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Celiac Sprue vs Tropical Sprue

Sprue means that you cannot absorb nutrients from the food that you eat, causing vitamin and mineral deficiencies, diarrhea and cramping. There are two major types of sprue. Celiac sprue means that a component of some foods called gliadin causes your own immunity to attack and damage the inner linings of your intestines so that normal absorption of nutrients from your food is disrupted. You may also develop a blistery skin rash. Tropical sprue means that you have an infection that causes the same results. Usually your doctor will draw blood to see if you have antibodies against gliadin and endomysial cells, and perhaps biopsy the inner lining of your intestines. You must be checked for intestinal cancers that are associated with celiac sprue. Your doctor will also test for infection.

Gliadin is a fraction of gluten, found in wheat, rye and barley. Those with celiac sprue are told to avoid these grains and all foods that contain them. Oats are often included in the list of grains to avoid, but some studies show that most people with celiac sprue can eat oats safely (1,2,3,4,5,6). However, since whole grains are often kept in common storage facilities, cross-contamination can occur.

It can take more than six months for your intestines to heal with a diet that eliminates gluten, so most doctors prescribe dapsone or sulfapyridine which usually stops the diarrhea within a few days. Nutritional deficiencies such as lack of B12, iron and so forth, may need to be treated with vitamin and mineral pills.

On the other hand, if blood tests for antibodies to gliadin are be negative and you continue to have symptoms after taking dapsone or sulfapyridine, you may have an infection called tropical sprue. Not all doctors will treat you with antibiotics, but some may prescribe quinolones or metronidazole.

1. Hardman CM et al. Absence of toxicity of oats in patients with dermatitis herpetiformis. NEJM 1997(Dec 25);337:1884-7.

2) NEJM 1995;333:1033-7.

3) BMJ 1996;313:1300-1.

4) BMJ 1974;4:189-91.

5) BMJ 1997;314:159-60.

6) T Thompson. Do oats belong in a gluten-free diet? Journal of the American Dietetic Association 97: 12(DEC 1997):1413-1416.

7) HT Pruessner. Detecting celiac disease in your patients. American Family Physician 57: 5 (MAR 1 1998):1023-1034.

8) W Holtmeier, WF Caspary. Diagnostic use of antibodies in celiac disease. Zeitschrift Fur Gastroenterologie 36: 7 (JUL 1998):587-597.

9) EO Riecken, S Daum, JD Schulzke, W Dieterich, D Schuppan. Tissue transglutaminase as autoantigen in coeliac disease - New aspects in diagnosis and etiopathogenesis. Deutsche Medizinische Wochenschrift 123: 48(NOV 27 1998):1454-1460.

Checked 12/24/12

January 1st, 2015
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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