A case is described of adult coeliac disease with subepithelial collagen in a jejunal biopsy (‘collagenous sprue’) which responded well to treatment with prednisolone in addition to a gluten-free diet. The indications for corticosteroid treatment in adult coeliac disease are discussed in the light of the findings. It is suggested that collagenous sprue may represent the most severe form of adult coeliac disease, and the presence of sub-epithelial collagen in a jejunal biopsy may be the strongest indication for treatment with the combination of a gluten-free diet and corticosteroids.
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