Celiac Sprue: Diagnosis and Treatment

Diagnosis

Diagnosis in infants is suggested by a constellation of diarrhea, failure to thrive, and irritability.

Serologic testing with IgA antitissue transglutaminase or antiendomysial antibody is used to screen for celiac disease. Antigliadin antibody testing is no longer routinely used.

In equivocal cases, a small–intestine biopsy or HLA haplotype testing may be useful. HLA testing may also be done to determine susceptibility in offspring. Rarely, a follow–up biopsy may be performed for comparison after the patient has followed a gluten–free diet for 3 to 6 months.

It may also be advisable to assess hematologic indices to check for iron deficiency anemia.

Treatment

The cornerstone of treatment is dietary adjustment to avoid gluten (see Nutritional Considerations below). In addition to easing symptoms, dietary adjustment may decrease the risk of esophageal carcinoma, small bowl carcinoma, and B–cell lymphoma, which occur in greater frequency in these patients. In addition, immunosuppressant therapy with corticosteroids may be necessary for patients who do not respond to gluten avoidance. Dapsone has been used to treat associated dermatitis herpetiformis.