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Against the grain: The growing awareness of celiac sprue

The wide-ranging symptoms of the disease can disguise the intestinal disorder, but new tests are helping to make diagnosis easier.

By Susan J. Landers, amednews staff. Aug. 18, 2003.

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True or false: Celiac disease is rarely seen in the United States. When Alessio Fasano, MD, born, raised and medically trained in Italy, first arrived on American shores, he would have said "true" without hesitation.

The intestinal disorder was common in his native country. One of his medical school mentors was an expert in the condition. And he already had treated celiac patients of all ages with a wide variety of symptoms ranging from diarrhea and abdominal pain to constipation, osteoporosis, anemia and even behavior changes.

But it also was widely accepted that Americans almost never harbor this illness, which is triggered in genetically susceptible people by gluten-containing foods. Dr. Fasano looked forward to the different experiences he thought would accompany his new position as professor of medicine, pediatrics and physiology at the University of Maryland School of Medicine in Baltimore.

Instead, he almost immediately began seeing patients who had the very familiar range of complaints.

Now, Dr. Fasano co-directs the University of Maryland's Center for Celiac Research and focuses on spreading a different truth among primary care physicians. Celiac disease actually is one of the most common lifelong disorders in the United States -- American doctors just had not been trained to look for it.

This task -- making physicians more aware about celiac disease -- runs counter to much of American conventional wisdom about the disorder's incidence. Thus, Dr. Fasano and colleagues decided that mounting a large-scale study was necessary to gather the evidence that celiac disease affected many patients.