I was encouraged to see the article, "The Importance of a Gluten-Free Diet," (July, 2003). As an RN with a recent diagnosis of celiac sprue, I have been disappointed in the lack of knowledge dissemination about the disease. I would like to add a couple of points about celiac sprue.

In the United States, it takes a child with celiac sprue approximately 2 years to be diagnosed and an adult up to 10 years. This delay predisposes those affected to other autoimmune disorders, osteoporosis, and cancer. Often, this highly prevalent health problem is inadequately addressed in nursing and medical education. Additionally, the manifestations of celiac sprue are highly variable. Clients often experience no G.I. symptoms. Approximately 256 signs and symptoms (often vague) have appeared in U.S. patients with celiac sprue (Guandalini, 2002, University of Chicago Celiac Disease Program).

Nurse practitioners can screen for the disease with serologic testing. It should always be considered with weight loss and fatigue. I was pleased that the authors encouraged clinicians to "maintain a high index of suspicion". Thank you for this important article.

Leah Lewis, RN, BSN, FNP