Celiac sprue is a chronic disease of the digestive tract that interferes with the absorption of nutrients from food. People with celiac sprue cannot tolerate gluten, a protein commonly found in wheat, rye, barley, and, sometimes, oats. When affected individuals ingest gluten, the mucosa of their small intestine is damaged by an immunologically mediated inflammatory response, resulting in maldigestion and malabsorption.
Celiac sprue is hereditary.
The presentation of gluten-derived peptides by the HLA molecules to helper T cells, which mediate the inflammatory response, damages the intestinal mucosa. Absence of intestinal villi and lengthening of the intestinal crypts characterize mucosal lesions in untreated celiac sprue. Destruction of the absorptive surface of the intestine leads to a malabsorption syndrome. This might be due to underdiagnosis of the disease in part because of the lack of diagnostic laboratories experienced in celiac sprue. For example, the frequency of the disease is between 1 in 250 persons and 1 in 300 persons in Italian and Irish populations.