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Refractory sprue

Sophie Scialom, Georgia Malamut, Bertrand Meresse, Nicolas Guegan, Nicole Brousse, Virginie Verkarre, Coralie Derrieux, Elizabeth Macintyre, Philippe Seksik, Guillaume Savoye, Guillaume Cadiot, Lucine Vuitton, Lysiane Marthey, Franck Carbonnel, Nadine Cerf-Bensussan, Christophe Cellier
BACKGROUND AND OBJECTIVES: Anti-hypertensive treatment with the angiotensin II receptor antagonist olmesartan is a rare cause of severe Sprue-like enteropathy. To substantiate the hypothesis that olmesartan interferes with gut immune homeostasis, clinical, histopathological and immune features were compared in olmesartan-induced-enteropathy (OIE) and in autoimmune enteropathy (AIE). METHODS: Medical files of seven patients with OIE and 4 patients with AIE enrolled during the same period were retrospectively reviewed...
2015: PloS One
Farina M Hanif, Nasir Hassan Luck, Zaigham Abbas, Syed Mujahid Hassan, Sabhita Shabir, Muhammad Mubarak
Celiac Disease (CD), also known as non-Tropical sprue, and Celiac sprue is an immune-mediated disorder, triggered by gluten containing grains in genetically susceptible people. The disease may be diagnosed at any age and can affect many organ systems. Its diagnosis and management can often be challenging. A high index of suspicion is required to diagnose this disease at an early stage in patients presenting with atypical symptomatology and delayed onset. Although serological tests are widely used, duodenal biopsy remains the gold standard for diagnosis of CD...
April 2015: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
Dietmar Schiller, Alexander Ziachehabi, Rene Silye, Rainer Schöfl
No abstract text is available yet for this article.
November 2015: Gut
Syed Shafae Hasan, Nauman Saleem Siddiqui, Sri Krishna Chaitanya Arudra, Luis de Las Casas, Basil Akpunonu, Ali Nawras
Autoimmune enteropathy (AIE) is a rare disease that causes intractable diarrhea not responsive to a gluten free diet and must be distinguished from refractory sprue. It is associated with circulating autoantibodies against goblet cells and enterocytes. AIE mainly involves the small intestines, with very few cases reported in adults. Because of the paucity of cases, the epidemiology of the disease remains unclear, and treatment is based on the cases found in the literature. Of the 35 adult cases reported, only 4 involved the colon...
May 2016: American Journal of Therapeutics
Michele L Sanford, Angela K Nagel
Objective:To review the evidence of an association between olmesartan medoxomil and symptoms mimicking celiac disease.Data Sources:Literature was searched in PubMed (1965-November 2013) using the key words or MeSH terms olmesartan, enteropathy, celiac disease, sprue, and diarrhea. References from the Food and Drug Administration (FDA) and Dipiro's Pharmacotherapy eighth edition textbook were also reviewed.Data Synthesis:There have been recent implications of olmesartan medoxomil being linked to symptoms mimicking celiac disease...
March 28, 2014: Journal of Pharmacy Practice
Christoffer Soendergaard, Lene Buhl Riis, Ole Haagen Nielsen
Collagenous sprue is a rare clinicopathological condition of the small bowel. It is characterised by abnormal subepithelial collagen deposition and is typically associated with malabsorption, diarrhoea and weight loss. The clinical features of collagenous sprue often resemble those of coeliac disease and together with frequent histological findings like mucosal thinning and intraepithelial lymphocytosis the diagnosis may be hard to reach without awareness of this condition. While coeliac disease is treated using gluten restriction, collagenous sprue is, however, not improved by this intervention...
2014: BMJ Case Reports
M Viswambaran, S K Agarwal
STATEMENT OF PROBLEM: Sprue design is a factor that controls the velocity and adequate supply of metal to the mould. Currently various manufacturers recommend different shapes of sprue, which have not been advocated in textbooks and literature is lacking for their routine applications. PURPOSE: This in vitro study was carried out to determine the efficacy of four sprue shapes in producing complete, void free cobalt-chrome removable partial denture frameworks. MATERIALS AND METHODS: A brass metal die with a Kennedy class III, modification 1, partially edentulous arch was used and four sprue shapes (Group A-Ribbon, Group B-Square, Group C-Round and Group D- Round with reservoir) were evaluated...
