Celiac Sprue Disease: Information on Causes, Diagnosis & Treatments

Diorder of Gi Gluten Free Celiac sprue disease (gluten-sensitive/induced enteropathy, celiac disease) is a chronic disorder that interferes with the digestion and absorption functions of the gastrointestinal tract. The condition disrupts the function of the G.I. tract by causing considerable damage to the lining of the small intestines as a reaction to consuming gluten. The intestine becomes inflamed and prevents the absorption of food components essential to remaining healthy. This comes as a reaction to consuming gluten that is found in a variety of products including wheat, rye, barley and possibly oats.

The disease can cause significant health problems by disrupting absorption during digestion that could lead to malabsorption of essential nutrients, compromising their health and well-being. Individuals with the disease can experience significant improvement to their health by following a strict gluten free diet. However, the disease can easily recur with the reintroduction of dietary gluten products. While the condition is rarely fatal, if left untreated, it might increase the potential risk of developing some forms of cancer including intestinal lymphoma.

Who Is at Risk for Celiac Sprue Disease?

Medical science has determined that celiac disease is likely a genetic condition that might be passed on the certain family members but not all. The disease usually reveals itself when triggered by an event that could be severe emotional stress, a viral infection, pregnancy, childbirth, or surgery. There are certain risk factors associated with the disease including:

  • Gender – Females have a slightly greater risk of developing celiac disease compared to males.

  • Ethnicity – While all races are at risk for celiac disease, it is rare in individuals with an Asian, Caribbean or African-American background.

  • Age – The disease tends to manifest itself more often in infants between 8 and 12 months of age or in adults in their 30s and 40s.

  • Genetics – An individual’s genetic makeup plays a crucial role in the development of celiac disease, meaning that the disease tends to occur more often in individuals who have a relative who also suffers from celiac sprue.

  • Type I diabetes

  • Turner syndrome or Down syndrome

  • Addison’s disease

  • Microscopic colitis

  • Rheumatoid arthritis

  • Autoimmune thyroid disease

What Causes Celiac Sprue Disease?

Individuals who consume certain grain products that contain gliadin, a specific gluten, can cause a negative interaction with the lining of the small intestine. This reaction is a result of the immune system identifying gliadin as a threat to the body. In response, the body produces anti- gliadin antibodies directed at fighting gliadin gluten.

In recent years, scientists have discovered that individuals with celiac disease also have two additional antibodies in their bloodstream. Unlike anti-gliadin antibodies, these other autoantibodies that fight against the body’s organs and cells including the small intestinal smooth muscle endomysium and transglutaminase enzymes. The interaction of these autoantibodies reveals that it is the body’s autoimmunity that’s playing a role in causing celiac sprue disease.

Common Symptoms

Because the disease is known to cause malabsorption of nutrients in the body, adults and children are highly affected by the condition in diverse ways. Children who suffer from celiac disease usually display impaired growth resulting in a short stature in their mature years. Infants, toddlers, children, and teenagers usually suffer serious intestinal problems compared to adults who often do not. These problems in children can include:

  • Frequent vomiting or nausea

  • Chronic diarrhea

  • Abdominal discomfort

  • Constipation

  • Muscle wasting

  • Swollen or bloated belly

  • Unexpected weight loss

  • Poor appetite

  • Steatorrhea (foul-smelling, fatty, pale stools)

The symptoms of celiac sprue disease in adults involve:

  • Severe abdominal pain

  • Loss of bone density

  • Anemia

  • Nausea

  • Dermatitis herpetiformis (blistering itchy rash)

  • Mouth ulcers

  • Injury to the nervous system that might involve tingling or numbness in the hands and feet, cognitive impairment and balance issues

  • Joint pain

  • Bone pain

  • Overall fatigue

  • Headaches

  • Heartburn

Vitamin and Nutrient Deficiencies

Individuals who suffer from celiac disease are often highly deficient in folic acid and iron, which are essential nutrients and vitamins necessary for producing erythrocytes (red blood cells). Abnormal levels of these essential components are often the result of malabsorption caused by celiac sprue disease that could diminish a low red blood cell count (anemia). In addition, a deficiency in vitamin B12 is also a common occurrence in individuals with celiac sprue disease that helps contribute to the development of anemia.

Additionally, a deficiency in vitamin D and K is also a common occurrence in individuals with celiac sprue disease. This is because these vitamins are soluble in fat, which can be difficult to absorb when the intestinal lining is inflamed or damaged. A deficiency in vitamin K can result in excessive bleeding because the body can no longer produce clotting proteins. Vitamin D is crucial to bone growth because it helps the body absorb calcium. The deficiency could result in hypocalcemia (low blood calcium levels). Over time, the body loses its ability to absorb calcium and protein, which could result in osteoporosis where the bones become brittle and porous.

Typically, individuals with celiac sprue disease will only display one or a few of the above symptoms. Others will never display any symptoms at all, which can make diagnosing the condition very challenging.

Diagnosing Celiac Sprue Disease

Medical scientists believe that most individuals with celiac disease never have the condition diagnosed because they never displayed any symptoms. This is because intestinal damage caused by the disease occurs slowly and over time, which means it could take years before an accurate diagnosis can be made.

To verify a diagnosis of celiac sprue disease, the doctor will likely order that the patient undergo two specific tests that can validate the doctor’s findings. These tests include:

  • Serology Test – This type of test can identify antibodies in the bloodstream to rule out or verify the presence of celiac sprue disease.

  • Genetic Test – This test can identify human leukocyte antigens that can either validate or rule out the presence of celiac disease.

Verifying a diagnosis of celiac sprue disease is nearly impossible if the individual has been surviving on a gluten free diet. The doctor will instruct the patient to return to a more traditional diet containing gluten to ensure the results of the antibody test are accurate. If the blood test is positive for celiac disease, the doctor will likely recommend an endoscopic procedure to view the interior of the small intestine and likely take a biopsy (tissue sample) to determine the extent of the damage.

Treating the Condition

The only sure and effective treatment for celiac sprue disease is to live a lifelong strict gluten free diet. While it does not cure the disease, can manage many of the symptoms associated with the condition. The patient will be instructed to avoid foods containing gluten that include:

  • Semolina

  • Durum

  • Barley

  • Farina

  • Rye

  • Malt

  • Spelt

  • Graham flour

  • Triticale

Usually, the doctor will recommend that the patient seeks out the assistance of a dietitian who can help plan and an effective, delicious, and healthy diet free of gluten products. After the patient has removed gluten from their daily diet, the inflammation that has caused considerable damage to the small intestine will start to lessen. This process usually takes several weeks. However, the patient will likely begin feeling much better in a few days. The damage and the small intestines tend to happen at a faster pace and children compared to adults.

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Sources:

https://my.clevelandclinic.org/health/articles/celiac-disease

http://www.mayoclinic.org/diseases-conditions/celiac-disease/home/ovc-20214625

https://www.sfgimd.com/san-francisco-digestive/resources/

https://www.cdc.gov/features/datastatistics.html

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