<<Disclaimer: Verify this information before applying it to your situation.>>

Those of you who have had a biopsy confirming villus atrophy or other CD-
like symptoms and do not respond to a GF diet should make sure any
medications they are taking for other medical conditions are not
responsible for the villus atrophy.  The following article makes clear the
point:

Gastroenterology, July 2003, Volume 124, Number 7, 1950-57

Case report:

Severe villus atrophy and chronic malabsorption induced by azathioprine

Thomas R. Ziegler, Concepción Fernández-Estívariz, Li H. Gu, Michael W.
Fried, Lorraine M. Leader

Abstract:

Azathioprine is commonly prescribed for autoimmune hepatitis and
inflammatory bowel disease. An acute gastroenteritis-like syndrome has been
ascribed to azathioprine use, but chronic diarrhea has not. We report a
patient with autoimmune hepatitis who developed severe small-bowel villus
atrophy and chronic diarrhea after azathioprine was initiated (50 mg/day).
We present a case report of a patient followed up prospectively. Duodenal
mucosal histology and expression of brush border enzyme dipeptidyl
peptidase IV and peptide transporter PepT1 messenger RNA levels were
determined before and after azathioprine discontinuation. Chronic diarrhea
developed several weeks after the initiation of azathioprine and resulted
in micronutrient depletion and severe protein-calorie malnutrition, which
was unresponsive to oral pancreatic enzyme therapy or a gluten-free diet.
Severe malabsorption required parenteral nutrition support for longer than
1.5 years; this was complicated by unstable blood glucose control, acute
calculous cholecystitis, catheter sepsis, and severe venous thrombosis.
When the temporal association between azathioprine and diarrhea was
identified, the drug was tapered while the patient consumed an unrestricted
diet. Within 2 weeks after azathioprine was discontinued, diarrhea had
completely resolved, and parenteral nutrition was discontinued. Mucosal
biopsies obtained before and 4 months after azathioprine discontinuation
showed complete reversal of severe duodenal villus atrophy and marked up-
regulation of mucosal dipeptidyl peptidase IV and PepT1 messenger RNA. The
patient has subsequently maintained normal liver function tests on low-dose
prednisone alone, with normal stools and stable nutritional status for
longer than 4 years. Azathioprine can induce severe small-bowel villus
atrophy, diarrhea, and malabsorption that is reversible with drug
discontinuation.

* Please remember some posters may be WHEAT-FREE, but not GLUTEN-FREE *