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  • Jefferson Adams
    Jefferson Adams

    Collagenous Sprue Update

    Celiac.com 02/05/2010 - Collagenous sprue is classically understood as a disorder of the small intestinal mucosa marked by persistent diarrhea, severe malabsorption with multiple nutrient deficiencies, and progressive weight loss.

    H. J. Freeman of the Department of Medicine, University of British Columbia Hospital, Vancouver, BC, Canada offers an update on collagenous sprue.

    Patients with collagenous sprue typically show a severe to variably severe "flattened" mucosal biopsy lesion with distinctive sub-epithelial deposits in the lamina propria region.  These deposits contain collagens, as demonstrated by both histochemical stains and ultrastructural studies.

    Moreover, permanent disappearance of these deposits after resection of a localized colon cancer suggests that this disorder might actually involve a para-neoplastic morphologic marker of an occult malignancy.

    In collagenous sprue cases, physicians often first consider a diagnosis of simple celiac disease, until the patient fails to respond to a gluten-free diet. Recent studies portray a close association between collagenous sprue and celiac disease, sometimes with concomitant T-cell enteropathy.

    A number of studies demonstrate gastric and/or colonic associations with the unusual inflammatory mucosal process in collagenous sprue, which suggests that the condition may be more complex and have more varied contributing causes than presently understood.

    Source: World Journal of Gastroenterology. 2010 Jan 21; 16(3):296-8

     



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  • About Me

    Jefferson Adams earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in biology, anatomy, medicine, science, and advanced research, and scientific methods. He previously served as Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

  • Related Articles

    Scott Adams
    Celiac that do not remain on a gluten-free diet can develop Refractory Sprue. Refractory Sprue and Collagenous Sprue patients who initially respond to a gluten-free diet many subsequently relapse despite maintaining their diet. Such patients are then refractory to further dietary therapy. In contrast, others are refractory to dietary therapy from its inception and, assuming they are truly on a gluten-free diet, may not have celiac disease; these patients are said to have unclassified Sprue. Some refractory patients with celiac disease, typical or atypical, respond to treatment with corticosteroids or other immunosuppressive drugs. In others, there is no response and malabsorption may be progressive. Collagenous Sprue is characterized by the development of a thick band of collagen-like material directly under the intestinal epithelial cells and has been regarded by some as a separate entity from celiac disease. However, subepithelial collagen deposition has been noted in up to 36% of patients with classic Celiac Disease and in Tropical Sprue. Although individuals with large amounts of subepithelial collagen may be refractory to therapy, the presence of collagen does not , a riori, preclude a successful response to a gluten-free diet. Collagenous colitis accompanying celiac disease also has been observed and would be considered in the diagnosis of diarrhea occurring in celiac disease patients on a gluten-free diet.

    Jefferson Adams
    Celiac.com 03/18/2009 - A recent study used lactulose hydrogen-breath assays to show that small intestine bacterial overgrowth (SIBO) is likely a routine cause of non-responsive celiac disease.
    A team of researchers from the Mayo Clinic College of Medicine recently set out to assess the rates and significance of SIBO in celiac disease based on the results of quantitative culture of intestinal aspirate.
    The team was made up of Alberto Rubio-Tapia, M.D., Susan H. Barton, M.D., Joseph A. Murray, M.D., of the Mayo’s Division of Gastroenterology and Hepatology, and Jon E. Rosenblatt, M.D., of the Mayo’s department of Laboratory Medicine and Pathology. Their efforts were supported by the American College of Gastroenterology (ACG) International Training Grant 2006 (ART) and the NIH grants DK-57892 and DK-070031 (JAM).
    Currently, the rate of SIBO in celiac disease diagnosed by quantitative culture of intestinal aspirate is not known. The team set out to assess the rate and determine the significance of SIBO in celiac disease based on the results of quantitative culture of intestinal aspirate.
    The team set out to examine the causes of non-responsive celiac disease by looking at people with celiac disease in whom culture of intestinal aspirate was assessed for the presence of both aerobic and anaerobic bacteria. They defined bacterial overgrowth as culture >105 colony forming units/mL.
    In all, they evaluated 149 people with biopsy-confirmed celiac disease. They took intestinal aspirate samples from 79 (53%) patients with non-responsive celiac disease, 47 (32%) as initial work-up for mal-absorption, and in 23 (15%) with asymptomatic treated celiac disease.
    The team diagnosed 14 cases of SIBO (9.3%), nine cases of non-responsive celiac disease (11%), five cases at initial work-up for mal-absorption (11%), and 0 cases in asymptomatic treated celiac disease. Patients with a positive culture showed signs of worse mal-absorption. 67% of patients with both non-responsive celiac disease and bacterial overgrowth showed a coexistent disorder.
    The results showed that nearly 1 in 10 celiac patients had SIBO as diagnosed by quantitative culture of intestinal aspirate (9.3%). This figure included both patients with symptomatic treated or untreated celiac disease. This shows that SIBO may exist along with other maladies associated with non-responsive celiac disease.
    Journal of Clinical Gastroenterology: Volume 43(2)February 2009pp 157-161


