Celiac sprue a disease
that goes against the grain
By Anne Bromley
you have heard of celiac sprue disease, you are better informed
than some doctors at least in the United States.
the incidence of this condition seems to be growing, knowledge
is lagging. It might actually be more prevalent than cystic fibrosis,
inflammatory bowel disease or multiple sclerosis.
brief primer, then. Celiac sprue is a form of a food allergy,
but rather than produce an immediate and obvious physical reaction
like peanut allergy, the immune reaction to proteins found in
certain grains (known as gluten in wheat) instead slowly damages
the small bowel, setting the stage for other illnesses and increasing
the risk for some kinds of cancer. Symptoms include gastrointestinal
discomfort, diarrhea, weight loss and/or a rash.
disease is little-known in the U.S., but since the 1940s, it has
been well documented and studied in northern Europe. Greeks described
the celiac condition as early as the second century A.D.
Disease, A Multi-System Disorder: Update for Clinicians
24, 6-8 p.m.
Jordan Hall Conference Center Auditorium
Continuing Medical Education program has a $25 fee, but
U.Va. employees can attend for free if they register in
information, contact Pam MacIntyre at 982-4136 or firstname.lastname@example.org.
To register, call CME Registrar Bebe Moore at 982-5310.
recent spike in the diagnosis of celiac disease likely
due to a new blood test for the disease has sent U.S. physicians
and dietitians in pursuit of the latest information about celiac
sprue, also known as gluten-sensitive enteropathy. At a recent
national conference devoted to gastroenterology, the sessions
on celiac disease were well attended, said Dr. Sheila Crowe, an
associate professor of internal medicine who came to U.Va. last
specialist in gastrointestinal inflammatory conditions, Crowe
has had a long-standing interest in celiac disease and its management.
Support groups are helpful, Crowe said. People with the disease
share new information, such as where to buy gluten-free products
(there are several options locally).
exact prevalence of celiac disease is hard to determine. Since
the blood test came out just a few years ago, it may be simply
that more people are being identified rather than more people
having it. As Crowe explained in a recent lecture: Celiac
disease may be much more common than previously thought, with
a prevalence as high as 1 in 125 to 1 in 300 [people] in the western
world. The true prevalence of celiac sprue remains to be established
by large multi-center studies in which serology and intestinal
biopsy are consistently evaluated.
U.Va. hopes to participate in that kind of national study, which
is currently in the planning stage, she added.
Parrish, a nutritionist at U.Va. who started a celiac support
group, asked Crowe to help heighten awareness here. Crowe has
since lectured to medical students, residents, GI fellows and
others in her department. Shell also speak on the topic
at a forum that U.Va.s Digestive Health Center of Excellence
is hosting next month.
disease can be tricky to diagnose, because it has many symptoms.
The classical form in which children have diarrhea, suffer from
malnutrition and failure to thrive or grow, is much less common
now. Celiac disease often causes non-specific GI symptoms and
it can also be the culprit behind symptoms usually attributed
to other causes. A physician might see a woman patient in her
60s who feels more tired than usual, turns out to be anemic or
has osteoporosis all caused by celiac disease. It can also
lead to repeated miscarriages. Some people might not feel bad
disease arises from an abnormal immune response to certain proteins
in grains such as wheat, rye, oats and barley leading to inflammation
and damage in the small bowel of genetically susceptible individuals.
As a result, nutrients dont get absorbed properly.
good news is that celiac disease is much more detectable now,
thanks to more accurate blood testing, and can be almost completely
cured with a change in diet. Although that sounds simple, the
bad news is that its a pretty drastic change to cut
out eating foods made with ordinary flour: breads, pasta, baked
goods like cakes and cookies. Rice and cornmeal can stay on the
payoff is getting cured. A gluten-free diet can put you
back to the same life expectancy, Crowe said. If not
treated, it can get worse and the chronic inflammation predisposes
you to increased risk for some kinds of cancer.