Celiac Sprue

Introduction:

It is a malabsorption syndrome related to immune reaction to gluten in diet, also called nontropical sprue, celiac disease and gluten sensitive enteropathy (GSE).

Causes:

• Toxic effect of gluten/gliadin (gliadin is a glycoprotein component of gluten)
• immune reaction (antibody to gluten/gliadin)
• adenovirus type 12
• may be autosomal dominant with incomplete penetrance

Physical Findings:

In infants - growth retardation, failure to thrive and irritability. Most patients are thin, emaciated.

Microscopic Findings:

This is a micrograph of a typical celiac disease intestine.

Diagnosis:
There are several tests that can be used to assist in diagnosis. The level of symptoms may determine the order of the tests, but all tests lose their usefulness if the patient is already taking a gluten-free diet. Intestinal damage begins to heal within weeks of gluten being removed from the diet, and antibody levels decline over months. For those who have already started on a gluten-free diet, it may be necessary to perform a re-challenge with 10 g of gluten (four slices of bread) per day over 2–6 weeks before repeating the investigations. Those who experience severe symptoms (e.g. diarrhoea) earlier can be regarded as sufficiently challenged and can be tested earlier.


Prognosis:
Patient do recover and villi regenerate.
Celiac disease associated with increased mortality among patients with malabsorption symptoms.