Small bowel (small intestine)
Refractory sprue

Author: Hanni Gulwani, M.D. (see Authors page)

Revised: 12 February 2018, last major update August 2012

Copyright: (c) 2003-2018,, Inc.

PubMed Search: Refractory sprue[TIAB] small bowel

Cite this page: Gulwani, H. Refractory sprue. website. Accessed March 23rd, 2018.
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