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                   CELIAC SPRUE

Causes

Celiac sprue results from a combination of immunological responses to an environmental factor (gluten) and genetic factors. People need both a genetic predisposition and the exposure to gluten in order to develop celiac sprue.

  • Immune mechanisms

The interaction of gliadin (a specific gluten present in certain grain products) with the lining of the small intestine is critical in the development of celiac sprue. When people with celiac sprue eat foods containing gluten, gliadin is identified by the immune systems as a threat. As a result, the body produces antibodies called antigliadin antibodies. Antigliadin antibodies are directed against gliadin.

Two additional antibodies have been identified in the bloodstream of people with celiac disease. In contrast to antigliadin antibodies, these antibodies target the person's own body and are referred to as autoantibodies (antibodies against our own cells and organs). The first antibody targets endomysium, a small intestinal smooth muscle component. The second antibody targets an enzyme called tissue transglutaminase. The presence of these autoantibodies suggests that autoimmunity plays a role in the disease process of celiac sprue.

Genetic factors: Genes play an important role in celiac sprue. Celiac disease occurs much more frequently in relatives of persons with celiac sprue than in the general population. Celiac disease may occur in up to 10% of close family members of persons with celiac sprue.

Celiac sprue can be a debilitating condition, especially if the diagnosis is not considered early in the course of the disease. As a result, persons with any of the symptoms mentioned above (see Signs and Symptoms) or those with a family history of the disease are encouraged to seek medical advice. Because celiac sprue is hereditary, close family members of persons with celiac sprue should be tested for the disease. About 10% of an affected person's first-degree relatives (parents, siblings, or children) will also have the disease.

Females who are pregnant and have worsening anemia should seek medical care. This diagnosis should be considered in females with significant worsening of anemia  during pregnancy.

Self-Care at Home

For the most part, successful control of celiac sprue consists of what happens at home to modify diet and to select foods that can be eaten. Many resources are available to assist a person with choosing appropriate foods and modifying recipes to work within his or her diet.

Food labels should be read carefully. Wheat and rye flours, barley, and oats are common ingredients in many products. Many products a person would not suspect contain flour, such as salad dressings. In addition, barley is used in the brewing process of beer. The following substitutions may be tried:

1.   Rice flour and bread made with rice flour may be found at local specialty grocery stores.

2.   Cornstarch may be substituted for thickening sauces or gravies.

3.   Sorghum may also be substituted.

Outlook

Celiac sprue begins to improve within days of starting a gluten-free diet. Complete healing of the small intestine usually occurs in 3-6 months, although it may take up to 2 years in older persons.

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