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.
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
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
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
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
are encouraged to seek medical advice. Because celiac sprue is hereditary, close
family members of persons with celiac sprue should be tested for the
About 10% of an affected person's first-degree relatives (parents, siblings, or
children) will also have the disease.
Females who are
should seek medical care. This diagnosis should be considered in females with
significant worsening of
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
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.
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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