Classification and management of refractory coeliac disease

Alberto Rubio-Tapia, Joseph A Murray

Research output: Contribution to journalArticle

189 Citations (Scopus)

Abstract

Refractory coeliac disease (RCD) is defined by persistent or recurrent malabsorptive symptoms and villous atrophy despite strict adherence to a gluten-free diet (GFD) for at least 6-12 months in the absence of other causes of non-responsive treated coeliac disease and overt malignancy. Symptoms are often severe and require additional therapeutic intervention besides a GFD. RCD can be classified as type 1 (normal intraepithelial lymphocyte phenotype), or type 2 (defined by the presence of abnormal (clonal) intraepithelial lymphocyte phenotype). Patients with RCD may never have responded to a GFD or may have relapsed despite adherence and initial response to the GFD. RCD type 1 usually improves after treatment with a combination of aggressive nutritional support, adherence to a GFD, and alternative pharmacological therapies. By contrast, clinical response to alternative therapies in RCD type 2 is less certain and the prognosis is poor. Severe complications such as ulcerative jejunitis and enteropathy-associated T cell lymphoma may occur in a subgroup of patients with RCD. The aims of this article are to (1) review recent advances in the diagnosis and management of patients with RCD, and (2) describe current and novel methods for classification of patients with RCD into categories that are useful to predict outcome and direct treatment.

Original languageEnglish (US)
Pages (from-to)547-557
Number of pages11
JournalGut
Volume59
Issue number4
DOIs
StatePublished - Apr 2010

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Celiac Disease
Gluten-Free Diet
Complementary Therapies
Enteropathy-Associated T-Cell Lymphoma
Lymphocytes
Phenotype
Nutritional Support
Atrophy
Pharmacology
Therapeutics

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Classification and management of refractory coeliac disease. / Rubio-Tapia, Alberto; Murray, Joseph A.

In: Gut, Vol. 59, No. 4, 04.2010, p. 547-557.

Research output: Contribution to journalArticle

Rubio-Tapia, Alberto ; Murray, Joseph A. / Classification and management of refractory coeliac disease. In: Gut. 2010 ; Vol. 59, No. 4. pp. 547-557.
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