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    Do you have questions about celiac disease or the gluten-free diet?

  • Scott Adams
    Scott Adams

    What is tropical sprue?*

    Tropical sprue is a disease which causes a food absorption problem, especially with fat. The high risk places for catching tropical sprue are Southeast Asia and South America, and it is not normally found in Africa. The cause is not fully understood, but may be due to a viral infection, and/or from dietary factors. The symptoms are diarrhea (pale large stools), a sore tongue, loss of appetite, and weight loss. In the latter stages of the disease, a patient may develop ostemalacia (softening of the bones), peripheral neutitis, edematous swelling of the extremities, and megaloblasitic anemia. The standard treatment for tropical sprue is folic acid and cyanocobalamin. If diarrhea continues a cycle of tetracycline can be given. Anemia can be corrected by intracenous transfusions if necessary, and iron can be administered if there are any signs of iron-deficiency anemia in addition to megaloblastic anemia. Tropical sprue must be distinguished from gluten sensitivity. It is said that the damage form tropical sprue does not get as severe as that of celiac disease, but it may be very hard to distinguish the two. Arasitic infestations also need to be considered in people who have problems upon returning from underdeveloped areas.



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    I learned a lot of information about gluten intolerance and the background of the disease and the contributing factors that make up the disease-like alabsorption of fats and bacterial implications. Very educational.

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    This information is very educational. I have been suffering from malabsorption for the last twenty years. Thanks a lot.

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  • About Me

    In 1994 I was diagnosed with celiac disease, which led me to create Celiac.com in 1995. I created this site for a single purpose: To help as many people as possible with celiac disease get diagnosed so they can begin to live happy, healthy gluten-free lives. Celiac.com was the first site on the Internet dedicated solely to celiac disease. In 1998 I founded The Gluten-Free Mall, Your Special Diet Superstore!, and I am the co-author of the book Cereal Killers, and founder and publisher of Journal of Gluten Sensitivity.

  • Related Articles

    Scott Adams
    There is no prescriptive drug celiacs can take to effect a cure. In fact, there is no cure, though there is every opportunity for celiacs to lead normal, healthy lives by following a diet that contains no gluten. This means avoiding all products derived from wheat, rye, barley, oats, and a few other lesser-known grains.
    Extra vitamins may be taken, if necessary, but the only way for a celiac to avoid damage to their intestinal villi and the associated symptoms, is by maintaining a gluten-free diet.

    Scott Adams
    Vijay Kumar, M.D., Research Associate Professor at the University of Buffalo and President and Director of IMMCO Diagnostics: Not really. It is not true that the serological methods have lower predictive value in children less than two years of age. In all the studies that we did, there was 100% correlation of the EMA to the disease activity irrespective of the age.
    Karoly Horvath, M.D., Ph.D., Associate Professor of Pediatrics; Director, Peds GI & Nutrition Laboratory; University of Maryland at Baltimore: There are age dependent changes in several blood parameters during childhood. It is well known that immunoglobulin levels depend on the age of children. E.g. the IgA class immunoglobulins reach the adult level only by 16 years of age, and the blood level of IgA immunoglobulins is only 1/5th of adult value below two years of age. A large study from Europe (Brgin-Wollf et al. Arch Dis Child 1991;66:941-947) showed that the endomysium antibody test is less specific and sensitive in children below two years of age. They found that the sensitivity of the EmA test decreased from 98% to 88% in children younger than 2 years of age. It means that 12% of their patients with celiac disease, who were younger than two years of age, did not have an increase in their endomysium antibody levels.

    Scott Adams
    The following labs have excellent reputations for such tests:
    Specialty Labs
    2211 Michigan Ave.
    Santa Monica California 90404
    Tel: 310 828-6543 or 800 421-4449
    Internet: http://www.specialtylabs.com
    The University of Maryland at Baltimore
    Attention: Karoly Horvath, MD, or Athba Hammed, Research Assistant
    School of Medicine
    Division of Pediatric Gastroenterology and Nutrition Laboratory
    UMAB/Bressler Research Building, Room 10-047
    655 West Baltimore Street
    Baltimore, MD, 21201
    410 706-1997 or fax at 410 328-1072
    University of Iowa Foundation for Celiac Disease Research
    University of Iowa Hospitals and Clinics
    200 Hawkins Drive
    Iowa City, IA 52242
    IMMCO Diagnostics, Inc.
    Vijay Kumar, Ph.D.
    IMMCO Diagnostics 
    60 Pineview Drive 
    W. Amherst, NY 14228
    Tel: (716) 691-0091 
    Toll Free Tel: (800) 537-TEST
    E-mail: IMMTEST@AOL.COM
    Immunopathology Laboratory
    Dept. of Pathology
    5233 RCP
    University of Iowa Hospitals and Clinics
    200 Hawkins Drive
    Iowa City, IA 52242
    Tel: (319) 356-2688
    Mayo Clinic
    Dr. Joeseph Murray
    Internet: http://www.mayohealth.org/mayo/common/htm/index.htm
     
    Prometheus, Inc.
    5739 Pacific Center Boulevard
    San Diego, California 92121
    Tel: (619) 824-0895
    Toll Free (888) 423-5227
    Fax: (619) 824-0896

    Scott Adams
    Vijay Kumar, M.D., Research Associate Professor at the University of Buffalo and President and Director of IMMCO Diagnostics: The biopsy may be inconclusive. Serum, if tested for gliadin, endomysial and reticulin antibodies, should provide unequivocal information. Ours and other studies have provided a strong reliability of the serum tests.
    Karoly Horvath, M.D., Ph.D., Associate Professor of Pediatrics; Director, Peds GI & Nutrition Laboratory; University of Maryland at Baltimore: The biopsy may be inconclusive in a small percentage of patients with so-called patchy lesions in the duodenum. It means that there are histologically normal looking spots with finger like villi and pathologic spots showing flattened mucosa in the upper half of the duodenum. If celiac disease is suspected, the gastroenterologist should obtain several biopsies from different spots of the whole duodenum. Most of the endoscopists routinely examine only the upper half of the duodenum (duodenal bulb and the descending part). The transverse segment of the duodenum is not viewed routinely. Few endoscopic centers have an enteroscope, which is a longer and more flexible endoscope for examining the entire duodenum and jejunum. The enteroscopy allows you to obtain biopsies even from the jejunum. The histological examination of a single biopsy specimen may increases the risk of false negative diagnosis.
    The experience of the pathologist in the interpretation of small intestinal histology is important. In centers specializing in celiac disease the gastroenterologist routinely reviews the histologic slides together with the pathologist. There is still a possibility of inconclusive results if multiple biopsies are obtained and the histological interpretation is appropriate. All disease has a developmental process. It means that it takes time for the pathological changes to be evident. There are cases when the symptoms suggest celiac disease, however, the histology is not conclusive. This problem occurs in only a few cases. A repeated biopsy may be necessary after a period of higher gluten intake. However, if the antiendomysium antibody test is positive and the histology is not conclusive a gluten-free diet is recommended.
    The serology test may be inconclusive if:
    The sample handling and shipping is inappropriate; e.g. the serum was shipped at room temperature for days The patient has IgA deficiency, which occurs in one out of 600 people in the general population and much more frequently in patients with celiac disease. In these cases the antigliadin IgA and the antiendomysium IgA tests give negative results. If the tests are performed in a laboratory specialized in celiac serological tests, the laboratory recommends a test for immunoglobulins. If a patient has IgA deficiency and positive antigliadin IgG test, he/she should undergo further absorptive tests and/or an intestinal biopsy.

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