Sprue

• Sprue is a chronic, degenerative disorder resulting from malabsorption of nutrients from small intestine.
• Sprue is characterized by

  • diarrhea
  • weakness
  • weight loss
  • poor appetite
  • pallor
  • muscle cramps
  • bone pain
  • Ulceration of the mucous membrane lining the digestive tract
  • smooth, shiny tongue
• Celiac sprue/disease also known as gluten-sensitive enteropathy.
• Gluten-induced enteropathy is a genetic, chronic malabsorption disorder that results from a sensitivity or abnormal immunologic response to protein, particularly gluten, a protein commonly found in barley, rye, oats and wheat. Upon ingestion of foods containing gluten, changes occur in the intestinal mucosa or villi that prevent the absorption of foods
• Causes of celiac sprue/disease:

  • immunological responses to an environmental factor (gluten)
  • genetic factors (children of north european background; down's syndrome)
• Clinical manifestations of sprue: (noticeable between 6-18 months old)

  • steatorrhea
  • deficiency of vitamins A, D, E and K
  • malnutrition
  • distended abdomen
• Clinical manifestations of sprue: (noticeable between 6-18 months old)

  • rickets and hypoprothrombinemia may occur
  • IDA and hypoalbuminemia
  • anorexia, irritability, poor weight and height gain
  • skinny, with spindly extremities and wasted buttocks but face may be plump and well-appearing
• Diagnosis of sprue:

  • serum analysis of antibodies against gluten (IgA antigliadin antibodies)
  • biopsy of intestinal mucosa (Via endoscopy)
  • oral glucose tolerance test = > 200 mg/dl
  • stool - tested for increased fat content
  • observing response to a gluten-free diet: begins to gain weight, steatorrhea improves, irritability fades
• Management for sprue:

  • gluten-free diet for life
  • avoid BROW
  • nutritional counseling for parents
  • administration of water-soluble forms of vitamins A and D
  • iron and folate supplementation
• Nutritional counseling for parents:

  • be careful shoppers and read food labels
  • small servings
  • create incentives to eat
• evaluation:

  • the disappearance of steatorrhea is a good indicator that the child's ability to absorb nutrient is improving