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 a disease of young children and usually begins between the ages of 6 and 18 months. It is a hereditary congenital disorder caused by a sensitivity to the gliadin fraction of gluten, a cereal protein. Nontropical sprue can be fatal, particularly if growth abnormalities are ignored or unrecognized. It is not known if scrupulous adherence 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.

or nontropical sprue

Digestive disorder in which people cannot tolerate gluten, a protein constituent of wheat, barley, malt, and rye flours. In celiac disease, gluten generates an immune response that damages the mucous lining of the small intestine; it is believed that a deficiency of gluten-digesting enzymes may underlie the disease. Poor nutrient absorption causes foul, bulky, fatty stools; malnutrition; stunting of growth; and anemia similar to pernicious anemia. It can run in families. Children begin having intermittent intestinal upset, diarrhea, and wasting at 6–21 months. In adults it usually begins after 30, with appetite loss, depression, irritability, and diarrhea. Symptoms in advanced cases stem from nutritional deficiencies and may require supportive measures. A high-protein diet low in glutens and saturated fats usually relieves symptoms.

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