Diagnosis and treatment of celiac sprue

Celiac sprue, also termed celiac disease or gluten-sensitive enteropathy, is a chronic disease in which malabsorption of nutrients is caused by a characteristic, but nonspecific, lesion of the small-intestinal mucosa. The lesion is produced, through unclear mechanisms, by protein constituents of some cereal grains. Exclusion of wheat gluten and rye, barley, and oat prolamins from the diet results in a prompt improvement in absorption, along with reversion, toward normal, of the associated small-intestinal lesion. The spectrum of manifestations of celiac sprue is remarkably broad, but the severity of disease generally correlates with the length of small intestine that is damaged. When most or all of the small-intestinal mucosa is involved, symptoms are severe and malabsorption is generalized. In such patients, a diagnosis of celiac sprue is usually considered. When, on the other hand, the mucosal lesion is limited to the duodenum and proximal jejunum, overt gastrointestinal symptoms and steatorrhea may be absent. In those patients, clinical manifestations, if present at all, may reflect malabsorption of only one or two substances, notably iron and folate, that normally are absorbed somewhat selectively by the proximal intestine. Arriving at the correct diagnosis in such cases may be quite challenging.