1/10. Approaching the patient with chronic malabsorption syndrome.The causes of chronic malabsorption may be categorized as decreased intestinal absorption, most commonly caused by celiac sprue; or maldigestion caused by pancreatic insufficiency. The initial step in the evaluation of these patients should include stool studies to confirm fat malabsorption. If fat malabsorption is confirmed, endoscopy with small-bowel biopsies and aspirates for bacterial culture usually follows. A normal endoscopic examination should lead to assessment of pancreatic function. In the setting of normal pancreatic function and the absence of bile acid deficiency, a barium radiograph of the small bowel should be made, looking for anatomical abnormalities. Celiac sprue is an intolerance to gluten caused by a combination of genetic, environmental, and immunologic factors. It classically causes malabsorption. However, it is likely that many patients who exhibit only minor manifestations of the disease go unrecognized and untreated. A presumed diagnosis of celiac sprue is confirmed after a clinical and endoscopic response to a gluten-free diet. Serological markers are available with high degrees of sensitivity and specificity, but duodenal biopsy remains the gold standard for diagnosis. A minority of patients are unresponsive to a gluten-free diet, and intestinal lymphoma should be suspected in these cases.- - - - - - - - - - ranking = 1keywords = sprue (Clic here for more details about this article) |
2/10. Microscopic colitis syndrome: lymphocytic colitis and collagenous colitis.Microscopic colitis is a syndrome consisting of chronic watery diarrhea, a normal or near-normal gross appearance of the colonic lining, and a specific histological picture described as either lymphocytic colitis or collagenous colitis. Since its initial descriptions a quarter of a century ago, microscopic colitis has become a frequent diagnosis in patients with chronic diarrhea. Understanding of the cause and pathogenesis of microscopic colitis remain incomplete, but potentially important clues have been discovered that shed light on predisposing factors. In particular, specific HLA-DQ genotypes may be permissive for the development of microscopic colitis, and suggest a linkage to the pathogenesis of celiac sprue. Although the differential diagnosis of chronic watery diarrhea is broad, the diagnosis of microscopic colitis is straightforward, involving endoscopic inspection of the colonic mucosa and proper pathologic interpretation of biopsy specimens. As the limitations of drugs ordinarily used for other forms of inflammatory bowel disease are being recognized, new approaches, such as the use of bismuth subsalicylate, are being evaluated. The prognosis of patients with microscopic colitis syndrome remains good, and symptomatic improvement can be expected in most patients.- - - - - - - - - - ranking = 0.33333333333333keywords = sprue (Clic here for more details about this article) |
3/10. Collagenous enterocolitis: a manifestation of gluten-sensitive enteropathy.We report coexistent collagenous colitis and collagenous sprue in a 62-year-old woman with diarrhea. Investigations suggested malabsorption, and small intestinal biopsies demonstrated a flattened mucosa with subepithelial collagen deposition. Colonic biopsies also showed a thickened subepithelial collagen band as well as a striking lamina propria inflammatory cell infiltrate. Symptomatic remission was induced with a gluten/lactose-free diet, oral prednisone, and sulfasalazine and has been maintained with gluten restriction alone. Repeat biopsies after 2 months demonstrated restoration of normal small intestinal and colonic collagen bands; only a chronic inflammatory cell infiltrate (consistent with microscopic/lymphocytic colitis) persisted in colonic biopsies. We propose that, in this instance, collagenous enterocolitis represented a diffuse manifestation of gluten sensitivity.- - - - - - - - - - ranking = 0.33333333333333keywords = sprue (Clic here for more details about this article) |
4/10. eating disorders and celiac disease: a case report.OBJECTIVE: Although chronic physical illness may be associated coincidentally with an eating disorder, some clinicians may overlook the possibility that another medical illness may coexist and contribute concurrently to symptoms such as peculiar eating behaviors, restrictive eating, and/or vomiting accompanied by body dissatisfaction. We present a 31-year-old single woman initially diagnosed with an atypical eating disorder. METHOD: After a gastroenterology consultation prompted by the atypical characteristics of her eating disturbance, the diagnosis of celiac disease was established. RESULTS: Cause-and-effect relationships between anorexia nervosa and celiac disease are unclear, and celiac disease may lead to confusion in the differential diagnosis of anorexia nervosa. CONCLUSION: Particularly in atypical cases, and in cases where nausea and bloating are prominent complaints, workup for celiac sprue may reveal the presence of this condition. In such instances, patients may achieve additional relief through the implementation of gluten-free diets.- - - - - - - - - - ranking = 0.33333333333333keywords = sprue (Clic here for more details about this article) |
5/10. Idiopathic chronic ulcerative enteritis: a report of two cases.Idiopathic chronic ulcerative enteritis (ICUE) is considered by some physicians to be a variant of sprue. Two patients being treated at our hospital for nonspecific abdominal symptoms had abnormal findings from a small-bowel series; at surgery, an ulcerating process involving the jejunum was found. Clinical, radiological, and pathological findings in these cases suggest that ICUE is a distinct entity.- - - - - - - - - - ranking = 0.33333333333333keywords = sprue (Clic here for more details about this article) |
