Lymphocytic enterocolitis in patients with 'refractory sprue'
R. N. DuBois, A. J. Lazenby, J. H. Yardley, T. R. Hendrix, T. M. Bayless and F. M. Giardiello
Department of Internal Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD.
We describe a patient with refractory sprue with malabsorption, a flat
small-bowel biopsy specimen unresponsive to a gluten-free diet, and colonic
biopsy specimens consistent with lymphocytic (microscopic) colitis. To
investigate further the relation between celiac disease and lymphocytic or
collagenous colitis (a similar and possibly related entity), we examined
colorectal and small-bowel biopsy specimens in patients indexed
histologically as having celiac disease who have been seen at The Johns
Hopkins Hospital since 1958. Of 135 indexed patients, 21 had colorectal
biopsies. Colorectal biopsy specimens were abnormal in 7 of the 21
patients. Four patients had biopsy specimens resembling lymphocytic
colitis, 2 patients had acute colitis, and another patient had both
lymphocytic and acute colitis. No patients had collagenous colitis. Three
of the patients with lymphocytic colitis and celiac-like changes of the
small bowel never responded to a gluten-free diet and may represent a
distinctive panintestinal disease for which the term "lymphocytic
enterocolitis" with malabsorption is proposed.
