Clinical and histological resolution of collagenous sprue following gluten-free diet and discontinuation of non-steroidal anti-inflammatory drugs (NSAIDs)

Abstract

Collagenous sprue is a rare small bowel enteropathy that has overlapping clinical features with coeliac disease; it is commonly associated with arthritic autoimmune conditions, which often require non-steroidal anti-inflammatory drugs (NSAIDs). In the limited published literature available, there are putative suggestions of a link between NSAID use and collagen deposition in intestinal subepithelia in such patients. The authors present a case of a 43-year-old woman with long-standing NSAID use for autoimmune polyarthropathy and positive coeliac antibodies. However, distal duodenal biopsies revealed a thickened band of subepithelial collagen with villous atrophic appearances consistent with collagenous sprue. The patient was treated with a gluten-free diet and her NSAIDs were discontinued. After 6 months, her gastrointestinal symptoms had resolved with complete histological resolution of the collagenous subepithelial bands and villous atrophy on duodenal biopsy.

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“…From the existing literature, CS is most associated with CD where 50% of the cases occurred in CD patients, CS can also be associated with other co-existing autoimmune conditions [8]. Interestingly, there have been reports of pharmacologically induced CS associated with nonsteroidal anti-inflammatory drugs and angiotensin receptor blockers use, in which cessation of these drugs have resulted in clinical improvement and histological resolution of the villous atrophy and collagenous subepithelial bands [9][10][11].…”