Celiac sprue

Noninfectious causes of acute diarrhea include drugs and toxins (Table 18-3), laxative abuse, food intolerance, irritable bowel syndrome (IBS), inflammatory bowel disease, ischemic bowel disease, lactase deficiency, Whipple s disease, pernicious anemia, diabetes mellitus, malabsorption, fecal impaction, diverticulosis, and celiac sprue. 

Piper, J. L., Gray, G. M., and Khosla, C. (2002). High selectivity of human tissue transglutaminase for immunoactive gliadin peptides Implications for celiac sprue. Biochemistry 41, 386-393. 

Upton, M. P. (2008). "Give us this day our daily bread"—Evolving concepts in celiac sprue. Arch. Pathol. Lab. Med. 132,1594-1599. 

There are several forms of intolerance to lactose and galactose. Primary adult lactase deficiency is a normal age-related decrease in lactase activity seen in the majority of adults. Secondary lactase deficiency is a transient state of low enzyme activity following injury to the intestinal mucosa as a result of diseases such as celiac sprue, infectious gastroenteritis, and protein-calorie malnutrition. The last two states are common conditions (Dahlqvist 1983). 

De Angelis, M., Rizello, C.G., Fasano, A., Clemente, M.G., De Simone, C., Silano, M., De Vincenzi, M., Losito, I., Gobbetti, M. 2006. VSL 3 probiotic preparation has the capacity to hydrolyze gliadin polypeptides responsible for celiac sprue. Biochim Biophys Acta 1765 80-93. 

Shan, L., Molberg, O., Parrot, I., Hausch, F., Filiz, F., Gray, G.M., Sollid, L.M., Khosla, C. 2002. Structural basis for gluten intolerance in celiac sprue. Science 297 2275-2279. 

Wheat starch is low in protein, ash and fiber, and contains no residual sulfites. Sulfur dioxide is detrimental to the viscoelastic character of wheat gluten and is not used in the commercial production of wheat starch.28,323 The protein content of ten samples of unmodified and modified wheat starches ranged from 0.06-0.22%.28 A 0.23% protein (0.0404% nitrogen) level in wheat starch essentially indicates a gluten-free starch, as confirmed by an enzyme immunoassay.324 That purity of wheat starch is important in diets for celiac individuals. Wheat starch-based, gluten-free flour products were not harmful in the treatment of celiac sprue and dermatitis herpetiformis,325 although traces of an immunoreactive gliadin can be found in wheat starch.326... 

Shan L, Qiao SW, Arentz-Hansen H, Molberg O, Gray GM, Sollid LM, et al. Identification and analysis of multivalent proteolytically resistant peptides from gluten Implications for celiac sprue. J Proteome Res 2005 4 1732-1741. 

Pyle GG, Paaso B, Anderson BE, Allen DD, Marti T, Li Q, et al. Effect of pretreatment of food gluten with prolyl endopeptidase on gluten-induced malabsorption in celiac sprue. Clin Gastroenterol Hepatol 2005 3 687-694. 

Marsh MN. Gluten, major histocompatibility complex, and the small intestine. A molecular and immunobiologic approach to the spectrum of gluten sensitivity ( celiac sprue ). Gastroenterol 1992 102 330-354. 

Heneghan MA, Stevens FM, Cryan EM, Warner RH, McCarthy CF. Celiac sprue and immunodeficiency states A 25-year review. J Clin Gastroenterol 1997 25 421 425. 

The Lundh test also includes intestinal intubation and direct measurement of enzyme output in duodenal juice but uses a standardized test meal as a pancreatic stimulus. Because this test requires release of physiological regulatory mediators from the duodenal mucosa, it is less specific than the SC test and may render falsepositive results in intestinal diseases such as celiac sprue. 

Measurement of stool weight and quantitative fecal fat excretion on three consecutive days during a balanced diet are common screening tests for both pancreatic insufficiency and other pathologies that result in malabsorption. However, these tests are insensitive and nonspecific for pancreatic malfunction Steatorrhea occurs only after loss of more than 90% of exocrine parenchyma, and other causes of malabsorption (e.g., celiac sprue or Crohn s disease) may also induce abnormal fecal fat excretion of more than 7 g/day or more than 5 g/100 g. 

Dickey, N., McMillan, St.A., Callender, M.E. High prevalence of celiac sprue among patients with primary bihary cirrhosis. J. Clin. Gastroenterol. 1997 25 328-329... 

Fine, K. D. (1996). The prevalence of occult gastrointestinal bleeding in celiac sprue. New Engl.. Med. 334,1163-1167. 

Gray, G. (1997). Persistence of diarrhea in treated celiac sprue Refractory disease of another organ s malfunction Gastroenterology 112,2146-2147. 

Celiac Disease (Celiac Sprue, Gluten-Sensitive... 

Farrell RJ, Kelly CP. Current concepts celiac sprue. New Engl J Med 2002 346 180-8,... 

FarreU RJ, Kelly CP. Celiac sprue and refractory sprue. In Feldman M, Friedman LS, Sleisenger MH, eds. Sleisenger and Fordtran s gastrointestinal and liver disease, 7th ed. Philadelphia WB Saunders, 2002 1817-41. 

Celiac Sprue Association. (CSA). A member-based nonprofit organization to help individuals with Celiac Sprue and Dermatitis Herpetformes through education and research. Its mailing address is P.O Box 31700, Omaha, NE 68131. Website http //www.es aceliacs. org. 

Intrinsic diseases of the small intestinal mucosa may impair mineral absorption. Such conditions as celiac sprue, dermatitis herpetiformis, infiltrative lymphomas, and occasionally inflammatory bowel disease produce diffuse mucosal damage. Protein energy malnutrition causes similar damage, and tropical enteropathy affects part of the population of developing countries living under adverse nutritional and hygienic conditions. 

In patients with vitamin D deficiency, oral vitamin D 50,000 units daily for 10 days or once weekly for 8 weeks, or 50,000 to 500,000 units intramuscularly is recommended. Serum calcium and 25(OH) vitamin D should be monitored periodically. Once replete, daily intakes of 600 to 1000 units are usually required. In the community or nursing home, vitamin D 100,000 units once per quarter is reasonable. In patients with vitamin D malabsorption (e.g., gluten-sensitive celiac sprue), 25(OH) vitamin D (calcidiol) administration is needed. In patients with severe hepatic or renal disease, calcitriol therapy may be required. This drug requires careful titration and serum calcium and creatinine monitoring because of its hypercalcemic potential and the limited calciuric ability of the dysfunctional kidney. 

Celiac disease (celiac sprue) is an allergic inflammatory condition caused by poorly digested proline-rich sequences of wheat gluten and related proteins (p. 74). The disease is usually not recognized, but it may occur in 3% or more of the United States population. A T-cell response that causes destruction of the smaller intestinal mucosa, celiac disease is characterized by malabsorption and diarrhea. It can cause death by starvation. A primary target of the autoantibodies is a transglutaminase. ... 

M. -A. Deathridge, F.P. Guengerich, D. Kelleher et al. (1996). Decreased intestinal P450 3A4 in celiac sprue Reversal following successful gluten free diet. Clin. Pharmacol. Then 59, 41—46. 

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