Collagenous sprue (CS) is a rare sprue-like enteropathy with villous atrophy and a subepithelial collagen band. Published evidence is fragmented. We conducted a systematic scoping review with a pooled, descriptive patient-level analysis to summarize presentation, evaluation, management and outcomes in reported adult CS. We searched PubMed/MEDLINE, Embase, Web of Science, CINAHL and Scopus from inception through 1 December 2025. We included adult cases with biopsy-confirmed CS, defined as small-bowel villous atrophy with a subepithelial collagen band. Of 777 records, 50 publications met inclusion criteria and contributed 99 unique patients with extractable data. Median age was 65 years and 62% were women. Symptoms were prolonged (median 36 weeks) with prominent diarrhea (median 6.5 stools/day) and frequent malnutrition and edema. Laboratory findings reflected severe malabsorption (median albumin 2.9 g/dL; potassium 2.6 mEq/L; hemoglobin 11.95 g/dL). Exposure to medications associated with sprue-like enteropathy was common when reported (30/38, 79%), most often angiotensin receptor blockers. Histology showed a median collagen band thickness of 19.2 μm and total villous atrophy in 54%. Treatment commonly combined nutritional rehabilitation (often parenteral nutrition), gluten-free diet, withdrawal of suspected medications and corticosteroids. Symptom improvement was often rapid (median 7 days). Histologic improvement occurred in 74% (37/50) with follow-up biopsies. Relapse occurred in 31% (4/13). Mortality among patients with known vital status was 23% (12/53). CS is profoundly morbid but frequently improves with early recognition, medication review and withdrawal, aggressive nutritional support and steroid-based therapy, although relapse and mortality remain substantial. What is already known on this topic: Collagenous sprue is a rare, highly morbid sprue-like enteropathy described mainly in case reports and small series, and optimal evaluation and therapy remain uncertain.What this study adds: In pooled data from 50 publications describing 99 well-characterized adults, collagenous sprue typically presents after prolonged symptoms with profound malnutrition, hypoalbuminemia and electrolyte derangements; medication exposures linked to sprue-like enteropathy are common; most patients improve after combined nutritional support, medication review or withdrawal of triggers and steroid-based therapy, though relapse occurs and mortality remains substantial.How this study might affect research, practice or policy: Clinicians should consider collagenous sprue early in older adults with refractory diarrhea and villous atrophy, especially when presumed celiac disease is unresponsive, obtain adequate and sometimes extended small-bowel sampling and prioritize prompt supportive care and targeted immunosuppression while prospective evidence is developed.

Tropical sprue, a rare malabsorption syndrome, remains a significant yet underrecognized gastrointestinal disorder endemic to tropical regions, including South and Southeast Asia (e.g., India, Pakistan) and Caribbean islands (e.g., Puerto Rico, the Dominican Republic, Haiti). Its etiology remains uncertain, but mounting evidence supports an infectious origin, with bacterial overgrowth involving pathogens such as Alcaligenes, Klebsiella, and Enterobacter species frequently implicated. The disease causes profound intestinal alterations that impair the absorption of vitamin B12, fat-soluble vitamins (A, D, E, and K), and minerals such as calcium and magnesium, frequently resulting in chronic diarrhea and severe nutritional deficiencies. Histologically, villous atrophy of the jejunal and ileal mucosa is a hallmark feature. This narrative review synthesizes current knowledge on the epidemiology, etiology, intestinal pathophysiology, and histopathology of tropical sprue, while highlighting diagnostic challenges and the urgent need for further research to elucidate its pathogenesis and improve clinical management in endemic settings.

Thiamine (vitamin B1) deficiency is a reversible, yet potentially fatal condition that affects both the central and peripheral nervous systems. Although commonly linked to chronic alcoholism, non-alcoholic causes, including malabsorption syndromes, are increasingly being recognized. We report the case of a 22-year-old woman who presented with progressive lower limb weakness, gait disturbances, and confusional symptoms, following a history of intermittent diarrhea and vomiting. Neurological examination revealed ascending motor deficits, areflexia, cerebellar syndrome, and internuclear ophthalmoplegia. Brain magnetic resonance imaging (MRI) showed bilateral symmetrical lesions in the caudate nuclei and periaqueductal area, suggesting Gayet-Wernicke encephalopathy (GWE). The electroneuromyography (ENMG) revealed axonal sensorimotor polyneuropathy. Cerebrospinal fluid (CSF) analysis showed mild hyperproteinorachia mimicking acute inflammatory demyelinating polyneuropathy (AIDP). A profound thiamine deficiency (22.4 nmol/L) was identified alongside duodenal lymphocytosis without villous atrophy or celiac-specific antibodies. High-dose intravenous (IV) thiamine therapy led to rapid improvement in neuropsychiatric symptoms, with partial motor recovery over two months and near-complete resolution on follow-up MRI at six months. This case highlights the diagnostic complexity of non-alcoholic thiamine deficiency, in which Gayet-Wernicke encephalopathy and dry beriberi may present atypically. MRI findings and clinical response to thiamine are key to early diagnosis. Duodenal lymphocytosis may suggest an underlying malabsorption process even in the absence of definitive celiac disease. Clinicians must maintain a high index of suspicion for thiamine deficiency in patients with neurological and gastrointestinal (GI) symptoms regardless of alcohol use. Prompt thiamine supplementation is crucial to prevent irreversible neurological damage.

