What Is Celiac Sprue (Celiac Disease, Gluten Enteropathy)

Celiac sprue disease is defined as the intolerance to the protein gluten present in grains such as wheat, oats and barley. This hereditary condition results in malabsorption due to the typical alteration caused to the intestinal lining. It is also known as gluten enteropathy, non-tropical sprue or celiac disease.

  • Diarrhea, weight loss, and malnutrition are the usual symptoms. Bloated abdomen and bulky stools with foul smell are the common symptoms found in children.
  • Inflammation of the lining of the small intestine results from the consumption of foods containing gluten.
  • The characteristic symptoms help diagnose the condition and a biopsy of the tissue taken from the intestinal lining confirms the diagnosis.
  • Gluten intolerance can be managed by following a gluten-free diet.

Celiac sprue disease is rarely seen in Asian and African countries though it is very common in Europe and America affecting one out of every 250 to 300 people. Southwestern Ireland has the highest incidence of celiac disease with one out of every 150 people being affected. This may point to a genetic factor at play, especially when 10% of those affected are found to have at least one close relative with the same condition. Gluten is a protein mainly found in the food grain wheat. Oats, barley and rye also contain it in lesser amounts. In people who are predisposed to celiac sprue, gluten triggers an immune reaction, resulting in the production of antibodies which damage the lining inside the small intestine. The small intestine has a brush-like lining with numerous projections called villi and micro villi which greatly increase the surface area available for absorption. The damage caused by the antibodies result in flattening of the villi, making the lining smooth and reducing the absorptive capacity of the small intestine. Malabsorption of nutrients results as a consequence.


Diarrhea, weight loss and malnutrition are the typical symptoms of the condition, but some people do not experience any digestive symptoms. A small fraction of people, about one in ten, may have a distressing condition called dermatitis herpetiformis characterized by an itchy and painful skin rash with tiny blisters.

The symptoms of celiac disease may appear early in childhood, but some develop it much later in life. The extent of damage caused to the intestinal wall determines the intensity of the symptoms. The symptoms start appearing in children with the introduction of gluten containing foods in the diet. They may range from mild abdominal discomfort to severe abdominal pain and bloating. Stools may be bulky, with a terrible foul smell, and light in color due to the presence of fat (steatorrhea).

The deficiency diseases resulting from the malabsorption caused by celiac disease precipitate several other symptoms, especially in children. Abnormalities in development, including stunted growth, may affect some children. Deficiency in iron may result in anemia and associated weakness and fatigue. Protein deficiencies may cause fluid accumulation, resulting in edema or swelling of various parts of the body. Pins-and- needles sensation may be felt in the legs and arms due to the damage caused to the nerves by vitamin B12 deficiency. Malabsorption of calcium results in abnormalities in the growth and development of bones as well as that of teeth. Pain in the joints, higher incidence of fractures, discoloration of teeth and severe tooth decay are some of the symptoms of calcium deficiency. Due to the decreased production of estrogen and other hormones, girls who suffer from celiac disease may not attain menarche.


The characteristic symptoms of celiac sprue help in diagnosing the condition. Testing the levels of the antibodies after consuming gluten also helps in diagnosing the condition. Biopsy of the intestinal lining before and after a person is put on a gluten-free diet helps to confirm the diagnosis. If flattened villi are present in the first sample and significant improvement is observed in the sample taken after the restricted diet, it is a definite indication of celiac disease.

Prognosis and Treatment

Gluten in very small quantities also produce symptoms, hence all foods containing even traces of gluten should be strictly avoided. A gluten-free diet usually revives the normal absorptive surface of the small intestine as the villi regenerate and the brush-like texture of the intestinal lining is restored. The use of gluten in processed foods is so widespread that people on gluten-free diet need the advice of a dietitian to know what foods are safe for them. Since gluten is used in most ice creams and hotdogs, and commercially available sauces and soups, they should carefully check the ingredients listed on the label of foods to avoid accidental exposure.

People who continue to display symptoms of celiac disease even after following a gluten-free diet may have been misdiagnosed or they may be having an advanced form of the disease referred to as refractory celiac sprue. This condition cannot be treated with diet restrictions alone and may require drug therapy using corticosteroids like prednisone. If the drug therapy combined with gluten-free diet does not improve the condition, the patient may have to be fed intravenously. Children who are severely affected by the disease are often fed intravenously for a period, to give rest to the digestive tract and help it recover, before a diet free of gluten is followed.

Avoiding gluten helps in preventing symptoms sprue disease but over a period of time, a small fraction of those with this condition develop a lymphoma of the intestine which may have a fatal outcome. Whether following a strict diet free of gluten helps in reducing the risk of cancers of the intestine is not clear.

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Yasser Elnahas

MD, PHD, Professor Of CardioVascular Surgery
Dr. Yasser Elnahas, Is an associate Professor of Cardiovascular Surgery. Dr. Elnahas was trained as a fellow At Texas Heart Institute And Mayo Clinic Foundation.Dr. Elnahas is dedicated to educating the general public about different disease conditions and simplifying the medical knowledge in an easy to understand terminology.

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