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Raymond N. DuBois, MD, PhD; Audrey J. Lazenby, MD; John H. Yardley, MD; Thomas R. Hendrix, MD; Theodore M. Bayless, MD; Francis M. Giardiello, MD

JAMA. 1989;262(7):935-937.

Abstract
We describe a patient with refractory sprue with malabsorption, a flat smallbowel 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 smallbowel 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.

(JAMA. 1989;262:935-937)

Author Affiliations
From the Department of Internal Medicine, Division of Gastroenterology (Drs DuBois, Hendrix, Bayless, and Giardiello), and the Department of Pathology (Drs Lazenby and Yardley), The Johns Hopkins University School of Medicine and Hospital, Baltimore, Md. Dr Lazenby is the recipient of a fellowship from the National Foundation for Ileitis and Colitis.

Footnotes
Reprint requests to Blalock 4, Division of Gastroenterology, Meyerhoff Center for Digestive Diseases, 600 N Wolfe St, Baltimore, MD 21205 (Dr DuBois).

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