Small bowel (small intestine)
Refractory sprue

Topic Completed: 1 August 2012

Revised: 8 March 2019

Copyright: 2003-2019,, Inc.

PubMed Search: Refractory sprue[TIAB] small bowel

Hanni Gulwani, M.B.B.S.
Page views in 2018: 478
Page views in 2019 to date: 686
Cite this page: Gulwani H. Refractory sprue. website. Accessed November 17th, 2019.
Definition / general
  • Also called unclassified sprue
  • Celiac sprue that does not respond to gluten free diet of 6 - 12 months (note: wheat is present in many foods so must verify that diet is actually gluten free) and is not due to other disorders
  • Must rule out gluten contamination, microscopic colitis, bacterial overgrowth, pancreatic insufficiency, lactose intolerance, inflammatory bowel disease, lymphoma (Gut 2010;59:547)
Diagrams / tables

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Diagnostic approach

Clinical features
  • Two subtypes: type 1 (normal intraepithelial lymphocyte phenotype) and type 2 (presence of abnormal clonal intraepithelial lymphocyte phenotype)
  • Often associated with thromboembolic events, coexisting autoimmune disorders, cavitation of mesenteric lymph nodes and hyposplenism, lymphoma
Microscopic (histologic) images

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Various images

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