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Small bowel (small intestine)


Refractory sprue

Reviewer: Hanni Gulwani, M.D. (see Reviewers page)
Revised: 14 December 2012, last major update August 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.


● 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)

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


Micro images

Various images

End of Small bowel (small intestine) > Malabsorption > Refractory sprue

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