CELIAC DISEASE

also called Nontropical Sprue, relatively rare malabsorption syndrome of children and adults, characterized by the passage of foul, bulky, fatty stools (steatorrhea), progressive malnutrition, often with multiple vitamin deficiencies, stunting of growth, and, late in the disease, a blood picture of microcytic anemia (more often in children) or macrocytic anemia (usually in adults) similar to that of pernicious anemia. In children, celiac disease usually begins between the ages of 6 and 21 months, frequently following an infection; the course is chronic, with periods of intestinal upset, diarrhea, and wasting, interspersed with periods of apparent normality. Adult celiac disease commonly begins past the age of 30; 25 percent of cases report having had repeated attacks of diarrhea, or clinically evident celiac disease, in childhood. Symptoms of mild celiac disease include loss of appetite and weight, mental depression and irritability, and constipation alternating with diarrhea. Advanced cases may display bone pain, deformation, and osteoporosis (increased bone porosity) from calcium and vitamin D deficiency, disturbances of vision from lack of vitamin A, bleeding tendencies from lack of vitamin K, or scurvy from deficiency of vitamin C (ascorbic acid). The cause of celiac disease is not known: many cases show a familial tendency; the symptoms of most patients are relieved by a diet free of glutens (protein constituent of wheat, barley, malt, and rye flours), and it is believed that a deficiency of certain enzymes (peptidases) necessary for the digestion of glutens may underlie the disease. Successful treatment consists of the use of diets high in proteins but low in glutens and saturated fats; other supportive measures may be necessary in advanced cases.