April 2013: Contemporary Clinical Dentistry
Ujjal Poddar
Differences between children and adults in celiac disease (CD) presentation and epidemiology are reviewed here. Clinical manifestations, histological changes, serology, and response to gluten-free diet are similar. Differences exist in epidemiology, type of clinical presentations, coexisting diseases, complications, and association with obesity. CD is two to five times more common in children than in adults. Classical CD with gastrointestinal symptoms is more common in children whereas nonclassical CD dominates in adults...
September 2013: Indian Journal of Gastroenterology: Official Journal of the Indian Society of Gastroenterology
Pekka Collin, Emanuele Rondonotti, Knut Ea Lundin, Cristiano Spada, Martin Keuchel, Katri Kaukinen, Roberto DE Franchis, Maarten Ajm Jacobs, Federica Villa, Chris Jj Mulder
OBJECTIVE: A complete examination of the small intestine is possible by video capsule endoscopy (VCE). The aim of this study was to evaluate current indications for performing VCE in celiac disease. METHODS: In all 84 celiac disease patients on a gluten-free diet who had undergone VCE were enrolled at five centers in Europe. The indications, findings and clinical impact of VCE were recorded by a structured questionnaire. VCE was also carried out in 34 consecutive patients with untreated celiac disease (controls) in another center...
February 2012: Journal of Digestive Diseases
H Garnier-Lengliné, G Malamut, N Cerf-Bensussan, F M Ruemmele
Celiac disease (CD) is a chronic inflammatory enteropathy caused by the ingestion of gluten. A safe and efficient but unpleasant treatment exists for CD in form of a strict gluten-free diet. Thus, there is a need for new treatment strategies, which are based on the improved and advanced understanding of the pathophysiology of CD. The first strategy consists in reducing or even eliminating major antigenic motifs in gluten, responsible for the inflammatory reaction. The use of less immunogenic wheat was suggested but this seems rather difficult to realize...
June 2013: Pathologie-biologie
Keely R Parisian, Thomas P Plesec, Kyrsten D Fairbanks, Anthony S Tavill, Bo Shen
Collagenous sprue (CS) is a progressive malabsorptive disorder characterized by collagen deposition beneath the basement membrane of small bowel epithelium in refractory celiac sprue. CS is a pathologically distinct entity from celiac disease, despite a similar clinical presentation. The etiology of CS is unclear, although there are speculations that CS and celiac disease may share similar pathogenetic pathways. On the other hand, HFE hemochromatosis (HH) is a distinct disease entity. Celiac disease and HH are common HLA-associated genetic disorders in Northern European populations...
August 2011: Journal of Crohn's & Colitis
Xiangrong Zhao, Rebecca L Johnson
Collagenous sprue is a severe malabsorptive disorder, histologically characterized by small intestinal villous and crypt atrophy, and a subepithelial collagen deposit, thicker than 12 µm, that entraps lamina propria cellular elements. Collagenous sprue is a rare disease entity, with only about 60 sporadic cases reported worldwide since it was first described in 1947. Its exact etiology is still under investigation, and its relationship with classic celiac disease and other refractory, spruelike intestinal disorders remains controversial...
June 2011: Archives of Pathology & Laboratory Medicine
G Malamut, C Cellier
Celiac disease is an enteropathy due to gluten intake in genetically predisposed persons (HLA DQ2/DQ8). Celiac disease occurs in adults and children at rates approaching 1% of population in Europe and USA. Celiac disease is extremely various and anaemia, oral aphthous stomatis, amenorrhea or articular symptoms may be the only revealing symptoms. Diagnosis releases on evidence of histological villous atrophy in proximal small bowel and presence of specific serum antibodies. Treatment relies on eviction of gluten...
