Collagenous Sprue, a Heterogeneous Small Bowel Disorder

Collagenous sprue is a disorder characterized by severe diarrhea, progressive malaborption of multiple nutrients, protein depletion and weight loss accompanied by a pathognomic small bowel biopsy lesion characterized by a villus atrophy and a band-like subsepithelial mucosal deposit containing collagen. It has been closely linked to celiac disease, tends to be refractory to treatment and prognosis has been poor with only anecdotes of successful therapy. In recent years, the disorder has been detected in different settings, including early malignancies as a paraneoplastic phenomenon and due to the toxic effects of some medications including non-steroidal anti-inflammatory drugs (NSAIDs) and the angiotensin II receptor antagonist, olmesartan. Here, dramatic reversal to normal of the clinical and pathological changes have been documented so that a medication history is critical in any patient presenting with sprue-like intestinal disease.