Celiac disease or sprue

Historical perspective

• This disorder is also known as gluten-sensitive enteropathy or nontropical sprue. It was initially suggested by Aretaeus from Cappadochia (Turkey) in the 2nd century AD. Samuel Gee in his 1888 report entitled "On the Coeliac Affection" provided the first modern version of the disease.
• Willem K Dicke, a Dutch pediatrician is credited with describing the association of bread and the celiac disease. His initial observations were confirmed since symptoms improved during food shortages during the World War II.

The disease

• It is a disorder of malabsorption due to sensitivity to gluten contained in wheat, rye and barley. The tolerance to oats is variable and may depend on the amount of oats ingested.
• As many as one in 150 healthy persons have the diagnosis based on antibody testing. It is more common among Caucasians although it may occur in other races. However most are asymptomatic.

Clinical manifestations

• Age of presentation and the symptoms are variable. Symptoms may start in early childhood or later on in adult life. While diarrhea, fatty stools, weight loss are seen in typical patients, some may present only with unexplained iron deficiency anemia.
• Still others may mimic irritable bowel syndrome. Thus patients with diarrhea predominant IBS should have blood tests for celiac disease.
• Neurological problems (depression, anxiety, seizures), menstrual abnormalities, arthritis, and reduced bone mineral density, diabetes mellitus, chronic liver dysfunction, thyroid disease (over or underactive), infertility, may be seen. There is high rate of selective IgA deficiency, dermatitis herpetiformis , myocarditis, lymphoma and cancers of gut.

Diagnosis

• Serological tests can be done by looking for IgA endomysial antibody (IgA EMA), IgA tissue transglutaminase antibody (IgA tTG) IgA antigliadin antibody (IgA AGA) IgG antigliadin antibody (IgG AGA).
• Currently anti-tTG antibody test is believed to be the most cost-effective antibody test with high sensitivity and specificity above 90 percent. IgA endomysial antibody (IgA EMA) is at least equally good if not better, but is somewhat more expensive.
• Antigliadin antibody tests have high false positive rates with poor predictive value and no longer recommended. Routine screening for celiac disease using these tests is not recommended.
• The diagnosis of celiac disease must be confirmed small bowel biopsies which can be done during endoscopy. The biopsies are usually undertaken only in symptomatic patients.

Treatment

• Strict gluten free diet is cornerstone for therapy. Some patients with severe refractory disease require corticosteroids and other immunosuppressive agents. Relapse despite strict adherence to diet raises red flags for the possibility of cancer.

Do you or someone you know has celiac disease? If so, what are the day to day challenges you face at work or home? If you have been diagnosed with irritable bowel syndrome with diarrhea, have you been excluded for celiac disease?

Comments

[Jacob van Hemert]

Ever since I can remember I have suferd from acid reflux
I am 67 years old and can not remember a day free from acid in the stomach. I recently found out that when I eat bread it causes the acid reflux. I have been free of acid now since
January 20, 2007. It is a small miracle that it is such a small solution for that big a problem. I don't eat bread
anymore.

Yours truly

J van Hemert

[Shinga]

Family friends had coeliac disease and I remember how difficult it was for them - they travelled everywhere with their own food and it very much cut into their social lives. Because the mother had been so punctilious about controlling what they ate, the children failed to adhere to the diet when they moved away from home. For quite some time, they seemed to be on repeat courses of corticosteroids.

It is easier now to be gluten-free because we have good labelling in the UK. Ironically, for some people it seems to have de-skilled them as they now rarely cook from scratch, but by 'certified' and 'labelled' foods.

I meet quite a lot of people with IBS who speculate that they have coeliac disease but have never been tested for it. There are various commercially available tests in the UK but I think there is poor understanding as to which may be relevant - but now I can point people towards your overview, so thank you.

Regards - Shinga