Collagenous sprue cross-sectional imaging: a comparative blinded study

Badr Al-Bawardy, Shannon P. Sheedy, Michelle B. Herberts, Joseph A. Murray, Alberto Rubio-Tapia, Elizabeth Rajan, David H. Bruining, Stephanie L. Hansel, John M. Barlow, Joel G. Fletcher, Jeff L. Fidler

Research output: Contribution to journalArticlepeer-review


Purpose: Collagenous sprue (CS) is a rare enteropathy characterized by villous atrophy and a thickened subepithelial collagen band. The aim of this study is to describe the cross-sectional imaging findings of CS. Methods: A case–control, retrospective study with cases of all CS patients from January 2000 to 2015 was performed. Inclusion criteria were (1) Histopathologic diagnosis and (2) Imaging with computed tomography abdomen/pelvis (CT A/P), CT enterography (CTE), or magnetic resonance enterography within 6 months of small bowel (SB) biopsy. Control subjects were irritable bowel syndrome (IBS) patients who underwent CTE. Imaging studies were examined by two GI radiologists, blinded to patient data. Results: 108 patients (54 CS; 54 IBS) were included. Mean age was 56.7 ± 16.5 years, and 68% were female (72% in CS group vs. 63% in IBS group; p = 0.3). CS patients were significantly older (67 ± 12 vs. 47 ± 15 year; p < 0.001) and more likely to be on angiotensin receptor blockers (41% vs. 6%; p < 0.001) as compared to the IBS group. Compared to IBS, CS patients were more likely to have mesenteric lymph node (LN) prominence (56% vs. 15%; p < 0.001), jejunoileal fold pattern reversal (46% vs. 6%; p < 0.001), SB dilation (28% vs. 0%; p < 0.001), SB conformational change (28% vs. 6%; p = 0.002), SB wall thickening (13% vs. 2%; p = 0.03), and ulcerative jejunoileitis (4% vs. 0%; p = 0.01). Radiologists suspected malabsorption in 72% in the CS group and 2% in the IBS group (p < 0.001). Conclusion: Imaging findings suggestive of mucosal malabsorption are commonly demonstrated in CS.

Original languageEnglish (US)
Pages (from-to)396-402
Number of pages7
JournalAbdominal Radiology
Issue number2
StatePublished - Feb 1 2017


  • CT enterography
  • Collagenous sprue
  • Enteropathy
  • MR enterography
  • Olmesartan

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging
  • Gastroenterology
  • Urology


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