0521779407-C01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53
Celiac Sprue and Malabsorption 291■irritable bowel syndrome (multiple stools but scanty quantity and
no malabsorption)
management
What to Do First
■Consider differential diagnosis of sprue vs. other causes of malab-
sorption
■Eliminate gluten-containing foods from the diet (wheat, barley, rye,
some oat preparations–if contaminated with wheat, barley or rye
during manufacturing or for the occasional patient with a toxic reac-
tion to this grain); consultation with a nutritionist/dietitian is essen-
tial at the onsetGeneral Measures
■Add vitamin supplements (multivitamins, folic acid, fat-soluble vita-
mins [A,D,E]) and calcium (usually as the carbonate); vitamin B12
supplementation is usually not necessary
specific therapy
■All patients with sprue are treated with dietary gluten exclusion,
even if symptom-free, because of risk of osteoporosis, intestinal lym-
phoma and cancer.
■If gluten exclusion fails to achieve remission within a few weeks,
corticosteroids (prednisone 10–20 mg/day) given for 1–4 months
■No nutritional risk of gluten exclusion; meats, fish, vegetables and
rice allow adequate oral nutrition
■For refractory disease not responding to corticosteroids, immuno-
suppressants such as 6-mercaptopurine, azathioprine, methotrex-
ate, or cyclosporine may be indicated
■Specific treatment of other causes of malabsorption dependent on
condition
follow-up
■Response to gluten elimination usually prompt, days to a few weeks
■Monitoring of improvement in functional absorptive parameters
(xylose, fecal fat) usually sufficient; serial intestinal biopsies not indi-
cated routinely
■Long-term monitoring: brief yearly visits for global assessment
■Prompt thorough evaluation for any anorexia, fatigue, weight loss
complications and prognosis
■Most common complications: osteoporosis due to calcium malab-
sorption and iron deficiency anemia