The full content of Annals is available to subscribers

Subscribe/Learn More  >
Brief Reports |

Successful Treatment of Refractory Sprue with Cyclosporine

George F. Longstreth, MD
[+] Article, Author, and Disclosure Information

From Southern California Permanente Medical Group, San Diego, California. Requests for Reprints: George F. Longstreth, MD, Kaiser Medical Center, 4647 Zion Avenue, San Diego, California 92120. Acknowledgment: The author thanks Dr. William Cory for substantial contributions to the patient's care, Dr. Naomi Buckwalter for pathology consultation and the photographs, Dr. Martin F. Kaghoff for DNA typing.

Copyright 2004 by the American College of Physicians

Ann Intern Med. 1993;119(10):1014-1016. doi:10.7326/0003-4819-119-10-199311150-00008
Text Size: A A A

Celiac sprue is a disorder of absorption that is identified by characteristic histologic abnormalities in the small-bowel mucosa [12]. The clinical and histologic features respond to a gluten-free diet. Patients with refractory sprue do not respond to strict gluten avoidance and have a poor prognosis [3]. A patient with severe sprue who was unresponsive to a gluten-free diet and corticosteroid therapy experienced remission after receiving cyclosporine therapy.

First Page Preview

View Large
First page PDF preview


Grahic Jump Location
Figure 1.
Duodenal biopsy findings in a patient with sprue.Panel APanel BPanel CPanel D

Initial biopsy specimen showing total villous atrophy, crypt hyperplasia, flattened surface cells, and an intense inflammatory infiltrate in the lamina propria. Goblet cells are absent. Biopsy specimen obtained after the patient had been on a gluten-free diet for 2.5 years, showing persistence of abnormalities typical of sprue. Biopsy specimen obtained after cyclosporine use for 1 year, showing villi with a villous:crypt ratio of 1:1, columnar surface cells, a normal number of goblet cells, and less inflammation. Biopsy specimen obtained 3 years after cyclosporine therapy was discontinued, showing no abnormality. The villous:crypt ratio is 3:1 (hematoxylin and eosin).

Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Journal Club
Topic Collections
PubMed Articles
Management of refractory ulcerative colitis. Curr Treat Options Gastroenterol 2006;9(3):234-45.
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.