Sprue Group

The main points in differential diagnosis between the sprue group and pancreatogenous malabsorption are summarized in Table 1. Occa-... 

Calcium and magnesium deficiency also occur in some patients with the malabsorption syndrome and this may lead to tetany or bone changes. Low blood calcium levels may result from decreased absorption associated with lack of effective compensatory parathyroid activity. In patients in whom secondary hyperparathyroidism is effective, extensive loss of calcium from the bones may occur. The cause of the defective absorption of calcium in patients of the sprue group is complex and not yet fully understood (B3, Dl, Jl, M7, Nl). It is important that complications such as calcium or magnesium deficiency should be corrected before the final steps of definitive diagnosis are attempted. If this is not done, the secondary effects may obscure the results of other tests. 

To differentiate the constituent members of the sprue group, it is necessary to consider 2 effects. First, the effect of a wheat gluten-free diet and second, the effects of reintroduction of gluten after a period of remission on a gluten-free regimen. 

The main points of differentiation are summarized in Table 2. It will be seen that the group can be divided up into gluten-induced enteropathy, acute sprue, chronic sprue and idiopathic steatorrhea. As the cause of the sudden development of severe folic add deficiency... 

Since vitamin A is a fat-soluble vitamin, any disease that results in fat malabsorption and impaired liver storage brings with it the risk of vitamin A deficiency these conditions include biliary tract disease, pancreatic disease, sprue, and hepatic cirrhosis. One group at great risk are children from low-income families, who are likely to lack fresh vegetables (carotene) and dairy products (vitamin A) in the diet. 

REFRACTORY CELIAC DISEASE Recently, immunohistochemistry has been shown to have utility in the evaluation of patients with refractory celiac disease. These patients continue to suffer from symptoms despite adherence to a gluten-free diet and are more likely to develop further complications such as ulcerative jejunoileitis and enteropathy-associated T-cell lymphoma. The group of patients with refractory sprue and loss of CDS expression in more than 50% of the CD3-positive intraepithelial lymphocytes are more likely to develop enteropathy-associated T-cell lymphoma. These patients with an abnormal T-cell phenotype are more likely to receive more aggressive immunosuppressive therapy. 

Cellier C, Delabesse E, Helmet C, et al. Refractory sprue, coeliac disease, and enteropathy-associated T-cell lymphoma. French Coeliac Disease Study Group. Lancet. 2000 356 203-208. 

Vitamin K deficiency may also result from absorption defects in the gastrointestinal tract. Vitamin K is a liposoluble vitamin thus, whenever there is interference with lipid absorption in the intestine, poor absorption of the vitamin ensues. Two groups of diseases primarily are associated with inadequate lipid absorption—obstructive jaundice and malabsorption conditions in the intestine. Among the latter are included sprue, regional ileitis, intestinal obstruction, intestinal lipodystrophy, short-circuiting anastomosis, hyperperistalsis, chronic dysentery, and ulcerative colitis. 

Figure 9.5 A 160-800 mm extended nozzle with replaceable tips a - open nozzle b - tip nozzle c - open nozzle with sprue gate (Reproduced with permission from PSG Plastic Group GmbH)...

The folic acid group of vitamins was recognized by various effects on several test organisms. The simplest active member may be considered to be pteroylglutamic acid or folacin. This may be combined with extra molecules of glutamic acid. Experimental production of a deficiency of these factors has not been reported in man, but the anemia of certain diseases of man responds to folacin therapy. These diseases include sprue, megaloblastic anemia of infancy, nutritional macrocytic anemia, and the pernicious anemia of pregnancy. Folic acid is involved in some way with the metabolism of amino acids. 

A collective term for a group of nutritional deficiency diseases characterized by impaired absorption of nutrients from the small intestine, especially fats, glucose, and vitamins. Although all sprues exhibit the same general clinical manifestations of intestinal malabsorption and steatorrhea (fatty diarrhea), the following three etiologic classifications are presented in this book ... 

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