Celiac Sprue

What is celiac sprue?

Celiac sprue, also known as celiac disease or gluten sensitive enteropathy, is an inflammatory disease of the small intestine due to exposure to gluten in the diet.

What is gluten?

Gluten is a component of dietary grains, notably wheat, rye, and barley. It is also commonly found in small quantities of prepared foods as an additive.

What symptoms are associated with celiac sprue?

Although commonly diagnosed by gastroenterologists, celiac disease is a systemic disorder and can result in neurologic symptoms, skin rash, joint problems, and infertility. It is more commonly diagnosed due to the presence of weight loss, diarrhea, anemia, and/or vague abdominal pain.

How common is celiac sprue?

It is common in the United States and Western countries. Prevalence can approach 5-15% in certain at risk populations, notably Caucasian females with a 1st degree family member with the disease. 0.5% to 1% of the population have positive blood tests for celiac sprue.

How is celiac sprue diagnosed?

Simple blood tests termed celiac serologies can be suggestive of celiac sprue, and a small intestinal biopsy is confirmatory. Most require that both tests be positive in order to establish the diagnosis.

What does one do if results of blood tests and biopsy are discordant?

Patients with discordant serologies and biopsy results need to be followed over time and retested at a later date if symptoms persist. Both celiac blood tests and biopsies can be falsely "negative" or normal if testing is done while an individual is following a gluten-free diet.

How is celiac sprue treated?

All symptomatic patients with celiac sprue should adopt and follow a gluten free diet. Consultation with a registered dietician is invaluable in educating patients about gluten containing products, particularly additives in processed foods. Grocers are capitalizing on the gluten-free market and making it easier for consumers to follow a gluten free diet.

Are patients with irritable bowel syndrome (IBS) at increased risk for celiac sprue?

Patients who meet criteria for the diagnosis of IBS, even constipation dominant IBS, should be screened for celiac sprue since symptoms associated with both can be very similar. See section on IBS.