Intestinal ulceration and malabsorption syndromes

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Abstract

Data from 47 patients with malabsorption and small intestinal ulceration were reviewed to provide information on the relationship of the ulcerative process to celiac disease and to lymphoma. Presentations included: (a) worsening of malabsorptive symptoms and abdominal pain in a patient with celiac disease in his or her fifth or sixth decade; (b) an unexplained, unresponsive malabsorption syndrome with a flattened jejunal mucosa; or (c) complications including obstruction, perforation, or hemorrhage. Ulcer diagnosis was usually first made at surgery and not radiologically. The ulcers were morphologically nonspecific, usually multiple, and predominantly jejunal. Twenty-two patients with benign ulceration could be classified as celiac disease. Eleven others with “unclassified sprue” had similar jejunal biopsies, often with a long history of malabsorption. They did not go into remission with gluten withdrawal or adrenocorticosteroids. In some, this may have been because of the ulcers. Intestinal resection “cured” 4 of 13 patients. Steroid therapy was associated with prolonged remissions in 2 of 13, but intestinal perforation occurred in 10 while on steroids. Currently 29 of the 40 patients with benign ulceration are known to have died as a result of the ulcers. Lymphoma was antedated for months or years by benign ulceration in 3 patients and by histiocytic cells in pleomorphic atypical ulcers probably representing early subtle lymphoma in 2 others. When intestinal ulceration accompanied by malabsorption is suspected, exploratory laparotomy for biopsy and bowel resection and to search for lymphoma is reasonable. Use of the term “nongranulomatous ulcerative jejunoileitis” may be misleading and is not recommended.

Original languageEnglish (US)
Pages (from-to)754-765
Number of pages12
JournalGastroenterology
Volume79
Issue number4
StatePublished - Jan 1 1980

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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