eMedicine Specialties > Gastroenterology > Intestine

Celiac Sprue: Follow-up

Author: Jan-Michael A Klapproth, MD, Assistant Professor, Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine
Coauthor(s): Vincent W Yang, MD, PhD, R Bruce Logue Professor, Director, Division of Digestive Diseases, Department of Medicine, Professor of Hematology and Oncology, Winship Cancer Institute, Emory University School of Medicine
Contributor Information and Disclosures

Updated: Sep 2, 2009

Follow-up

Complications

  • The risk for malignant disease is increased in patients with celiac disease.
    • These malignancies include adenocarcinoma of the oropharynx, esophagus, pancreas, small and large bowel, and hepatobiliary tract.
    • Other malignancies with an increased incidence in patients with celiac disease are enteropathy-associated T-cell lymphoma with a poor prognosis and T- and B-cell non-Hodgkin lymphoma. 
  • Refractory celiac disease occurs in approximately 5% of patients despite strict adherence to a gliadin-free diet.
    • Refractory celiac disease is characterized by symptoms of malabsorption, weight loss, diarrhea, abdominal distention, and anemia.
    • Refractory celiac disease is subdivided into two types: type 1 is characterized by a normal intraepithelial lymphocyte phenotype, and type 2 is characterized with an increased number of intraepithelial lymphocytes, possibly due to an increase in epithelial interleukin 15 expression.

Prognosis

  • The prognosis for patients with correctly diagnosed and treated celiac sprue is excellent.
  • The prognosis for patients with celiac sprue who are not responding to gluten withdrawal and corticosteroid treatment is generally poor.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Patients with celiac sprue are at increased risk for complications, such as lymphomas and adenocarcinomas of the intestinal tract. A small percentage of patients with celiac sprue fail to respond to a gluten-free diet, and, in some patients with refractory disease, corticosteroids might be helpful. In patients who fail to respond to corticosteroids, other comorbid conditions, such as lymphomas of the small intestine, should be considered.
  • Removal of gluten from the diet is essential to successful treatment of patients with celiac sprue. However, complete avoidance of gluten-containing grain products is relatively difficult to achieve and maintain because certain products, such as wheat flour, are virtually ubiquitous in the American diet. Careful and extensive indoctrination of the patient by the physician and the dietitian is often necessary to achieve full compliance.
    • Compliance is important for pregnant women because, if untreated, pregnant women are at risk of miscarriage and at risk of having a baby with a congenital malformation.
    • Compliance is important for infants and young children because, with untreated celiac sprue, failure to gain weight and growth retardation are common in this population.
 


More on Celiac Sprue

Overview: Celiac Sprue
Differential Diagnoses & Workup: Celiac Sprue
Treatment & Medication: Celiac Sprue
Follow-up: Celiac Sprue
References
Further Reading
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References

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Further Reading

Related eMedicine Topics

Clinical Trials

National Guideline Clearinghouse

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Keywords

celiac sprue, celiac disease, gluten, gluten-sensitive enteropathy, coeliac disease, gluten allergy, food allergy, food allergies, gluten intolerance, gluten free diet, gluten-free diet, gliadin, gliadin free diet, gliadin-free diet, nontropical sprue, malabsorption, diarrhea, maldigestion

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Contributor Information and Disclosures

Author

Jan-Michael A Klapproth, MD, Assistant Professor, Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine
Jan-Michael A Klapproth, MD is a member of the following medical societies: American College of Gastroenterology, American Federation for Medical Research, American Gastroenterological Association, and Crohns and Colitis Foundation of America
Disclosure: Nothing to disclose.

Coauthor(s)

Vincent W Yang, MD, PhD, R Bruce Logue Professor, Director, Division of Digestive Diseases, Department of Medicine, Professor of Hematology and Oncology, Winship Cancer Institute, Emory University School of Medicine
Vincent W Yang, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Gastroenterological Association, American Society for Clinical Investigation, and Association of American Physicians
Disclosure: Nothing to disclose.

Medical Editor

Mounzer Al Al Samman, MD, Department of Internal Medicine, Division of Gastroenterology, Assistant Professor, Texas Tech University School of Medicine
Mounzer Al Al Samman, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, and American Gastroenterological Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

James L Achord, MD, Professor Emeritus, Department of Medicine, Division of Digestive Diseases, University of Mississippi School of Medicine
James L Achord, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, Mississippi State Medical Association, New York Academy of Sciences, Sigma Xi, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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