Nontropical Sprue - Celiac Disease

Celiac disease is a malabsorption syndrome. The intestine is not able to absorb vital dietary nutrients from foods containing gliadin, an alcohol-soluble portion of gluten.

What is going on in the body?

Nutritional considerations are important for persons with celiac disease. People with celiac disease are sensitive to cereal protein found in wheat and other grains. But they are more sensitive to the protein in wheat than the protein in other cereals such as rye, oats, and barley. The protein causes a reaction in the person's small intestine that prevents absorption of essential nutrients from the diet. The defect in absorption leads to the symptoms of the disease and malnutrition.

What are the causes and risks of the disease?

Celiac disease is suspected to be a genetic disorder. But exactly how the genetic changes cause the sensitivity to gluten is not known.

Celiac disease, for example, is common among people from northwest Europe. The frequency among the British is 1 in 1,000 to 1 in 2,000. The frequency among the Irish is as high as 1 in 600. Relatives of people with celiac disease are at higher risk than others in the same population.

What are the signs and symptoms of the disease?

The symptoms of celiac disease are:

How is the disease diagnosed?

Celiac disease may be diagnosed by observing the symptoms after an infant begins eating cereals. More often, however, it is diagnosed during the second year of life. The age and onset of celiac disease can vary, though. A blood test may show impaired levels of carbohydrate absorption.

Stool may be examined for excessive amounts of fat as this is a common sign of celiac disease. A healthcare provider may also order a barium enema x-ray study of the small bowel to check for increased intestinal secretion and clumping of the barium in the bowel. When celiac disease is suspected, a biopsy of the small intestine may be done. The biopsy shows an abnormal inner surface of the small intestine.

What can be done to prevent the disease?

There is no way to prevent celiac disease. Genetic testing may be useful in some cases.

What are the long-term effects of the disease?

The long-term effects of celiac disease include:

What are the risks to others?

Celiac disease is not contagious. It is an inherited disease, but the way it is inherited is not clear. Genetic counseling is useful for those at risk of passing it to their children. The risk for identical twins may be as high as 70%. The risk for other brothers and sisters is 10%. The risk for children of parents with celiac disease is 5-10%.

What are the treatments for the disease?

Many of the effects of celiac disease can be minimized with a special diet. People with celiac disease learn to avoid the proteins in cereal. The proteins in wheat, rye, barley, and oats cause the symptoms of the disease. A healthcare provider may recommend a gluten-restricted and gliadin-free diet. Gluten is found in wheat, rye, barley, oats, corn and rice. Gliadin, the substance that seems to cause the symptoms in celiac disease is not found in corn or rice. People with the disease cannot tolerate wheat, rye, barley and oats or any products made with these grains. They can eat corn and rice because these grains do not contain gliadin. Some people may be able to tolerate oats, but this should not be tested until initial recovery has occurred. Some people do not respond to dietary limitations, and may need steroid therapy.

What are the side effects of the treatments?

Use of steroids may cause memory loss, bone loss, weight gain, congestive heart disease, or high blood pressure.

What happens after treatment for the disease?

Dietary restriction or drug therapy will be needed throughout the person's life.

How is the disease monitored?

Celiac disease is monitored by simple observation of symptoms.

Author:Ronald J. Jorgenson, DDS, PhD, FACMG
Date Written:
Editor:Wendel, Sandra J., BA
Edit Date:06/05/00
Reviewer:Eileen McLaughlin, RN, BSN
Date Reviewed:03/13/01

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