Celiac disease - sprue

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Symptoms	Surgery	Test	Special Topic

Digestive system

Celiac sprue - foods to avoid

Dermatitis, herpetiformis on the knee

Dermatitis, herpetiformis on the arm and legs

Digestive system organs

Celiac disease - sprue

Alternative Names:

Sprue; Nontropical sprue; Gluten intolerance; Gluten-sensitive enteropathy
Symptoms:

The symptoms of celiac disease can vary significantly from person to person. Symptoms may be intestinal or seemingly non-intestinal in nature. This variability 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.

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A partial listing of gastrointestinal symptoms:

Abdominal pain
Abdominal distention, bloating, gas, indigestion
Constipation
Decreased appetite (may also be increased or unchanged)
Diarrhea, chronic or occasional
Lactose intolerance (common upon diagnosis, usually goes away following treatment)
Nausea and vomiting
Stools that float, are foul smelling, bloody, or ?fatty?
Unexplained weight loss (although people can be overweight or of normal weight upon diagnosis)

A partial listing of non-intestinal symptoms:

Anemia (low blood count)
Bone and joint pain
Bone disease (osteoporosis, kyphoscoliosis, fracture)
Breathlessness (due to anemia)
Bruising easily
Dental enamel defects and discoloration
Depression
Fatigue
Growth delay in children
Hair loss
Hypoglycemia (low blood sugar)
Irritability and behavioral changes
Malnutrition
Mouth ulcers
Muscle cramps
Nosebleed
Seizures
Short stature, unexplained
Skin disorders (dermatitis herpetiformis)
Swelling, general or abdominal
Vitamin or mineral deficiency, single or multiple nutrient (for example, iron, folate, vitamin K)

Signs and tests:

A complete blood count (CBC) may indicate anemia. It is important to determine the cause if anemia is detected. An elevated alkaline phosphatase level may indicate bone loss, which is commonly experienced before diagnosis. Low cholesterol and albumin levels may reflect malabsorption and malnutrition. Mildly elevated liver enzymes and abnormal blood clotting may also be noted.

There are several antibody blood tests that are useful in screening. A panel consisting of antiendomysial antibody (IgA), antitransglutaminase (IgA), antigliadin (IgA and IgG), and total serum IgA is typically ordered. Combined, these antibodies provide a sensitive and specific indicator for the presence of celiac disease.

An endoscopy (EGD) with small bowel biopsy, particularly of the lower sections of the intestine most commonly affected, will show an abnormal intestinal lining (flattening of the villi).

A follow-up biopsy or blood work may be ordered several months after the diagnosis and treatment. These serve as a final confirmation of the disease. Normal resultsmean the patient has responded to treatment, thereby confirming the diagnosis. However, this does not suggest that the disease has been cured. Ongoing treatment for celiac disease is the gluten-free diet.