**7. Hyposplenism in CD**

*Celiac Disease - From the Bench to the Clinic*

sites usually show villous atrophy.

has a poor prognosis [70].

presented with EATL. Patients with enteropathy associated T cell lymphoma of the small intestine, involving jejunum demonstrates large circumferential ulcer without overt mass. The involved area typically shows lymphoma, while the non-involved

The other variant of EATL, ulcerative enteritis, is another complication of long standing and refractory sprue. It presents with abdominal pain, nausea, vomiting and diarrhea. The other complication of CD includes intestinal ulceration independent of lymphoma and so called refractory sprue and collagenous sprue (**Figure 9**). It is a clinicopathological entity characterized by diarrhea and malabsorption accompanied by the histological findings of subepithelial collagen deposition and severe villous atrophy of small bowel mucosa [68]. The occurrence of collagenous sprue has been seen in patients with celiac disease, tropical sprue, milk intolerance and common variable immunodeficiency states [69]. Regardless of etiology it has a poor prognosis. Collagenous sprue associated with CD usually does not respond to gluten free diet and

**78**

**Figure 9.** *Collagenous colitis.*

**Figure 8.** *Lymphoma.*

One of the earliest manifestations of CD is hyposplenism, though the exact mechanism of development of hyposplenism is not known. Due to hyposplenism there is increased susceptibility of infection due to encapsulated bacteria especially. Vaccination against prophylaxis for pneumococcus is not highly recommended [71, 72].