Sartan-induced enteropathy is an uncommon side effect of treatment with angiotensin II receptor antagonists (ARBs), which has predominantly been described for olmesartan. For the first time, we describe sartan-induced enteropathy as an adverse drug reaction associated with azilsartan in a 74-year-old male patient who was admitted to the hospital twice within 5 months because of excessive non-bloody diarrhea and weight loss. In this case, histopathological findings of intraepithelial lymphocytosis and intestinal villous atrophy resembled celiac disease; however, celiac disease-specific antibodies remained negative, and a gluten-free diet did not result in significant clinical recovery, while symptoms stopped rapidly after stopping azilsartan. When the patient was seen 5 months later, he was free of clinical symptoms, and histological changes disappeared after stopping azilsartan. This case illustrates sprue-like enteropathy as a potential side effect of azilsartan, emphasizing to consider this differential diagnosis in ARB-treated patients with chronic diarrhea. The causality of our findings was confirmed by drug de-challenge and re-challenge resulting in typical histological changes.

Celiac crisis is a rare, severe manifestation of celiac disease, characterized by acute gastrointestinal symptoms, malnutrition, metabolic disturbances, and potential life-threatening complications. Postpartum celiac crisis is particularly rare but can be triggered by the physiological and hormonal changes of the puerperal period. We report the case of a 42-year-old woman with a 3-month history of watery diarrhea, significant weight loss, extremity paresthesias, muscle spasms, and lower limb edema following childbirth. Initial evaluation revealed severe malnutrition, electrolyte imbalances, and hypoalbuminemia. Endoscopic studies showed significant villous atrophy and mucosal damage, suggestive of celiac disease, which was confirmed by serological and histological findings. The patient was diagnosed with celiac crisis and initiated on a strict gluten-free diet with supportive care, resulting in full clinical and biochemical recovery. This case highlights the importance of considering CD in the differential diagnosis of postpartum malnutrition and chronic diarrhea. Postpartum period may trigger the disease, underscoring the need for awareness in clinical settings. Celiac hepatitis is a prevalent occurrence within the spectrum of CD, with transient transaminase elevation with resolution following the initiation of a gluten-free diet. Celiac crisis, though rare, requires prompt diagnosis and intervention to avoid further complications. A crise celíaca é uma manifestação grave e rara da doença celíaca, caracterizada por sintomas gastrointestinais agudos, desnutrição, distúrbios metabólicos e complicações potencialmente fatais. A crise celíaca no período pós-parto é rara, podendo ser desencadeada pelas alterações fisiológicas e hormonais do puerpério. Reportamos o caso de uma mulher de 42 anos com antecedentes de diarreia aquosa, perda de peso significativa, parestesias nos membros, espasmos musculares e edema nos membros inferiores com três meses de evolução após o parto. A avaliação inicial revelou desnutrição grave, desequilíbrios eletrolíticos e hipoalbuminémia. Estudos endoscópicos revelaram atrofia das vilosidades, sugestivo de doença celíaca, confirmado por estudos serológico e histológico. Foi feito o diagnóstico de crise celíaca e a doente iniciou uma dieta isenta de glúten e terapêutica de suporte, com consequente melhoria clínica e bioquímica. Este caso destaca a importância de considerar a doença celíaca no diagnóstico diferencial de desnutrição e diarreia crónica no período pós-parto. As alterações no período pós-parto podem despoletar a doença, reforçando-se a necessidade de consciencialização desta entidade neste contexto clínico. A hepatite celíaca é uma entidade prevalente no espetro da doença celíaca, caraterizada pelo aumento transitório de transaminases e com resolução após adoção de dieta isenta de glúten. A crise celíaca, embora rara, requer um diagnóstico e intervenção atempados de modo a evitar complicações.