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sprue

sprue, chronic disorder of the small intestine caused by impaired absorption of fat and other nutrients. Two forms of the disease exist.

Tropical sprue occurs in central and northern South America, Asia, Africa, and other specific locations. No cause has been identified, but suggested causes include infection, parasitic infestation, vitamin deficiency, and food toxin. Tropical sprue responds to antibiotic and folic acid therapy.

Nontropical sprue, also called celiac disease, is primarily an autoimmune disease of young children and usually begins between the ages of 6 and 18 months, but it also can be triggered in susceptible adults. It is a hereditary congenital disorder caused by a sensitivity to the gliadin fraction of gluten, a cereal protein, but it appears to require an immunological trigger. The presence of gluten in the diet causes the immune system to attack the villi in the small intestine, interfering with the absorption of nutrients.

Nontropical sprue can be fatal, particularly if growth abnormalities are ignored or unrecognized. It is not known if scrupulous adherence to a gluten-free diet in this disease decreases the likelihood of intestinal lymphoma, but the deletion of gluten from the diet and the intake of vitamin, mineral, and hematinic supplements facilitate remission. Steroid treatments are often used if a gluten-free diet is ineffective; if steroid treatment is ineffective the prognosis is not good.

The symptoms of both types of sprue are generally the same: diarrhea with bulky, frothy, foul-smelling stools containing large amounts of fatty acids and soaps, and later weight loss, anemia, and other symptoms related to malabsorption of vitamins. X-ray examination of the small intestine revealing dilation, segmentation, and other typical changes is used in diagnosis.

The Columbia Electronic Encyclopedia, 6th ed. Copyright © 2012, Columbia University Press. All rights reserved.

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