MODERN TREATMENT OF THE MALABSORPTION SYNDROME IN ADULTS

Abstract

The effect of cortisone and a gluten-free diet was studied in 27 patients[long dash]1 with tropical sprue, 14 with non-tropical sprue, and 12 with malabsorption secondary to various intestinal disorders. The patient with tropical sprue made no response to cortisone but of 8 patients with non-tropical sprue only one failed to respond. This patient recovered when given a gluten-free diet in addition. Four of the remaining cortisone-treated patients also improved further on a gluten-free diet. Eleven patients were fiven a gluten-free diet either as initial therapy or following relapse when cortisone was withdrawn. Ten responded well, but one failed to improve until given cortisone as well. In the secondary group, 5 of 9 patients responded to cortisone. One developed intestinal obstruction and died. Two of the failures responded to combined therapy, as did one patient who had failed to respond to a gluten-free diet alone. One patient with regional ileitis became worse because of progression of her disease while on combined therapy. Five of 7 patients responded to a gluten-free diet alone. Fat absorption was markedly improved in these patients; returning to normal in 4 cases, and to more than 90% of fat intake in nineteen. Marked weight gain, correction of diarrhea, hypoproteinemia, hypotension, hypocalcemia, hypoprothrombinemia and improvement in carbohydrate absorption was demonstrated. The effect of cortisone was more rapid than that of a gluten-free diet, but less complete. A combination of the 2 treatments is recommended as initial therapy in seriously ill patients. Relapse has occurred when treatment was withdrawn even after 4 years of remission.