<<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]>