title: The first cases of collagenous sprue successfully treated with thioguanine.
abstract: OBJECTIVE
  Collagenous sprue (CS) is a rare form of small bowel enteropathy characterised by a thickened basement membrane and is, in most of the literature, reported as part of coeliac disease. Multiple treatment strategies are suggested in CS, but there is no standardised therapy. The aim of this series is to describe 4 cases of CS and to propose thioguanine (6-TG) treatment.
  
  
  METHODS
  We reviewed 4 cases of CS. Data were obtained from our prospective database of patients referred to our coeliac centre. Evaluation of small bowel biopsies was performed by an expert pathologist.
  
  
  RESULTS
  None of the patients had ever had coeliac-specific antibodies, and all were negative for HLA-DQ2 and HLA-DQ8 phenotype. Three patients were treated with a combination of 6-TG and budesonide, and 1 patient received 6-TG only. All patients improved remarkably. Normalisation of the thickened basement membrane was found in 2 patients and complete histological improvement including full recovery of villi was found in 1 patient. In the third patient, the thickened basement membrane was only very focally recognised. The thickened membrane persisted in the last patient, probably because of the short time of follow-up.
  
  
  CONCLUSIONS
  CS should be separated from coeliac disease. Based on the lack of typical HLA phenotyping and the absence of coeliac-specific antibodies, there seems to be no relation with coeliac disease in these 4 cases. A promising treatment option might be 6-TG with or without budesonide. Research in a larger cohort is needed to standardise treatment for CS.
authors.affiliation: Department of Gastroenterology and Hepatology , VU University Medical Center , Amsterdam , The Netherlands.
authors.forename: Tom
authors.initials: T
authors.lastname: van Gils
authors.affiliation: Department of Gastroenterology and Hepatology , VU University Medical Center , Amsterdam , The Netherlands.
authors.forename: Tine
authors.initials: T
authors.lastname: van de Donk
authors.affiliation: Department of Gastroenterology and Hepatology , VU University Medical Center , Amsterdam , The Netherlands.
authors.forename: Gerd
authors.initials: G
authors.lastname: Bouma
authors.affiliation: Department of Gastroenterology and Hepatology , VU University Medical Center , Amsterdam , The Netherlands.
authors.forename: Foke
authors.initials: F
authors.lastname: van Delft
authors.affiliation: Department of Pathology , VU University Medical Center , Amsterdam , The Netherlands.
authors.forename: E Andra
authors.initials: EA
authors.lastname: Neefjes-Borst
authors.affiliation: Department of Gastroenterology and Hepatology , VU University Medical Center , Amsterdam , The Netherlands.
authors.forename: Chris J J
authors.initials: CJ
authors.lastname: Mulder
keywords: HISTOPATHOLOGY; HLA; SMALL BOWEL; SMALL BOWEL DISEASE