FIND A PHYSICIAN        

Celiac Sprue, the GI Disease Proving to be More Common than Originally Thought

with Mary Catherine Gerleman, M.D., Gastroenterologist, Columbia St. Mary’s

Posted: April 1, 2006

One out of 133 people in the United States is affected with celiac disease, or celiac sprue. Celiac sprue is an allergic reaction to gluten, a particular molecule found in grains such as wheat, rye and barley, which leads to malabsorption of nutrition in the intestinal tract. In people affected by celiac sprue, the immune system is damaging their own tissue because of an allergic reaction to gluten.

Small, finger-like projections, called microvilli, line the walls of our intestines. In a healthy intestine, these microvilli are fluffy, waving tissue that effectively capture and process nutrition, keeping us healthy and in balance with our environment. A gluten allergy creates an inflammation in the wall of the small intestine causing our healthy microvilli to become a blunt, flat, swollen surface that can no longer pull the nutrition out of food and process it to support a healthy immune system and meet nutritional needs.

Continued damage to the small intestine and the resulting absorption problems put people at risk for malnutrition, anemia and other health issues including osteoporosis. Also in people with sprue, there’s a moderate increased risk for cancer of the small intestine.

Who gets celiac sprue?
Celiac sprue is gender non-specific. You can be diagnosed at any age. It is more prominent in people with Celtic or Viking backgrounds and it crosses racial lines.

Until recently, the thinking was that if celiac sprue didn’t present itself in childhood, it wasn’t a problem. Now we find that a lot of people have a degree of intolerance, but until something happens, such as an illness or stress, the body’s systems compensate for it. An illness may compromise your body’s ability to compensate for the allergy, or a health issue itself can uncover celiac sprue and cause symptoms.

Celiac sprue can be misdiagnosed as irritable bowel syndrome (IBS) because the intestinal tract has limited ways to tell us that there’s a problem. Sprue’s symptoms of diarrhea, abdominal pain and bloating, and weight loss also are present in other gastrointestinal disorders.

Many times, when a patient eliminates wheat from the diet, sprue symptoms go away. But it’s important to understand that there is a molecule in wheat that is very difficult for everyone to digest, so when removing wheat from your diet reduces the symptoms, it does not necessarily mean you have sprue.

If you have gas or bloating after you eat; if diabetes runs in your family; if small bowel lymphoma or cancer is in your family; if you have fair skin, blue eyes, red or blonde hair and have been diagnosed with IBS; if you are able to eat a lot of food compared to other people and not gain weight, you may want have your antibodies checked. A simple blood test available at your doctor’s office can say with about 95% accuracy whether you have a tendency to have sprue.

Sprue is associated with other diseases, like dermatitis herpetiformis (lesions on the skin), or microscopic colitis. These are red flags that will alert you to sprue.

Sprue would not be picked up in a routine colonoscopy, because sprue is a disease of the small intestine. If you have microscopic colitis on your colonoscopy biopsies, the doctor would then be alerted to check to see if you have sprue. If sprue is very severe, it can be detected in a small bowel X-ray. An endoscopy biopsy is needed to make a definitive diagnosis. However, if you stop eating wheat during the period of time before blood or biopsy testing, you will not get a definitive diagnosis.

We see a higher diagnosis rate of celiac sprue in children because pediatricians are alert to it. The babies are fussy and there are certain foods they won’t eat because the foods cause abdominal pain. Also, these babies don’t sleep well and their diapers smell particularly foul. They may not be gaining weight or height according to the growth chart.

Living with the disease
To treat celiac sprue, you take the allergy out of your life by following a gluten-free diet. The food industry has started to reflect the pervasiveness of gluten intolerance by labeling products as gluten-free or with a gluten warning. Grocery stores have designated aisles with gluten-free products and there are even bakeries that specialize in gluten-free baked goods.

Many people can grow out of certain allergies, but celiac sprue is not something you grow out of. It may become less severe as you get older, or after whatever brought it on has passed, the symptoms may go away. But once you are intolerant to gluten, you will always have some degree of intolerance to it. As patients learn to live with sprue, some people may find that they can tolerate small amounts of gluten in their diets. Some physicians feel that even small amounts of gluten raises the risk of future small intestine cancer. However, the data is not yet definitive about the cancer risk.

Patients should evaluate how they feel as they are being treated. No one knows how you are reacting to treatment better than you. Support groups and information found on the Internet can be very helpful as can dietitians and GI nurses.

Mary Catherine Gerleman, M.D.
Gastroenterologist
Columbia St. Mary’s
414-326-1745

We Have Answers
Do you have medical questions or need help finding a doctor? The experts at Columbia St.Mary’s can help. Click here.