Digestive Disorders — Celiac Sprue

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


  • 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)


  • 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:

  • tTG Antibody


  • 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)


  • 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