Celiac sprue after surgery of the upper gastrointestinal tract. Report of 10 patients with special attention to diagnosis, clinical behavior, and follow-up.

The clinical onset of celiac sprue (CS) may be precipitated by upper digestive tract surgery. We report a series of 10 patients who developed CS after diverse types of peptic ulcer surgery. Six were male and 4 female. Gastrectomy with Billroth II anastomosis was performed in 5 patients, truncal vagotomy and pyloroplasty in 2, parietal cell vagotomy and pyloroplasty in 1, and vagotomy with gastrojejunal anastomosis in 2. We found that eight patients had had previous symptoms that suggested CS. Symptoms occurred early in the postoperative period. Severe diarrhea and striking weight loss were the most prominent clinical findings. The response to gluten-free diet was independent of the type of surgical procedure performed and was similar to that observed in the general celiac population.