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COLLAGENOUS SPRUE

H. WALTER PEPPER M.D.1, LLOYD L. BRANDBORG M.D.2, JON D. SHANSER M.D.3, HENRY I. GOLDBERG M.D.3, and ALBERT A. MOSS M.D.4

1 Department of Radiology, Veterans Administration Hospital, San Francisco; and Department of Radiology, University of California School of Medicine, San Francisco; Department of Medicine, VAH and UCSF.
2 Department of Medicine, VAH and UCSF.
3 Department of Radiology, UCSF.
4 Department of Radiology, Oak Knoll Naval Hospital, Oakland, California.

The cause of collagenous sprue is, as yet, undetermined. A patient with clinical malabsorption, histologically flat mucosa, and little or no response to gluten withdrawal is a prime suspect.

Jejunal biopsy specimens show flat mucosa with an abundant deposit of collagen in the lamina propria. Serial and multiple biopsy specimens may be required to make the diagnosis.14 Trichrome staining is essential.

The roentgenograms demonstrate moderate to severe changes in the proximal small bowel differing somewhat from the characteristic appearance of celiac sprue. Duodenal involvement was present in each of our 3 cases and varied in appearance from mucosal thickening of the proximal small bowel to a virtually smooth, featureless, rigid pattern.

These features in patients with primary intestinal malabsorption that is partially or totally refractory upon strict exclusion of gluten from the diet should alert the radiologist to the possible presence of collagenous sprue. Differentiation of collagenous sprue from celiac sprue allows for more accurate prognosis and more definitive treatment for the patient.


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