<<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



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