Diagnosis Of Sprue Research Articles

Sailing Past the Horizon

When one reads about the histologic features of celiac disease in a textbook of surgical pathology, it is the absence of normal intestinal villi that generally is stressed as the key diagnostic feature. The features of a “flat mucosa,” in combination with elongation of the intestinal crypts, evidence of epithelial damage, and a variable increase in chronic inflammation of the lamina propria, form the histologic diagnosis of sprue. The alteration of villus architecture was deemed so central to the diagnosis of celiac disease that in the past it had been the practice of many institutions to include an examination of the villi in fresh small intestine biopsy specimens with a dissecting microscope before examination of histologic sections. However, just as Christopher Columbus sailed past an apparently flat horizon to help prove that the world is round, the time has come to broaden the horizons of the histologic diagnosis of celiac disease. In the Western world, the major cause of sprue is celiac disease, which is an autoimmune disease triggered by anti

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL. CASE 80-1963.

Presentation of CaseA forty-nine-year-old man entered the hospital because of weakness and chronic diarrhea.Diarrhea and abdominal distention developed during infancy, and ever since that time he had customarily passed 6 to 12 bulky, foul-smelling stools daily. His appetite had been voracious, and he had been active and in good health, having played professional basketball for seven years. Twenty years before admission he was told that he had pernicious anemia and was given injections of liver extract. Five years later he entered another hospital because of nausea, vomiting and increased frequency of bowel movements. A diagnosis of sprue was . . .

Radioactive Fat Absorption and Clinical Response of Sprue to Steroid Therapy

Summary Three unusual cases of spree are presented. Each patient had diarrhea, low serum albumin content, and was malnourished; 2 patients had hypocalcemia, tetany, and osteoporosis; 2 had edema; 1 patient had bleeding with an increased prothrombin time (180 seconds) which became normal eight hours after vitamin K was given intravenously. I 131 -tagged triolein and oleic acid curves showed poor absorption and curves for all 3 patients. None of the 3 patients responded clinically to standard treatment, including the glutenfree diet, vitamin B 12 given intramuscularly, and other measures, but did respond to steroid therapy. Repetition of the radioactive fat studies after steroid therapy showed great improvement in the absorption of fat, paralleling the clinical response. Steroid therapy would seem indicated for patients with sprue who do not respond to other treatment. Since many patients with sprue may not have the typical symptoms and signs of the disorder, but its complications, diagnosis is difficult and the diagnostic technique is one of exclusion. Radioactive fat studies of such patients can be of help because they uniformly show poor absorption with flat uptake curves. Determination of the uptake of radioactive triolein and oleic acid is a dependable, simple, and objective measure of fat absorption. Radioactive fat studies can be of aid not only in the diagnosis of sprue but also in determining the response to treatment.

Definition and diagnosis of sprue.

Definition and diagnosis of sprue.

Prolonged diarrhea with near-fatal hemorrhage due to hypoprothrombinemia.

