By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

ANEMIA CAN BE FIRST CLUE TO SPRUE, AS IN READER’S CASE

Question: I was recently diagnosed with Sprue. I was told to go on a strict diet and eat no grains. I am 62 and basically healthy. My doctor found this when she worked up my anemia. Will I have this forever? Is there a treatment that will cure this?

Answer: Sprue, also known as celiac disease, or gluten enteropathy, can occur at any age. It can start in young babies as well as senior citizens. Over 20 percent of the cases of sprue are in people over 60. Sprue is more common in women and people of European descent but is rare in those of Asian and African heritage. It does run in families.

Often sprue has no symptoms at all, and it is diagnosed when an alert physician is doing a workup for another condition such as fatigue, weakness, bone loss or even a mood disorder. I take it this is what happened in your case.

Recent research has shown that sprue is much more common than previously thought. It may affect as many as one out of every 133 people in the general population.

If you have this disorder and consume a food with gluten, your body undergoes an autoimmune reaction. Your immune system attacks several parts of your own body, focusing on the small intestines. This usually begins when the small intestine is exposed to antigens that are found in cereals and your body produces antibodies to them.

The resulting inflammation reduces digestion and may bring on a number of gastrointestinal symptoms. These can include excess intestinal gas, bloating, cramping, foul-smelling and oily or pale stools, and chronic diarrhea or constipation. In some people, as I mentioned earlier, symptoms like weight loss, fatigue or weakness are not as specific to the G.I. tract.

Given the wide range of possible symptoms, it’s not surprising that celiac disease can often be misdiagnosed. It’s not uncommon for doctors and patients to confuse the intestinal symptoms with those of irritable bowel syndrome, or I-B-S. On the other hand, if gastrointestinal symptoms aren’t present, but the inflammation causes a decrease in the absorption of nutrients and vitamins this can lead to an initial diagnosis of, for example, anemia or osteoporosis. You are fortunate that your doctor was wise enough to suspect sprue as the cause of your anemia.

Once the diagnosis is made with blood tests and possibly an endoscopy, the treatment is straightforward. Do not eat wheat, barley or rye or products containing even trace amounts. Oats are fine, but there can be cross contamination of gluten products in processing so be careful. Do not over-eliminate foods from your diet. Only wheat, barley and rye need to go. Get a consultation with a dietitian who is knowledgeable about sprue. More food manufacturers are making gluten-free products. Always read your labels carefully.

Some people in the early stages of the illness may need steroids to help reduce the inflammation in the intestines. Also, conditions caused by malabsorption, such as your anemia, need to be treated. The good news is that with strict avoidance of trigger foods, your symptoms may resolve in a few weeks.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.