Clinical Focus Box 272

Celiac Sprue (Gluten-Sensitive Enteropathy) Celiac sprue, also called gluten-sensitive enteropathy, is a common disease involving a primary lesion of the intestinal mucosa. It is caused by the sensitivity of the small intestine to gluten. This disorder can result in the malabsorption of all nutrients as a result the shortening or a total loss of intestinal villi, which reduces the mucosal enzymes for nutrient digestion and the mucosal surface for absorption. Celiac sprue occurs in about 1 to 6 of 10,000 individuals in the Western world. The highest incidence is in western Ireland, where the prevalence is as high as 3 of 1,000 individuals. Although the disease may occur at any age, it is more common during the first few years and the third to fifth decades of life.

In patients with celiac sprue, the water-insoluble protein gluten (present in cereal grains such as wheat, barley, rye, and oats) or its breakdown product interacts with the intestinal mucosa and causes the characteristic lesion. Precisely how the binding of gluten to the intestinal mucosa causes mucosal injury is unclear. One hypothesis is that patients prone to celiac sprue may have a brush border peptidase deficiency and that the consequent incomplete

Muscel Skeletal Injury

Surface area amplification by the specialized features of the intestinal mucosa.

(Modified from Schmidt RF, Thews G. Human Physiology. Berlin: Springer-Verlag, 1993, p. 602).

digestion of gluten results in the production of a toxic substance, which injures the intestinal mucosa. This idea is probably incorrect, however, because the intestinal brush border peptidases revert to normal after the healing of damaged intestinal mucosa. Another hypothesis is that immune mechanisms are involved. This is supported by the fact that the number and activity of plasma cells and lymphocytes increase during the active phase of celiac sprue and that antigluten antibodies are usually present. It has been demonstrated that the small intestine makes a lym-phokine-like substance, which inhibits the infiltration of leukocytes into the lamina propria of the intestinal mucosa when exposed to gluten. Unfortunately, it is not clear whether these immunological manifestations are primary or secondary phenomena of the disease.

The elimination of dietary gluten is a standard treatment for patients with celiac sprue. Occasionally, intestinal absorptive function and intestinal mucosal morphology of patients with celiac sprue are improved with glucocorticoid therapy. Presumably, such treatment is beneficial because of the immunosuppressive and anti-inflammatory actions of these hormones.

Why Gluten Free

Why Gluten Free

What Is The Gluten Free Diet And What You Need To Know Before You Try It. You may have heard the term gluten free, and you may even have a general idea as to what it means to eat a gluten free diet. Most people believe this type of diet is a curse for those who simply cannot tolerate the protein known as gluten, as they will never be able to eat any food that contains wheat, rye, barley, malts, or triticale.

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