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Refractory Sprue


PINKYPAL

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PINKYPAL Newbie

Hello,

I am seeking information regarding refractory sprue.

I was diagnosed with celiac in January of 2007, and my follow-up biopsy this January was normal due to strict adherance to the gluten free diet.

Since the end of April I have severe diarrhea, and yet have made no changes whatsoever to my diet. I am wondering if it is possible to have a normal biopsy in January, and yet possibly have this refractory sprue?

I called the specialist who follows me for celiac and explained how severe my symptoms have been. The receptionist certainly did not seem concerned and made me an appointment for July.

Any information would be greatly appreciated. I am really worried and am unsure of what to do, if anything.

Thanks kindly,

Pinkypal


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lovegrov Collaborator

Refractory sprue is exceedingly rare to begin with. I'm not a medical person, but if you had a normal biopsy and haven't changed your diet, I'd say refractory is not your problem.

richard

melmak5 Contributor

I went through a very similar situation.

Diagnosed, stopped eating gluten, felt better then got worse... lots of D, 7-10x a day.

I got little help from any medical professional (I went through 4 GIs)

For me, it was soy and dairy. Cutting them out has made a huge difference. (I am still waiting for the holy grail of solid poop day... somewhere in the future)

But I highly recommend trying to eliminate other foods from your diet and see how you feel.

jerseyangel Proficient

My first thoughts are either additional food intolerances or a small intestinal bacterial overgrowth (SIBO).

If you are currenty eating soy and/or dairy, I would try eliminating them one at a time and see if that makes any difference.

You can ask your gastroenterologist about the breath test for SIBO.

PINKYPAL Newbie

Thanks so much for the replies. I went back to read the article on RS written by Michelle Melin-Rogovin on this website and she mentions that when ruling out RS a colonscopy should be done to see if Lymphocytic Colitis is present. This has me a little nervous because I was first diagnosed with LC by colonoscopy and then diagnosed with Celiac by gastroscopy.

I will take the advice given, while patiently waiting for this re-assessment in July.

Best regards to all,

Pinkypal

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    • par18
      Thanks for the reply. 
    • Scott Adams
      What you’re describing is actually very common, and unfortunately the timing of the biopsy likely explains the confusion. Yes, it is absolutely possible for the small intestine to heal enough in three months on a strict gluten-free diet to produce a normal or near-normal biopsy, especially when damage was mild to begin with. In contrast, celiac antibodies can stay elevated for many months or even years after gluten removal, so persistently high antibody levels alongside the celiac genes and clear nutrient deficiencies strongly point to celiac disease, even if you don’t feel symptoms. Many people with celiac are asymptomatic but still develop iron and vitamin deficiencies and silent intestinal damage. The lack of immediate symptoms makes it harder emotionally, but it doesn’t mean gluten isn’t harming you. Most specialists would consider this a case of celiac disease with a false-negative biopsy due to early healing rather than “something else,” and staying consistently gluten-free is what protects you long-term—even when your body doesn’t protest right away.
    • Scott Adams
      Yes, I meant if you had celiac disease but went gluten-free before screening, your results would end up false-negative. As @trents mentioned, this can also happen when a total IGA test isn't done.
    • Seaperky
      I found at Disney springs and Disney they have specialist that when told about dietary restrictions they come and talk to you ,explain cross contamination measures tsken and work with you on choices. Its the one place I dont worry once I've explained I have celiac disease.  Thier gluten free options are awesome.
    • Churley
      Have you tried Pure Encapsulations supplements? This is a brand my doctor recommends for me. I have no issues with this brand.
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