    Jefferson Adams
    Celiac.com 12/22/2010 - A recent evaluation of the safety and efficacy of small intestinal release mesalamine (SIRM) for symptom relief in refractory celiac disease (RCD) shows that SIRM seems to be a safe and effective treatment option, though larger tests are needed to know for certain.
    The research team conducting the evaluation included Shailaja Jamma, MD, Daniel A. Leffler, MD, Melinda Dennis, RD, Robert M. Najarian, MD, Detlef B. Schuppan, MD, Sunil Sheth, MD, and Ciaran P. Kelly, MD,
    They set out to evaluate the safety and efficacy of small intestinal release mesalamine (SIRM) for symptom relief in refractory celiac disease.
    There are currently no adequate clinical therapies for patients with refractory celiac disease and corticosteroid and/or immunosuppressants treatments are of limited use due to side effects. SIRM has been shown to reduce local inflammation, and it is well tolerated.
    For the study, the team looked at records of the refractory celiac disease patients who received SIRM in an open-label therapeutic trial. Data included patient demographics, disease characteristics, dose and duration of SIRM therapy, and patient response.
    The team then categorized each response as complete, if symptoms resolved completely, partial if symptoms improved at least 50%, and non-responsive if symptoms improved less than 50%.
    The team treated four patients with SIRM alone and six patients with a combination of SIRM and oral budesonide. After four weeks, half of the patients showed complete response, while 10% showed a partial response. Two of the six patients were able to discontinue budesonide. One patient discontinued SIRM after complaining of headaches.
    These initial results indicate that SIRM seems to be a safe and efficacious treatment option in patients with refractory celiac disease, though a larger, more comprehensive study is needed to confirm these results.
    Source:

    J Clin Gastroenterol 2010 Sep 24. doi: 10.1097/MCG.0b013e3181f42401


    Jefferson Adams
    Celiac.com 01/15/2014 - Complicated celiac disease is uncommon, but patients have high death rates, say a team of researchers, who recently set out to better understand the epidemiology of complications in patients with celiac disease.
    The research team included F. Biagi, P. Gobbi, A. Marchese, E. Borsotti, F. Zingone, C. Ciacci, U. Volta, G. Caio, A. Carroccio, G. Ambrosiano, P. Mansueto, G.R. Corazza. They are affiliated with the Coeliac Centre/First Department of Internal Medicine at the Fondazione IRCCS Policlinico San Matteo at the University of Pavia in Italy.
    The team conducted a retrospective multi-center case-control study based on collection of clinical and laboratory data. They looked at incidence of complicated celiac disease among celiac patients directly diagnosed in four Italian centers.
    Their study did not include patients referred to these centers after being diagnosed with celiac disease and/or complicated celiac disease at other facilities.
    Between January of 1999 and October 2011, the team followed-up on 1840 adult celiac patients, for a total of 7364.3 person-years. They found that fourteen patients developed complications to they celiac disease.
    Five patients died by the end of the observation period in October 2011, making the rates of complicated celiac disease nine cases out of 1835 celiac patients (1/204, 0.49%, 95% CI 0.2-0.9%).
    The annual rates of complicated celiac disease in the study period was 14 out of 7364 celiac patients, or about 0.2%, 95% CI 0.1-0.31%.
    Although complications tend to occur soon after the diagnosis of celiac disease, Kaplan-Meier curve analysis showed that they can actually occur at any time after the diagnosis of celiac disease.
    Overall, complications of celiac disease in this study group were quite rare, but those patients with complications faced very high mortality rates.
    Source:
    "Dig Liver Dis. 2013 Nov 19. pii: S1590-8658(13)00624-5. doi: 10.1016/j.dld.2013.10.010.

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