June 2013: Pathologie-biologie
J Cosnes, I Nion-Larmurier
Numerous complications can occur in celiac disease, nutritional (growth failure in children, malnutrition, vitamin deficiencies), hematologic (anaemia), bone disease (osteoporosis, fracture), gynaecologic (hypo fertility), cardiovascular (coronaropathy, venous thrombosis), neurological (peripheral neuropathy), hepatic (cytolysis, cirrhosis). Celiac disease is associated with an increased risk of autoimmune diseases (type 1 diabetes, thyroiditis), and cancer (upper digestive tract, hepatocellular carcinoma, lymphoma)...
April 2013: Pathologie-biologie
M Schumann, K Herrlinger, M Zeitz, E F Stange
Numerous reports on fundamental research and clinical studies have appeared in the past 1-2 decades which have contributed decisively to understanding inflammatory diseases of the small intestine. Illustrated by the examples of Crohn's disease, celiac disease, refractory sprue, and Whipple's disease, the rationale and evidence for treatment approaches are presented that are based on these pathophysiological findings. Emphasis is placed on modulation of the intestinal flora with antibiotics and probiotics as well as immunomodulatory/immunosuppressive measures with so-called biological agents...
June 2010: Der Internist
Hugh J Freeman
Adult celiac disease is a chronic intestinal disorder that has been estimated to affect up to 1-2% of the population in some nations. Awareness of the disease has increased, but still it remains markedly underdiagnosed. Celiac disease is a pathologically defined condition with several characteristic clinical scenarios that should lead the clinician to suspect its presence. Critical to diagnosis is a documented responsiveness to a gluten-free diet. After diagnosis and treatment, symptoms and biopsy-proven changes may recur and appear refractory to a gluten-free diet...
December 2009: Gut and Liver
G Malamut, C Cellier
Celiac disease is an enteropathy due to gluten intake in genetically predisposed individuals (HLA DQ2/DQ8). Celiac disease occurs in adults and children at rates approaching 1% of population in Europe and USA. Clinical features observed in celiac disease are extremely various and anaemia, oral aphthous stomatis, amenorrhea or articular symptoms may be the only presenting manifestations. Diagnosis relies on the evidence of histological villous atrophy in proximal small bowel and the presence of specific serum antibodies...
June 2010: La Revue de Médecine Interne
F Mühr-Wilkenshoff, M Friedrich, H-D Foss, M Hummel, M Zeitz, S Daum
Tumors may influence immunologic reactions. Here, we report on a 72-year-old patient who suffered from celiac disease (CD) that had been diagnosed 20 years before. Under a normal diet but without any evidence of enteropathy or CD-associated antibodies, the patient developed a jejunal T-cell lymphoma. It was resected due to perforation and four courses of IMVP-16 were added. The patient started and kept a strict gluten-free diet (GFD). Two years later, he presented with weight loss and a clonally divergent refractory sprue type II with loss of antigen (CD8; T-cell receptor-beta) expression in intraepithelial lymphocytes...
2010: Digestion
Efsevia Vakiani, Carolina Arguelles-Grande, Mahesh M Mansukhani, Suzanne K Lewis, Heidrun Rotterdam, Peter H Green, Govind Bhagat
Collagenous sprue is associated with high morbidity; however, the etiology of this disorder is unclear. Data regarding the pathological and clinical manifestations of patients with collagenous sprue are also limited. We, thus, undertook this study to gain insight into the etiology, disease manifestations and outcomes of collagenous sprue. We searched our departmental database (1999-2008) to identify cases of collagenous sprue and to obtain clinical and laboratory data. Small bowel histology, including thickness of subepithelial collagen, intra-epithelial lymphocyte phenotype and results of T-cell clonality assays were evaluated...
January 2010: Modern Pathology: An Official Journal of the United States and Canadian Academy of Pathology, Inc
Hugh J Freeman, Douglas L Webber
A 67-year-old man with celiac disease developed recurrent diarrhea, profound weakness and weight loss, with evidence of marked protein depletion. His clinical course was refractory to a strict gluten-free diet and steroid therapy. Postmortem studies led to definition of unrecognized collagenous sprue that caused ulceration and small intestinal perforation. Although PCR showed identical monoclonal T-cell populations in antemortem duodenal biopsies and postmortem jejunum, careful pathological evaluation demonstrated no frank lymphoma...
September 21, 2009: World Journal of Gastroenterology: WJG
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