<<Disclaimer: Verify this information before applying it to your situation.>> This quote is from an medical review article called, “Refractory Celiac Disease,” Gastroenterology 2000;119:243-251. "RS is defined as an initial (primary RS) or subsequent failure (secondary RS) of a strict GFD to restore normal intestinal architecture and function in patients who have a celiac-like enteropathy." “Other important disorders that may mimic RS (Refractory Sprue) include intestinal lymphoma, ulcerative jejunitis, autoimmune enteropathy, collagenous sprue, and intolerance ot nongluten dietary proteins, such as milk, egg, and soya-induced enteropathies. Further, differential diagnosies include giardiasis, bacterial overgrowth, and Whipple’s disease. Accordingly, investigation of RS must include a rigorous attempt to rule out all other possible treatable causes. Exclusion diets are indicated to assess for other food protein enteropathies, such as milk, soy, or egg. Breath tests can diagnose bacterial overgrowth, examination of duodenal aspirates or stool samples may diagnose Giardia, and colonic biopsies are indicated to exclude the possiblility of concomitant inflammatory bowel disease, collagenous colitis, or lymphocytic colitis. Investigation of intestinal lymphoma will include abdominal computed tomography, enteroclysis, push enteroscopy, and multiple, serial duodenal and jejunal biopsies. A high index of suspicion for intestinal lymphoma would be triggered by the presence of such symptoms as profound weight loss, fluctuating pyrexia, or distant manifestations of lymphoma, such as skin rashes or ichthyosis. If the index of suspicion for intestinal lymphoma is high, and the aforementioned tests fail to identify a lesion, then laparotomy is indicated. The length of the bowel should be carefully scrutinized, followed by biopsy of intraperitoneal and retroperitoneal lymph nodes, and of the full thickness of the small intestinal bowel wall. If, after these extensive investigations, no cause for the persistent clinical and histologic features of sprue is found, then a diagnosis of RS may be made.” Laura _________________________________________________________________ Get your FREE download of MSN Explorer at http://explorer.msn.com/intl.asp. *Support summarization of posts, reply to the SENDER not the CELIAC List*