Sprue is the collective term for the malabsorptive gastrointestinal enteropathies although it may be used to refer directly to tropical sprue. It is composed of two entities:
In each, the radiologic features are not sensitive enough to confirm an absolute diagnosis. However, they do help to characterize the disease process. The gold standard investigation is upper GI endoscopy with duodenal biopsy.
Radiographic features
- small bowel dilatation: proportional to disease severity
- barium flocculation: due to intestinal hypersecretion
- hidebound-like appearance
- duodenal nodular changes
- jejunoileal fold pattern reversal
- segmentation
- hypersecretion and mucosal atrophy (moulage sign)
- transient non-obstructive intussusception (coiled spring appearance)
- cavitary mesenteric lymph node syndrome
Treatment and prognosis
With treatment of the underlying cause, the small bowel may return to normal and malabsorption ceases. Where there is longstanding, uncontrolled disease, there is an increased risk of small bowel lymphoma and carcinoma.
Associations have been made with other diseases. Dermatitis herpetiformis is associated with celiac disease, especially when dietary control is not adhered to. Additionally, adenopathy and hyposplenism may be seen.