Case Reports1 February 1956PROLONGED DIARRHEA WITH NEAR-FATAL HEMORRHAGE DUE TO HYPOPROTHROMBINEMIAWILLIAM B. SCHARFMAN, M.D., SIMON PROPP, M.D., F.A.C.P.WILLIAM B. SCHARFMAN, M.D.Search for more papers by this author, SIMON PROPP, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-44-2-385 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThis report is concerned with a severe hemorrhagic disease which followed prolonged diarrhea. The patient presented as a medical emergency which was promptly relieved by appropriate therapy. Subsequent investigation established the diagnosis of sprue which had caused severe hypoprothrombinemia.Several clinical features of this case deserve emphasis. The hypoprothrombinemia was so extreme as to endanger the patient's life. Further, the immediate medical problem was not characteristic of sprue, but was due to a rare complication of the abnormal physiology of this disease. The infrequency of severe purpura associated with diarrhea probably accounted for the delay in diagnosis. The importance of...Bibliography1. Stefanini M: Clinical features and pathogenesis of tropical sprue, Medicine 27: 379, 1948. CrossrefMedlineGoogle Scholar2. HanesMcBryde FMA: Identity of sprue, non-tropical sprue and celiac disease, Arch. Int. Med. 58: 1, 1936. CrossrefGoogle Scholar3. Ingelfinger FJ: The diagnosis of sprue in non-tropical areas, New England J. Med. 228: 180, 1943. CrossrefGoogle Scholar4. KarkSouterHayward RAWJC: A hemorrhagic diathesis in idiopathic steatorrhea: observations on its association with vitamin K deficiency, Quart. J. Med. 9: 247, 1940. Google Scholar5. CollinsHoffman ENAD: Hemoptysis and hematuria in sprue, Cleveland Clin. Quart. 10: 105, 1943. CrossrefGoogle Scholar6. FullertonInnes HWJA: Case of idiopathic steatorrhea with multiple nutritional deficiencies, Lancet 2: 790, 1936. CrossrefGoogle Scholar7. ButtSnellOsterberg HRAMAE: Preoperative and post-operative administration of vitamin K to patients having jaundice, J. A. M. A. 113: 383, 1939. CrossrefGoogle Scholar8. ClarkDixonButt RLCFHR: Deficiency of prothrombin associated with various intestinal disorders, Proc. Staff Meet., Mayo Clin. 14: 407, 1937. Google Scholar9. ColcherDrachmanAdlersberg HSRD: Management of intractable sprue with cortisone and adrenocorticotropin, Ann. Int. Med. 38: 554, 1953. LinkGoogle Scholar10. Wintrobe MM: Clinical hematology, 3d Ed., 1951, Lea and Febiger, Philadelphia. Google Scholar11. CecilLoch RHRF: A textbook of medicine, 8th Ed., 1951, W. B. Saunders Co., Philadelphia. Google Scholar12. AdlersbergSchein DJ: Clinical and pathological studies in sprue, J. A. M. A. 134: 1459, 1947. CrossrefMedlineGoogle Scholar13. Rodriguez-Molina R: Fundamental concepts in the diagnosis of sprue, Ann. Int. Med. 40: 33, 1953. Google Scholar14. Brinkhous KM: Plasma prothrombin and vitamin K, Medicine 19: 329, 1940. CrossrefGoogle Scholar15. Sodeman WA: Pathologic physiology, 1950, W. B. Saunders Co., Philadelphia. Google Scholar16. AlbrightStewart FJD: Hypovitaminosis of all fat-soluble vitamins due to steatorrhea, New England J. Med. 223: 239, 1940. CrossrefGoogle Scholar17. Matoth Y: Plasma prothrombin in infantile diarrhea, Am. J. Dis. Child. 80: 944, 1950. Google Scholar18. Mackie TT: Vitamin K deficiency in the absence of jaundice, New York State J. Med. 40: 987, 1940. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Albany, N. Y.*Received for publication November 29, 1954.From the Department of Medicine and the Subdepartment of Hematology, Albany Medical College, Union University, Albany, N. Y. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byThe Liver and Blood Coagulation: Physiology and PathologyVitamin K in Medical Practice: AdultsClot Retention in the Kidneys as a Probable Cause of Anuria During Treatment of Haematuria with Epsilon-aminocaproic AcidMalabsorption Syndromes of Enteric Origin 1 February 1956Volume 44, Issue 2Page: 385-391KeywordsChronic diarrheaDiarrheaDysenteryGastroenterology and hepatologyHematology and oncologyHemorrhageVitamin K ePublished: 1 December 2008 Issue Published: 1 February 1956 PDF downloadLoading ...

A Case of Sprue Maintained on Folic Acid

Numerous observers have reported the treatment of macrocytic anemias with folic acid with the return of the blood to normal. Several (1–6) have found that the macrocytic anaemia of sprue was similarly improved. But so far, no one has reported the effect of folic acid in the maintenance of sprue over many months. For this reason, the fact that five milligrams of folic acid by mouth daily has been sufficient to maintain an old case of sprue in continued health for over one year, should be recorded.Case History. Diarrhoea commenced in 1924, twelve years after two periods of service in the Philippines. At first the diarrhoea was caused by acids like stewed tomatoes, and could be controlled by a rigid diet, but during a third tour in the Philippines in 1925–1928, the diarrhoea of a watery character became continuous, and following an episode of sore mouth which lasted only one week, the diagnosis of sprue was made.

The Diagnosis of Sprue in Nontropical Areas

SPRUE and spruelike states are not rare in northern latitudes, but the complicating features are often so prominent that the underlying disorder is not immediately recognized. Four patients seen within the last two) years at the Massachusetts Memorial Hospitals illustrate not only the wide variety of symptoms encountered but also the ensuing diagnostic difficulties. In each of these cases initial failure to make the correct diagnosis postponed adequate therapy, which, in sprue, may not be completely curative but will often allow a severely debilitated person to resume a normal life. Hence reports of these patients are presented,

