CELIAC SPRUE
Overview
Celiac Sprue is most commonly called Celiac Disease (CD) but may also be referred to as non-tropical sprue or gluten sensitive enteropathy. It is a lifelong auto-immune disorder in which the digestive tract adversely reacts to gluten. It is not a food allergy. Once considered a rare childhood disease, CD is now thought to affect approximately one out of every 133 people in the United States.
When a person with CD eats food that contains gluten, it goes through their digestive tract causing damage to the lining of the small intestine. Since the main job of the small intestines is to absorb nutrients from food, many patients suffering from CD may become malnourished.
Symptoms
Celiac sprue affects each patient differently. Some patients may not have any noticeable symptoms, but their blood tests may show vitamin and mineral deficiencies.
Children are more likely to experience digestive tract symptoms. These include:
- Nausea or lack of appetite
- Chronic diarrhea or constipation
- Foul-smelling or fatty stool
- Vomiting
- Abdominal bloating and pain
- Excessive gas
- Weight loss
- Irritability
Over time, the decreased absorption of nutrients in children can cause delayed growth and short stature, delayed puberty, and dental problems. Infants suffering from CD may be diagnosed with failure to thrive.
Adults with CD may experience digestive tract symptoms but are also more likely to have symptoms that are more widespread. These include:
- Tiredness
- Depression
- Anxiety
- Arthritis
- Osteopenia or osteoporosis
- Bone or joint pain
- Tingling or numbness in hands and feet
- Missed menstrual periods
- Infertility or recurrent miscarriages
- Canker sores/mouth ulcers
- Skin rash (dermatitis herpetiformis)
- Seizures
- Anemia
Common Nutrient Deficiencies in Celiacs
-Minerals
- Calcium
- Copper
- Iron
- Magnesium
- Phosphorous
- Potassium
- Selenium
- Zinc
-Vitamins
- Vitamins A, D, E, and K
- Folic Acid
- Vitamin B 1, 2, 3, 6, 9, 12
- Vitamin C
Lactose Intolerance
Newly diagnosed patients may also be lactose intolerant. This means that their body is unable to break down and digest lactose, a sugar found in milk products due to a deficiency in the lactase enzyme. This will lead to symptoms like bloating, cramping, abdominal discomfort, gas, and diarrhea 30 minutes to 2 hours after consuming milk products. For most patients, this problem will go away once a gluten-free diet is started and the lining of the small intestines has time to heal.
Cause/Risk Factors
The exact cause of CD is not fully understood. Patients with other genetic disorders (Down Syndrome, Turner Syndrome) and auto-immune disorders (Type 1 Diabetes, Rheumatoid Arthritis, Lupus, auto-immune thyroid disease) are at an increased risk of developing CD. Patients with celiac disease should suggest that first-degree relatives (parents, children, or siblings) get tested because there is a 1 in 22 chance that they may develop CD in their lifetime.
Testing
Once celiac sprue is suspected, the doctor should order a blood test. It is very important that the patient continues with their normal diet during evaluation and testing. The blood test ordered will measure specific autoantibodies (proteins that react against the body’s own cells). For a possible diagnosis of celiac disease, these three proteins may appear at higher levels than normal:
- EMA-anti-endomysial
- TTG-anti-tissue transglutaminase
- DGP-deaminated gliadin peptide
Blood tests may also be ordered to measure vitamins and minerals that would appear at lower levels than normal due to poor absorption and malnutrition from the damage to the lining of the small intestines.
If the blood tests suggest CD, the doctor will then order an endoscopy with biopsy of the small intestine. An endoscopy is a test where a tiny camera is inserted in the mouth and moved through the digestive system so the doctor can look at the tissue for any damage. During this procedure, a small amount of tissue in the upper small intestines will be removed and sent to the laboratory for examination. This test may need to be repeated several weeks later to confirm the diagnosis and ensure that healing has begun.
Treatment
The only treatment for CD is a completely gluten-free diet. Once all gluten products are removed from the diet, the patient will start to feel better after about two weeks. Complete healing of the lining of the small intestines may take six to twelve months or longer. It is very important to continue a strict gluten-free diet for life to avoid any effects from long-term malnutrition (gall bladder and pancreatic insufficiency, gastrointestinal cancers, nervous system disorders).
Gluten-Free Diet
Gluten is a protein found in foods that contain wheat, rye, or barley. These ingredients are found in most bread, pasta, cereal, beer, and processed foods. Several of these items are now specially manufactured to be gluten-free and have helped make living with celiac disease more manageable. Some patients with CD may be more sensitive to oats, so talking with a doctor or dietician before eating oat products is suggested. Learning how to read food labels properly is a very important first step once diagnosed with celiac disease. A dietician who specializes in nutrition for patients with celiac disease will be able to suggest food to avoid and nutrient rich food that would be beneficial in the diet. There are also support groups available for patients with celiac disease.
Gluten-containing grains to avoid:
- Barley, barley malt, barley extract
- Bran
- Bulgur
- Couscous
- Durum
- Einkorn
- Emmer
- Farina
- Faro
- Graham flour
- Kamut
- Matzo flour/meal
- Orzo
- Panko
- Rye
- Seitan
- Semolina
- Spelt
- Triticale
- Udon
- Wheat, wheat bran, wheat germ, wheat starch
Other Products Containing Gluten
There are several non-food products that contain gluten that should be avoided. These include certain lipstick, lip balm, lip gloss, play dough, herbal supplements, over the counter medications, vitamins, minerals, and prescription medications. A pharmacist can help find information about whether specific OTC or prescription medications contain gluten. If the information is left off a product label, sometimes a call to the manufacturer may be needed to find out for certain if the product is gluten-free and safe to use.
A New Lifestyle
With practice, choosing gluten free foods and products will become easier. It may seem like a huge burden at first, but it is important to remember that avoiding gluten completely is the only way the body will heal and absorb nutrients. It is important for those close to the patient to be educated on the disease so they are able to help support the new lifestyle. There are several resources available to learn more about Celiac Disease.
http://www.celiac.org/index.php
http://www.csaceliacs.info/index.jsp
http://www.uptodate.com/contents/celiac-disease-in-adults-beyond-the-basics
http://www.gastrokids.org/files/documents/resources/Gluten-FreeDietGuideWeb.pdf
