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The Influence of Pteroylglutamic Acid (A Member of the Vitamin M Group) on Gastrointestinal Defects in Sprue. A Study of Interrelationships of Dietary Essentials¹

Five Figures

Departments of Medicine and Biochemistry, Vanderbilt University School of Medicine, Nashville; and Tennessee Department of Public Health, Nashville

Observations on 6 patients with sprue during 7 remissions following therapy with PGA have been summarized. Each remission has been characterized by relief of the glossitis, regeneration of the lingual papillae (fig. 1), cessation of the diarrhea, and gain in weight, as well as hematologic improvement (figs. 2a and 2b). In 5 instances a return toward the normal glucose tolerance following therapy was demonstrated. A gradual increase in the serum carotene concentration was observed in 6 of the remissions and improved vitamin A absorption and increased prothrombin concentration (fig. 4) demonstrated in 2 instances each. Increased concentrations of plasma tocopherol have been observed in 2 cases, and a decreased loss of fat in the stool has occurred in the 1 patient who was studied repeatedly (figs. 2a and 2b).

These findings are compatible with an interpretation that PGA exerts a favorable influence on the primary gastrointestinal disorder in sprue and thereby permits the correction of many secondary deficiencies which occur. Other possible interpretations are indicated.

Chronic sprue responds less completely to PGA than does the more acute disease.

As further evidence for the effectiveness of PGA in sprue, 2 patients have relapsed when therapy with PGA was withheld. All of the manifestations of the disease reappeared (figs. 2a and 2b).

Sprue and pernicious anemia differ in that gastrointestinal defects are pronounced in sprue.

Manuscript received 10 July 1947.