Celiac disease, also called sprue or gluten intolerance, is an inherited, autoimmune disease in which the lining of the small intestine is damaged from eating gluten and other proteins found in wheat, barley, rye, and possibly oats.
The exact cause of celiac disease is unknown. The intestines contain projections, called villi, that absorb nutrients. In undiagnosed or untreated celiac disease, these villi become flattened, affecting the ability to absorb nutrients properly.
The disease can develop at any point in life, from infancy to late adulthood. Those with a family member with celiac disease are at greater risk for developing the disease. The disorder is most common in Caucasians and those of European ancestry. Women are affected more commonly than men.
Numerous diseases and conditions are associated with celiac disease, including:
The symptoms of celiac disease can vary significantly from person to person. This is part of the reason the diagnosis is frequently delayed. For example, one person may have constipation, a second may have diarrhea, and a third may have no irregularity in stools.
A partial listing of gastrointestinal symptoms:
A partial listing of nonintestinal symptoms:
Exams and tests
Blood tests can detect several special antibodies. The health care provider will order these antibody test if celiac sprue is suspected. If the tests are positive, upper endoscopy is usually performed to sample a piece of tissue (biopsy) from the first part of the small intestine (duodenum).
Genetic testing of the blood is also available to help determine who may be at risk for celiac disease.
An endoscopy with enteroscopy, particularly of the lower sections of the intestine most commonly affected, will show a flattening of the villi.
A follow-up biopsy or blood work may be ordered several months after the diagnosis and treatment. These confirm the disease. Normal results mean that you have responded to treatment, thereby confirming the diagnosis. However, this does not suggest that the disease has been cured.
You must follow a lifelong gluten-free diet. This allows the intestinal villi to heal. Eliminate foods, beverages, and medications that contain wheat, barley, rye, and possibly oats.
You must read food and medication labels carefully to look for hidden sources of these grains and their derivatives. Since wheat and barley grains are found abundantly in the American diet, keeping to this diet is challenging. With education and planning, you will achieve the goal of healing.
You should NOT begin the gluten-free diet before a diagnosis is made. Doing so will affect future testing for the disease.
The health care provider may prescribe vitamin and mineral supplements to correct nutritional deficiencies. Occasionally, corticosteroids (such as prednisone) may also be prescribed for short-term use or if you have refractory sprue. Following a well-balanced, gluten-free diet is generally the only treatment needed to stay well.
Upon diagnosis, get help from a registered dietitian who specializes in celiac disease and the gluten-free diet. A support group may also help you cope with the disease and diet.
Removing all damaging grains from the diet is the most important measure you can take to become healthy. If you follow the diet strictly, you can expect to lead a long, healthy life – if permanent damage did not occur before diagnosis.
You must carefully and continuously follow the gluten-free diet. When untreated, the disease can cause life-threatening complications.
Delaying diagnosis or not following the diet puts you at risk for related conditions such as: