Celiac sprue


Celiac sprue

Description, Causes and Risk Factors:

Celiac sprue is a disorder causing intestinal mucosal damage due to patient sensitivities to gluten products. Gluten is found in most cereals (e.g., wheat, rye and barley) and their end products. No gluten is contained in rice, soybean (soya), maize (corn), buckwheat, and sunflower seeds, for example. Oats and teffs do not contain gluten, but are usually milled on the same equipment as other grains that do, and so are commonly contaminated.

Celiac sprue

The exact cause of celiac sprue is not known; however, inheriting or developing certain irregular genes increases your susceptibility. You are more likely to have these abnormal genes and develop celiac sprue if you have a first-degree relative (mother, father, brother, sister, son, or daughter) with the condition.

The principal cause of the disorder is an immunologic reaction to components of certain dietary glutens. This is a cell-mediated reaction, not a typical IgE type allergy. The targets of the immunologic response are gliadin (a class of protein, separable from wheat and rye glutens; a member of the prolamins (proline-rich proteins), which are insoluble in water, absolute alcohol, and neutral solvents, but soluble in 50-90% alcohol), hordein, and secalin, proteins contained in the gluten component of wheat, barley, and rye.

Over 95 percent of patients with celiac sprue express the HLA-DQ (a1*501, b1*02) heterodimer (HLA-DQ2), which preferentially presents gluten-derived gliadin peptides on its antigen-presenting groove to stimulate intestinal mucosal T cells. The enzyme tissue transglutaminase is one of the targets of the autoimmune response in celiac sprue. The modification of gliadin by host tissue transglutaminase has a key role in enhancing the gliadin-specific T-cell response, and a single tissue transglutaminase-modified peptide is the dominant a gliadin T-cell epitope16 and may be a target for antigen-specific peptide therapy.

Environmental factors, such as bacteria, viruses, or surgery, may cause changes in the small intestine; then, eating gluten can trigger an irregular immune system response, resulting in celiac sprue.

Some people have an allergy to gluten and must go on a gluten-free diet. In their case, the gluten damages the mucosa of the small intestine in a way that a normal digestion becomes impossible. After avoiding gluten completely, the intestine will return to functioning normally. People with celiac sprue have a hereditary, genetic predisposition to autoimmune reaction to gluten in their digestive system and must avoid it entirely. People with autism and autistic spectrum disorders, like Asperger's syndrome, may be sensitive to gluten and casein (a protein in milk). Another condition which may cause one to follow a gluten-free diet is dermatitis herpetiformis.

Symptoms:

Symptoms may include the following:

    Severe (and foul smelling) diarrhea and/or severe constipation.

  • Abdominal cramps, bloating or gas.

  • Anemia/malabsorption of nutrients.

  • Weight loss (or weight gain).

  • Fatigue and weakness.

  • Peripheral neuropathy (tingling and weakness in an extremity).

  • Lactose intolerance (milk products), etc.

  • Villous atrophy.

  • Infertility.

  • Mouth sores.

  • Migraine-like headaches.

Children with celiac sprue may exhibit any of the abovesymptoms, as well as growth failure, projectilevomiting and a distended abdomen. Olderchildren may experience personality changes,irritability, crankiness, difficulty concentratingand poor memory.

Diagnosis:

Your doctor will ask about your symptoms and medical history and perform a physical exam. Because the symptoms of celiac sprue are often very similar to those of other conditions, it can be difficult to obtain an accurate diagnosis early on.

Your doctor may suspect celiac sprue:

In a child—if the child eats well but still shows signs of malnutrition (especially if there is a family history of the disease).

In an adult—if you have dermatitis herpetiformis (a gluten-sensitive skin rash), gastrointestinal symptoms, evidence of iron deficiency, signs of vitamin deficiency, or a family history of the disease.

Exam and Tests:

In many cases of celiac sprue, other conditions with similar symptoms, such as food intolerance or irritable bowel syndrome, are first suspected. Often, celiac sprue is only considered after the initial diagnosis of another condition is rejected because treatments are not effective.

Blood antibody tests: Celiac sprue triggers the immune system to produce certain antibodies. If celiac sprue is suspected, your doctor will order certain blood tests to detect and measure specific antibodies.

IgA-tTG: Immunoglobulin A (IgA) and tissue transglutaminase (tTG) antibody.

IgA-EMA: Immunoglobulin A (IgA) and antiendomysial antibody (EMA).

If either or both of these tests are positive, your doctor may perform a biopsy of the small intestine to confirm a diagnosis of celiac sprue.

Other tests:

    A stool analysis to evaluate fat content. A 3-day collection of stools usually shows higher-than-normal fat content in people who have celiac sprue that is causing symptoms.

  • A bone density test: This may be done to see if you have problems such as osteomalacia or osteoporosis, which may develop in some people with celiac sprue.

  • An upper GI series, which may detect intestinal problems but does not give precise information to guide diagnosis or treatment for celiac sprue. An upper GI series is rarely needed when celiac sprue is suspected.

  • Certain blood tests may be done to evaluate complications from celiac sprue. For example, a complete blood count (CBC) may be done to test for anemia. Also, a chemistry screen, which tests a blood sample for sodium, potassium, chloride, and carbon dioxide levels, may be done to identify whether you or your child has an electrolyte imbalance.

Treatment:

There is no prescriptive drug for celiac sprue. In fact, there is no cure, though there is every opportunity for celiac sprue patient to lead normal, healthy lives by following a diet that contains no gluten. This means avoiding all products derived from wheat, rye, barley, oats, and a few other lesser-known grains, which contains gluten. Extra vitamins may be taken, if necessary, but the only way for a celiac to avoid damage to their intestinal villi and the associated symptoms, is by maintaining a gluten-free diet.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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