The diagnosis of sprue is as yet on an unsatisfactory basis. In the late or advanced stages of the disease, clinical recognition is comparatively easy. In its earlier and initial course, it is recognized with considerable difficulty and uncertainty, and diagnosis really rests on its later development into a more or less classic picture. So far as evidence is available, we do not find a close correspondence between the symptoms and the gross pathologic condition. This observation leads to the inference that disturbance of function precedes the establishment of objective cellular changes by a variable and indefinite time. In this respect sprue resembles subacute myelinic degeneration of the spinal cord.
A diagnosis based on the characteristic diarrhea, stomatitis and afebrile course does not include many early cases which later prove to be sprue. Moreover, after this classic picture has been present even for years, one or all of these features
REED AC, ASH JE. ATYPICAL SPRUE. Arch Intern Med (Chic). 1927;40(6):786-799. doi:10.1001/archinte.1927.00130120045003