Recurrent symptoms in well-established celiac disease may result in further clinical evaluation. In most, poor diet compliance is present. Other considerations include an unidentified gluten source, an erroneous initial diagnosis, another or second and superimposed cause for symptoms, or a complication, including collagenous sprue or an intestinal lymphoma. Failure to define an initial gluten-f...

Sprue-like enteropathy associated with olmesartan, first identified by our group in 2012,1 is characterized by chronic diarrhea (often severe) and weight loss that is unresponsive to a gluten-free diet. Laboratory work-up commonly reveals non-specific anemia, hypoalbuminemia, electrolyte imbalance, and vitamin deficiencies, consistent with a severe malabsorption process. Histopathological findi...

Intestinal folate absorption was assessed in six normal subjects and in four patients with coeliac sprue who were studied before and after treatment by dietary gluten exclusion. Comparisons were made of the luminal disappearance from the perfused jejunum of 3H-pteroylmonoglutamate and pteroyl 14C-glutamylhexaglutamate, and of the 48-hour urinary recovery of each isotope after perfusion and a ti...

In a previously published paper (1), we recommended the laboratory criteria that could be used for the diagnosis of tropical sprue in Puerto Rico. Included were 1) serum vitamin B1 2 levels, for which when using Lactobacillus leichmannii as the test organism, normal values are over 150 pg/mI; 2) serum folate levels, measured with Lactobacillus casei, give normal values over 5 ng/ml; 3) whole bl...

Criteria used to establish the diagnosis of tropical sprue were previously published.5 Twenty-one of the patients with sprue and four of the normal subjects were Puerto Rican. The patients with sprue ranged in age from 15 to 74 and the normal groups from 25 to 56. Treated patients were receiving folic acid orally, 5 mg. daily. Gastric juice was collected before and for 90 mm. after subcutaneous...