Collagenous sprue is an uncommon disorder of the small intestine that is associated with significant morbidity and mortality. It should be considered in a case unclassified sprue or sprue that does not behave like celiac disease.


Clinical features:

(1) progressive malabsorption with steatorrhea

(2) fluid and electrolyte loss

(3) partial or complete failure to respond (refractory) to a gluten-free diet

(4) may require total parenteral nutrition to prevent deterioration

(5) may follow a fulminant course with renal failure and other complications


Histologic features:

(1) blunting or flattening of the villi in the small bowel

(2) an irregular band of eosinophilic, collagenous material deposited below the surface epithelium, best appreciated with a trichrome stain The appearance is the same as that seen in collagenous colitis. This may be patchy and it may take several biopsies to demonstrate it.

(3) marked subcryptal inflammation

(4) variable mucosal thinning, which may be marked

(5) occasionally concurrent collagenous colitis


Differential diagnosis: Celiac enteropathy with poor adherence to gluten-free diet


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