimination of gluten. Alternative diagnoses—including infection, food allergies, inflammatory bowel disease, and of the intestines—must also be considered.
The avoidance of gluten sounds straightforward, but it often requires significant dietary changes that must be rigorously followed throughout life. Most breads, pastas, and pastries must be avoided. Patients often benefit from counseling with a dietitian, since many processed foods contain gluten. Patients may also need to be screened for vitamin and mineral deficiencies. Folic acid supplementation is especially important for women of childbearing age. An x-ray to determine bone mineral density is sometimes helpful in patients with suspected vitamin D deficiency.
Perspective and Prospects
Celiac sprue is a genetic disease. It is known to be caused by a on chromosome 6, and attempts to identify the specific gene further are ongoing. Testing to determine whether one has celiac sprue includes blood tests for antibodies against gliadin, the offensive component of gluten. About 1 percent of the global population suffers from celiac sprue. People at higher risk for celiac sprue include those who have diabetes mellitus, an autoimmune disease, Down syndrome, or anemia and those with a family member who has celiac sprue.
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