6/10. exocrine pancreatic insufficiency in celiac sprue: a cause of treatment failure.The coexistence of nontropical sprue and advanced pancreatic insufficiency is uncommon. The purposes of this report are to: (a) describe 3 patients with non-tropical spruc and severe pancreatic insufficiency, (b) determine the frequency, magnitude, and clinical importance of diminished pancreatic secretion in nontropical sprue, and (c) assess whether patients with pancreatic insufficency secondary to chronic pancreatitis or pancreatic cancer have jejunal mucosal histologic abnormalities. In each of 3 patients with nontropical sprue and associated severe exocrine pancreatic insufficiency, an optimal clinical response required the appropriate treatment of both causes of malabsorption. Of 31 subjects with proved nontropical sprue, cholecystokinin-stimulated duodenal tryptic activity or lipolytic activity (or both) was reduced in 13 (42%) but severely reduced in only the three case reports (10%). The morphologic structure of the small bowel was normal in 21 patients with primary pancreatic insufficiency secondary to chronic pancreatitis or pancreatic cancer. Mild-to-moderate exocrine pancreatic insufficiency is a frequent finding in untreated nontropical sprue, is presumably reversible, and rarely contributes to the development of steatorrhea. However, if patients with nontropical sprue fail to respond to a gluten-free diet, coexistent severe pancreatic insufficiency is a possible cause for treatment failure.- - - - - - - - - - ranking = 3.3333333333333keywords = sprue (Clic here for more details about this article) |
7/10. association of lymphocytic (microscopic) colitis with tropical sprue.Lymphocytic (microscopic) colitis is a disease of unknown aetiology which manifests as long-standing intermittent diarrhoea. diagnosis is confirmed on histological examination of the colon. An association of this uncommon disease with tropical sprue is described. tetracycline therapy resulted in a favourable clinical response.- - - - - - - - - - ranking = 1.6666666666667keywords = sprue (Clic here for more details about this article) |
8/10. Oral T-cell lymphoma associated with celiac sprue. A case report.Celiac sprue, also called nontropical sprue, is a malabsorption syndrome with symptoms that are triggered mainly by gluten ingestion. Non-Hodgkin's lymphoma of the gastrointestinal tract has been reported in patients with a long history of celiac sprue. This case report describes the occurrence of primary oral lymphoma in such a patient. This case is unusual because lymphomas associated with celiac sprue usually develop in the small intestine or in the stomach, and primary lymphoma in the mouth is itself uncommon.- - - - - - - - - - ranking = 2.6666666666667keywords = sprue (Clic here for more details about this article) |
9/10. The brown bowel syndrome and gastrointestinal adenocarcinoma. Two complications of vitamin e deficiency in celiac sprue and chronic pancreatitis?The brown bowel syndrome is a rare disorder caused by vitamin e deficiency occurring in malabsorption syndromes. In patients with celiac sprue and chronic pancreatitis, the death rate from malignancy is high. We believe that vitamin e deficiency is responsible for the development of the brown bowel syndrome and may be partially responsible for the high incidence of malignancy in patients with celiac sprue and chronic pancreatitis. We report such a patient, and review the literature.- - - - - - - - - - ranking = 2keywords = sprue (Clic here for more details about this article) |
10/10. Nongranulomatous chronic idiopathic enterocolitis: clinicopathologic profile and response to corticosteroids.BACKGROUND & AIMS: Nongranulomatous ulcerative enterocolitis has been reported in association with celiac sprue, lymphoma, and hypogammaglobulinemia. The objective of this study is to present evidence that this disorder exists as a primary entity. methods: The medical records and histological material of 9 patients (mean age, 45.7 /- 5.9 years) who presented with severe chronic diarrhea without specific diagnosis after extensive investigations were reviewed. RESULTS: Endoscopically, the duodenum and proximal jejunum were inflamed in 6 of 7 patients, with superficial ulcerations in 5 patients. On histology, the lamina propria was infiltrated by polymorphonuclear and chronic inflammatory cells, with varying degrees of villous atrophy. There were no significant cellular abnormalities of the epithelial enterocytes. A similar inflammatory infiltrate was present in the colon in 4 or 5 patients. Eight of 9 patients responded to corticosteroids with clinical and variable histological improvement. Four patients developed bleeding from ulcerations in the small or large intestine. Three patients died: 1 patient who did not respond to treatment with corticosteroids and 2 patients with systemic infection. Four of the 6 surviving patients required maintenance low-dose corticosteroid therapy. No underlying disease was discovered during prolonged follow-up. CONCLUSIONS: Idiopathic nongranulomatous enterocolitis may present as a primary, frequently fatal disease. Corticosteroid therapy provides immediate benefit and may be required indefinitely.- - - - - - - - - - ranking = 0.33333333333333keywords = sprue (Clic here for more details about this article) |
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