An estimated 1.6 million Americans are currently following a gluten free diet, though many have never been diagnosed with celiac sprue (also known as celiac disease). Patients commonly ask me about celiac sprue and gluten free diets, so I will try to answer some of these questions. The first question I get is what is celiac sprue or celiac disease.
What is celiac sprue?
In celiac sprue, the ingestion of gluten causes inflammatory damage to the lining of the small intestine. Gluten is a protein, very common in our diet, found in wheat, rye, barley, and oats. (Ed. note - see this chart from the NIDDK that shows other ingredients and items that may contain gluten.) In people with celiac sprue, the usually large absorptive surface of the small intestine is flattened from damage, significantly limiting its ability to absorb nutrients.
Though celiac sprue is estimated to affect approximately 1.8 million Americans, many are unaware they have the disease.
What are the symptoms of celiac sprue?
Celiac sprue causes a variety of symptoms. They can range in intensity from very mild to debilitating. Some of the most common signs and symptoms are:
- diarrhea, gas, bloating, weight loss
- iron deficiency anemia
- low bone density
- abnormal liver tests
How is celiac sprue diagnosed?
Antibody blood tests are available as the first step in testing for celiac sprue. If this serology is positive, an upper endoscopy should be done to obtain a small intestinal biopsy as the gold standard for celiac sprue diagnosis. You should continue to eat a regular diet (containing gluten) while getting these tests for an accurate diagnosis. These results should normalize with adherence to a gluten free diet.
How is celiac sprue treated?
Treatment of celiac sprue is through a gluten free diet. In people with celiac sprue, strict avoidance of gluten is important to prevent subclinical nutritional deficiencies, decrease the risk of small intestinal lymphoma, and (in small studies) decrease the risk of other autoimmune conditions. If symptoms persist despite a gluten free diet, this could be caused by hidden gluten sources in the diet or a coexisting condition also causing gastrointestinal symptoms.
In a future post, I will discuss the differences between gluten intolerance and celiac sprue. If you have specific questions or other GI blog topics, please leave them in the comment section so that I can try to address them in the future.