In a significant portion of the case reports on collagenous sprue, the serologic tests are either not performed or results are negative, the HLA haplotype is not determined or is not DQw2, and the response to gluten-free diet is incomplete or absent.
There are 3 variants of refractory sprue, which are based on their response to a gluten-free diet: partial response, initial good response but a subsequent relapse, and no response, each of which have been observed in some collagenous sprue cases.
The exact relationship among collagenous sprue, classic celiac disease, and refractory sprue remains controversial.
Collagenous sprue usually presents with diarrhea, abdominal pain, weight loss, and/or isolated microcytic anemia, all of which are also frequently present in classic celiac disease.
The degree of mucosal abnormality in collagenous sprue seen in a biopsy, whether mild or severe, does not correlate with the severity of the clinical symptoms.
Patients with collagenous sprue were thought to have a dismal clinical course.
Some patients with collagenous sprue have coexisting collagenous colitis, lymphocytic gastritis, gastric metaplasia or heterotopia, or malignant lymphoma.
Adult patients with collagenous gastritis and celiac disease may respond to a gluten-free diet, (4) while patients with a concurrent collagenous sprue may have poor response to dietary changes and/or corticosteroids.
Collagenous sprue is a rare enteropathy that shares some clinical and histologic features with gluten-sensitive enteropathy (celiac disease).
Collagenous sprue often affects middle-aged to elderly females and presents with symptoms of malabsorption including diarrhea, weight loss, and sometimes abdominal pain.
The outcome of collagenous sprue is not as dismal as was once believed.
Interestingly, the histologic features of collagenous gastritis and collagenous sprue are similar to those seen in collagenous colitis.
Associated gastrointestinal diseases include celiac disease (20%), lymphocytic colitis, collagenous sprue, and lymphocytic gastritis.
Theories regarding the pathogenesis of collagenous gastritis and collagenous sprue suggest that the evolution of these diseases is similar to that of collagenous colitis, but there are few data to support or refute this.