CLINICAL AND HEMATOLOGICAL REVIEW OF SPRUE BASED ON THE STUDY OF 150 CASES

Article1 October 1938CLINICAL AND HEMATOLOGICAL REVIEW OF SPRUE BASED ON THE STUDY OF 150 CASESRAMON M. SUAREZ, M.D., F.A.C.P.RAMON M. SUAREZ, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-12-4-529 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptManson described sprue as "an insidious chronic remitting catarrhal inflammation of the . . . alimentary canal occurring particularly in Europeans who are residing or have resided in tropical or subtropical climates." Certain investigators, such as Newham, Morris and Manson-Bahr1stress the fact that the anemia of sprue is secondary to a gastrointestinal lesion and not due to disease of the blood-forming organs. The disease, however, is classified in some of the standard textbooks under Diseases of the Hematopoietic System and in others it is included under Gastro-Enterology. Now, is sprue primarily a disease of the alimentary canal or a...Bibliography1. MANSON B: Manson's tropical diseases, 1936, William Wood and Co. Google Scholar2. HANSENSTAA KVH: Die Einheimische Sprue und Ihre Folgekrankheiten, 1936, George Thieme. Google Scholar3. CASTLERHOADSLAWSONPAYNE WBCPHAGC: Etiology and treatment of sprue, Arch. Int. Med., 1933, lvi, 627. Google Scholar4. HANESMCBRYDE FMA: Identity of sprue, non-tropical sprue and celiac disease, Arch. Int. Med., 1936, lviii, 1. CrossrefGoogle Scholar5. BARKERRHOADS WHCP: The effect of liver extract on the absorption of fat in sprue, Am. Jr. Med. Sci., 1937, cxciv, 804. CrossrefGoogle Scholar6. HESS THAYSEN E: Quart. Jr. Med., 1935, iv, 359. Google Scholar7. SUAREZ RM: Anemia perniciosa de tipo macrocitico, Rev. Medica de Barcelona, 1934. Google Scholar8. MILLERBARKER DKWH: Clinical course and treatment of sprue, Arch. Int. Med., 1937, lx, 385-566. CrossrefGoogle Scholar9. SUAREZ RM: Hematological studies in sprue, Bol. Asoc. Medica de Puerto Rico, 1935, xxvii, 239. Google Scholar10. SUAREZ RM: El Tratamiento del Espru y el uso del Extracto Acuoso de Higado on su Anemia, Bol. Asoc. Med. de P. R., 1936, xxviii, 74-86. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: San Juan, P. R.*Delivered before the American College of Physicians, New York City, April 7, 1938. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byIdiopathic Small Intestinal Disease in the TropicsFolate in Tropical SprueRegarding the Definition of Tropical SprueTropical Sprue in New York CityThe structural and functional status of the liver in tropical sprueHemostasis in a case of tropical sprue with bleeding diathesisRole of Nutritional Deficiencies in Tropical SprueThe Roentgenologic Appearance of The Small Intestine in SprueFUNDAMENTAL CONCEPTS IN THE DIAGNOSIS OF SPRUE*RAFAEL RODRIGUEZ-MOLINA, F.A.C.P.Die Krankheiten des DarmesThe Sprue Syndrome—Improved Dietary ManagementThe Diagnosis and Pathogenesis of Tropical Sprue.Sprue: A Consideration of Etiology, Differential Diagnosis and ManagementCarbohydrate in the Treatment of Disease1NoticeAbstractsAbstracts 1 October 1938Volume 12, Issue 4Page: 529-535KeywordsAnemiaGastroenterology and hepatologyHematology and oncologyInflammationLesions ePublished: 1 December 2008 Issue Published: 1 October 1938 PDF downloadLoading ...

The Differential Diagnosis of Sprue and Pernicious Anemia 1

Ordinarily, the differential diagnosis between sprue and pernicious anemia should not present great difficulty to the clinician who is acquainted with both diseases, but of late we are hearing excellent men aver that they are identical or at least modalities of a common fundamental condition of nutritional character. These men, as a rule, are clinicians in temperate climates where sprue is not endemic and, with a clear knowledge of pernicious anemia, are impressed with the superficial clinical similarity and the almost identical hematology in certain cases of sprue which drift back to their Northern homes in or near a state of cachexia. When our best clinicians in the North can confuse pernicious anemia with tropical sprue, the justification therefore must be pretty strong. As a matter of fact, the case of sprue developing an anemia of pernicious type may be almost indistinguishable from that clinical picture we recognize as pernicious anemia.

Tropical Sprue: Its Differentiation from Pernicious Anemia by the Arneth Count

The difficulties attendant upon the differential diagnosis of sprue and pernicious anemia are well known to those called upon to treat the two conditions. In some cases it is impossible to distinguish between them and this has led some clinicians to regard them as the same disease. Christian (1) has suggested that they are one and the same disease and that sprue may develop into pernicious anemia. Wood (2) has added support to this idea by finding Monilia psilosis in cases of pernicious anemia, which yeasts are regarded by Ashford as the causative organism of sprue. Baumgartner (3) disagrees and thinks that they are two distinct diseases but states that some cases “probably cannot be correctly diagnosed, at least by methods now available.” This disagreement has been under discussion in the literature for years; the diagnosis of the two conditions meanwhile becomes constantly more complex.