General Definition
- Intolerance to gluten proteins from wheat and to related proteins from barley or rye. Oats are frequently contaminated with wheat products and can give rise to intolerance
- Presents with characteristic histopathological changes of the jejunal mucosa
- Consequences: from asymptomatic to global malabsorption and an increased risk for developing GI malignancies
- Manifested by genetic, environment, and immunologic factors. HLA-DQ2 is a genetic risk factor for Celiac Sprue, but most people with the marker do not get Celiac disease. 30% of the population has the marker
Prevalence:
- 1:113 to 1:250 in the U.S.
Sprue and Risk for Malignancies
- All malignancies (3 x grater risk)
- Lymphoma (30 x greater risk)
- Intestinal carcinoma (3 x greater risk)
- Esophageal carcinoma (8 x greater risk)
Triggers
- Genetic
- Dietetic gluten
- Infections (viral and bacterial)
- Autoimmunity
- Immune-maturation
Presentation in Adults
- Iron deficiency anemia
- Diarrhea
- Abdominal pain
- Less common features in adults
- Weight loss
- Apthous stomatitis, glossitis
- Dermatitis herpetiformis
- Arthralgias
- Osteoporosis
- Neuropathy
- Depression
- Vitamin deficiencies
- Folate — macrocytic anemia
- Vitamin K — abnormal pro time
- Vitamin A—follicular keratosis
Serum Testing:
Management
- Evaluate for associated nutritional deficiencies
- CBC
- Iron profile
- Folate
- B-12
- Pro time
- Vitamin D (25-hydroxyvitamin D)
- Carotene
- Calcium
- Proteins
- Consider associated disorders, e.g. thyroid disease
- Consider bone density study
- Educate family re: familial risk
- Post treatment monitoring — clinical and serologic (tTG Ab at 6 & 12 months)
Treatment
- Dietary counseling and strict avoidance of gluten
- Initial avoidance of dairy products
- Replacement of micronutrients in case of deficiencies
- Clinical improvement in 70% of patients within 2 weeks
Principles of Initial Dietary Therapy
- Avoid all foods containing wheat, rye, and barley gluten.
- Avoid all oats initially.
- Use only rice, corn, maize, buckwheat, potato, soybean, or tapioca flowers, meals, or starches.
- Wheat starch from which gluten has been removed can be tried after the diagnosis is established.
- Read all labels and study ingredients of processed foods.
- Beware of gluten in medications, food additives, emulsifiers, or stabilizers.
- Limit milk and milk products initially
- Avoid all beers, lagers, Ales, and stouts.
- Wine, liquors, ciders, and spirits, including whiskey and brandy are allowed.
- Representative foods that may or may not contain gluten, depending on manufacturer.
- Ice cream
- Nondairy creamer
- Yogurt and fruit
- Hot chocolates
- Instant coffee and tea