Gluten-Free Diet and Steroid Treatment Are Effective Therapy for Most Patients With Collagenous Sprue

Abstract

BACKGROUND & AIMS Collagenous sprue (CS) is characterized by the presence of a distinctive band of subepithelial collagen deposition in the small bowel. We evaluated the clinical characteristics, treatments, and outcomes of patients with CS. METHODS Thirty patients with CS were identified at the 3 Mayo Clinic sites between 1993 and 2009. Clinical data from medical records were reviewed. RESULTS The study cohort was 70% female (age range, 53–91 years). Most patients had severe diarrhea and weight loss. Hospitalization to treat dehydration was necessary in 16 (53%) patients. Associated immune-mediated diseases were noted in 70% of the patients; celiac disease was the most frequent. Other associated diseases were microscopic colitis, hypothyroidism, and autoimmune enteropathy. The median thickness of the layer of subepithelial collagen deposition in the small bowel was 29 μm (20 –56.5 μm). Subepithelial collagen deposition in the colon or stomach was noted in 8 patients. A clinical response was observed in 24 (80%) patients after treatment with a combination of a gluten-free diet and immunosuppressive drugs. Histologic improvement was confirmed in 9 patients, with complete remission in 5. Two patients died (1 of complications of CS and 1 of another illness). CONCLUSIONS Most patients with CS are treated effectively with a combination of gluten-free diet and steroids. CS is often associated with collagen deposition or chronic inflammation in other segments of the gastrointestinal tract as well as other immune-mediated disorders.

Severe spruelike enteropathy due to olmesartan

“…To date, olmesartan-related enteropathy has been rarely reported in literature, mainly as single case reports (8,9), or associate findings during evaluation of cohorts of celiac (1) or collagenous sprue patients (10), and only a relatively consistent case series (including 22 subjects) has been published (7). Albeit infrequent, this enteropathy may be quite severe in more than 50 % of cases -to the point that it received a recent FDA warning (11)-, and it is often considered as unresponsive celiac disease (7).…”

“…Blood chemistry revealed hemoglobin 13 g/ dL (n.v. [13][14][15][16][17], serum potassium 2.3 mEq/L (n.v. 3.5-5-5), calcium 6 mg/dL (n.v. 8.5-10.7), magnesium 0.8 mg/ dL (n.v. 1.5-2.6), phosphorus 2.4 mg/dL (n.v. 2.5-5), albumin 2.9 g/dL (n.v. 3.5-5.5), prealbumin 15.5 mg/dL (n.v. 20-40), total protein 4.9 g/dL (n.v. 6.2-8.5), B12 vitamin 103 pg/mL (n.v. 180-914), folic acid 2.7 ng/mL (n.v. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Abdominal ultrasound scans revealed mildly dilated small bowel loops in the epigastric area, mild hepatomegaly with steatosis, and biliary sludge.…”

Collagenous sprue with associated features of refractory celiac disease

“…Indeed, there is recent evidence that these patients may be successfully treated (7), and the vast majority of patients with collagenous sprue (that sometimes display associated celiac disease) may have relatively good clinical outcomes (8).…”

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

“…The pathological hallmark of collagenous sprue is a thickened subepithelial collagen band with villous atrophy detected on distal duodenal biopsy. There is evidence that most patients (63–70%) with collagenous sprue suffer with other autoimmune conditions2 3 and that this is 12-fold more likely than in coeliac disease 2. Many of the coexisting autoimmune diseases affecting these patients include various types of arthritis, for which patients often require non-steroidal anti-inflammatory drugs (NSAIDs).…”

“…Many of the coexisting autoimmune diseases affecting these patients include various types of arthritis, for which patients often require non-steroidal anti-inflammatory drugs (NSAIDs). Interestingly, the largest case series of collagenous sprue in the literature to date reported that 30% of patients with this diagnosis were taking acetylsalicylic acid or NSAIDs 3. It is therefore important to highlight the putative link between the latter medications and collagenous enteropathies,4 5 since NSAID cessation may potentially reverse collagen deposition.…”