Push enteroscopy in celiac sprue and refractory sprue

Background: The aim of this study was to determine in patients with sprue w hether jejunal endoscopy improves the diagnostic yield or provides informat ion that may modify management, when compared with evaluation limited to th e duodenum. Methods: From January 1994 to June 1998, a total of 31 patients (6 men, 25 women, mean age 41 years) were prospectively evaluated by push enteroscopy. They were divided into two groups: (1) celiac disease at different stages of activity (n = 23) and (2) refractory sprue (0 = 8). The endoscopic and h istologic findings in the duodenum and in the jejunum were compared. Results: Celiac disease: In 19 patients, endoscopic and histologic findings in the duodenum and jejunum were similar; in four patients villous atrophy was more severe in the duodenum than in the jejunum. Refractory sprue: In 5 of 8 patients, enteroscopy revealed ulcerative jejunitis, whereas ulcerat ions were found in the duodenum in only one case. Conclusion: In refractory sprue, push enteroscopy with jejunal biopsies was of diagnostic value in 50% of cases demonstrating ulcerative jejunitis, wh ereas it did not modify the management of patients with responsive celiac d isease.