Sprue, nontropical

Megaloblastic anem/a.- Treatment of megaloblastic anemias due to a deficiency of folic acid as seen in tropical or nontropical sprue, anemias of nutritional origin, pregnancy, infancy, or childhood. 

Gastrointestinal diseases Inflammatory bowel disease, nontropical sprue, subacute hepatic necrosis... 

Calcium and phosphate enter the body from the intestine. The average American diet provides 600-1000 mg of calcium per day, of which approximately 100-250 mg is absorbed. This figure represents net absorption, because both absorption (principally in the duodenum and upper jejunum) and secretion (principally in the ileum) occur. The amount of phosphorus in the American diet is about the same as that of calcium. However, the efficiency of absorption (principally in the jejunum) is greater, ranging from 70% to 90%, depending on intake. In the steady state, renal excretion of calcium and phosphate balances intestinal absorption. In general, over 98% of filtered calcium and 85% of filtered phosphate is reabsorbed by the kidney. The movement of calcium and phosphate across the intestinal and renal epithelia is closely regulated. Intrinsic disease of the intestine (eg, nontropical sprue) or kidney (eg, chronic renal failure) disrupts bone mineral homeostasis. 

Nontropical sprue (adult celiac disease) results from a reaction to gluten, a protein found in grains. Intestinal epithelial cells are damaged and malabsorption results. Common symptoms are steatorrhea, diarrhea, and weight loss. 

Patients with anorexia nervosa, untreated insulin-dependent diabetes mellitus, hyperthyroidism, and nontropical sprue all will... 

C. All of these patients will lose weight the anorexics because of insufficient calories in the diet, the diabetics because of low insulin levels, those with hyperthyroidism because of an increased BMR, and those with nontropical sprue because of decreased absorption of food from the gut. The untreated diabetics will have high ketone levels because of low insulin. Ketone levels may be elevated in anorexia and also in sprue. 

Celiac disease is sometimes called nontropical sprue, cefiac sprue, or gluten-sensitive enteropathy. 

Hypocupremia and low serum ceruloplasmin levels were reported in celiac disease (A13, LI), and in tropical (B36) and nontropical sprue (Cl, S40). Oral administration of copper to the patients with tropical sprue resulted in a sustained rise of serum copper in only one of four patients (B36). Stemlieb and Janowitz (S40) have recently shown that in nontropical sprue the absorption of copper from the gut is impaired. 

Synonyms gluten-sensitive enteropathy, nontropical sprue Definition hypersensitivity to gluten (and gliadin), resulting in loss of small bowel villi and malabsorption... 

Gastrointestinal Diseases Chronic active hepatitis Crohn s disease Nontropical sprue Ulcerative colitis Neurologic Conditions Acute cerebral edema Multiple sclerosis Myasthenia gravis Eye Diseases Allergic conjunctivitis Exophthalmos Optic neuritis Scleritis Uveitis... 

M5. Mann, J. G., Brown, W. R., and Kem, F., The subtle and variable clinical expressions of gluten-induced enteropathy (adult celiac disease, nontropical sprue). An analysis of twenty-one consecutive cases. Amer. J. Med. 48, 357-366 (1970). 

In the case of phenoxymethylpenicillin, the levels are prohahly lowered because oral neomycin can cause a reversible malabsorption syndrome (histologically similar to nontropical sprue). 

Since nontropical sprue and Whipples disease involve the proximal small intestine primarily, quantitative alterations of bile salt enterohepatic cir-... 

Carbohydrate Malabsorption 318 The Dumping Syndrome 318 Steatorrhea Idiopathic Steatorrhea Celiac Disease or Nontropical Sprue... 

The pathogenesis of nontropical sprue is not known, yet the disease improves when a gluten-free diet is administered. At first nontropical sprue was thought to be caused by hypersensitivity of the intestinal... 

Primary steatorrhea is referred to as celiac disease in children and nontropical sprue in adults. In severe nontropical sprue, the delicate pattern designed by the slender villi is replaced by a flattened knobby epithelium [147-149]. Thus, the distended crypts open directly in the flat luminal surface. These changes result... 

Thus, nontropical sprue expresses itself by a complex blend of general malnutrition with vitamin deficiencies and dehydration (see Fig. 4-49). The dehydration results from lack of water absorption because of the reduced mucosal surface and interference with sodium absorption (see Electrolyte Metabolism). 

In any event, this and related syndromes (celiac disease, also known as nontropical sprue or idiopathic steatorrhea), call attention to an almost completely neglected aspect of folic metabolism— the glutamyl chains in the native folic coenzymes. 

Nontropical sprue, the term commonly applied to adults exhibiting a sensitivity to gluten. 

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