Hafkemeyer P, Herbst E, Köhler G, Fuhrmann K, Kreisel W
Abteilung Innere Medizin II, Universität, Freiburg.
Dtsch Med Wochenschr. 1995 Oct 20;120(42):1430-4. doi: 10.1055/s-2008-1055495.
A 45-year-old man with type I diabetes mellitus was admitted to hospital because of colicky abdominal pain and 5-6 watery stools daily. Upper gastrointestinal endoscopy showed nearly total atrophy of the villi in the duodenum and jejunum suggesting coeliac disease. However, gluten-free diet for 2 weeks brought no improvement. Another examination of the biopsy 6 weeks after the first endoscopy revealed extensive collagen deposition in the lamina propria of the small intestine, giving the diagnosis of collagenous sprue.
Parenteral nutrition, lactulose, cisapride, cholestyramine, doxycycline, paromomycin, vancomycin and octreotide failed to affect the loss of fluid from the gut which 12 weeks after admission had increased to 221 daily. However, it was stopped after prednisolone was administered (100mg daily). 7 months after starting the steroid treatment the collagen layer had disappeared and the villous atrophy had partially regressed. Over the next 6 months the prednisolone dosage was decreased to 10 mg daily. Shortly thereafter a perimembranous glomerulonephritis occurred, with proteinuria (up to 60 g/d) and oedema. It regressed to 6 g/d when the steroid dose was increased and cyclosporin, 0.5 g/d, had been added. On maintenance dosage of cyclosporin the histological and clinical remission of the collagenous sprue has now lasted for over 2 years.
This case suggests that steroid administration is an effective treatment of collagenous sprue. The presence of diabetes and other immune-related diseases in this case also suggests that an immunological mechanism may play a causative role in collagenous sprue.
一名45岁的I型糖尿病男性因腹部绞痛和每日5 - 6次水样便入院。上消化道内镜检查显示十二指肠和空肠绒毛几乎完全萎缩，提示乳糜泻。然而，2周的无麸质饮食并未带来改善。首次内镜检查6周后对活检组织的再次检查显示小肠固有层有广泛的胶原沉积，从而诊断为胶原性口炎性腹泻。
肠外营养、乳果糖、西沙必利、考来烯胺、强力霉素、巴龙霉素、万古霉素和奥曲肽均未能改善肠道液体丢失，入院12周后肠道液体丢失增加至每日221毫升。然而，在给予泼尼松龙（每日100毫克）后，液体丢失停止。类固醇治疗开始7个月后，胶原层消失，绒毛萎缩部分消退。在接下来的6个月里，泼尼松龙剂量减至每日10毫克。此后不久，发生了膜性肾小球肾炎，伴有蛋白尿（高达60克/天）和水肿。当增加类固醇剂量并加用环孢素（每日0.5克）后，蛋白尿降至6克/天。目前，在环孢素维持剂量下，胶原性口炎性腹泻的组织学和临床缓解已持续超过2年。
该病例表明类固醇给药是治疗胶原性口炎性腹泻的有效方法。该病例中存在糖尿病和其他免疫相关疾病也提示免疫机制可能在胶原性口炎性腹泻中起致病作用。
