<<Disclaimer: Verify this information before applying it to your situation.>>
 
Subscribers to this list who also have access to the World Wide Web may
be interested in the current issue of the New England Journal of
Medicine On-line includes this article:
 
"A 79-Year-Old Woman with Anorexia, Weight Loss, and Diarrhea after
Treatment for Celiac Disease."
 
The complete article is available at no cost on the World Wide Web at:
 
http://www.nejm.org/publicM/1996/0334/0020/1316/2.htm#topAnchor
 
Here are a couple of paragraphs from the article:
 
....."Celiac disease, also called gluten-sensitive enteropathy or
nontropical sprue, has fascinated gastroenterologists since its response
to a diet free of wheat (gluten) was described in 1950. (1) The disease
remains fascinating because its spectrum of presentation is very broad.
(2) Although the presence of diarrhea and malabsorption typically alerts
the clinician to the diagnosis, an unexplained iron-deficiency anemia or
osteomalacia caused by malabsorption of calcium and vitamin D without
gastrointestinal manifestations may be the initial diagnostic clue."
 
"In this case the initial diagnosis was based on the small-bowel biopsy
performed 10 years before admission.  Although the biopsy findings may
have been typical, the patient had only a transient response to a
gluten-free diet and subsequently required low-dose prednisone to relieve
the diarrhea and malabsorption. This type of response raises the difficult
question whether the patient complied with the gluten-free diet, which is
notoriously difficult to follow, (3) or whether she had refractory sprue.
 
Refractory sprue is a diagnosis made after all other diseases that can
mimic sprue, such as the Zollinger-Ellison syndrome and eosinophilic
enteritis, are ruled out; and after failure of a strict attempt at gluten
withdrawal, corticosteroids or immunosuppressive therapy with drugs such
as cyclosporine, azathioprine, or both is required to reestablish
villous maturation. (2,4,5) I suspect that the patient under discussion
had refractory sprue, and I believe that a late complication of that
disorder was responsible for the radiologic findings and the gradual
clinical decline."
 
Copyright ) 1996 by the Massachusetts Medical Society
 
Persons with a growing interest in medical literature will enjoy looking
at other articles in NEJM. Back issues to January 1996 are available
online as well.
 
One last Web pointer:
 
DR K'S GASTROINTESTINAL DISEASES WEB PAGE
 
at http://pages.prodigy.com/DVBL86A/drk3-hp.htm
 
This is am interesting site that includes many useful links.
 
Marvin Pollard <[log in to unmask]>