Cross-sectional imaging in refractory celiac disease

Badr Al-Bawardy, John M. Barlow, Rogerio N. Vasconcelos, Sarasa T. Kim, David H. Bruining, Stephanie L. Hansel, Shannon P. Sheedy, Joseph A. Murray, Alberto Rubio Tapia, Elizabeth Rajan, Jeff L. Fidler, Joel G. Fletcher

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Purpose: The purpose of this study is to identify unique imaging findings of refractory celiac disease (RCD) including Type I RCD, Type II RCD versus healed celiac disease (CD). Methods: A retrospective study of patients with known CD and refractory symptoms with cross-sectional imaging was performed. We included patients who underwent T cell receptor rearrangement or T-cell immunophenotyping studies on small bowel (SB) biopsies to classify patients into: healed CD, Type I RCD, or Type II RCD. GI radiologists performed a blinded review of the imaging studies. Results: One-hundred eighteen patients (32 healed; 67 Type I RCD; 19 Type II RCD) were included (mean age 53 ± 6 years; 62% female). The presence of any fold pattern abnormality was more likely to be found in Type II and Type I RCD than healed CD (53% vs. 43% vs.16%; p = 0.009). Type II RCD patients were more likely than Type I RCD and healed CD to have imaging findings of ulcerative jejunitis (26% vs. 6% vs. 3%; p = 0.009), SB wall thickening (37% vs. 16% vs. 0%; p = 0.002) and SB dilation (26% vs. 7% vs. 6%; p = 0.04). Type II RCD demonstrated non-significant trends for decreased number of jejunal folds only, SB mass, mesenteric lymphadenopathy, localized peri-mural edema, and intramural duodenal edema. Conclusions: Fold pattern abnormalities, ulcerative jejunitis, SB wall thickening, and SB dilation are more likely to be identified in cross-sectional imaging of RCD than healed CD. SB dilatation and ulcerative jejunitis are more likely to be found in Type II than Type I RCD.

Original languageEnglish (US)
Pages (from-to)389-395
Number of pages7
JournalAbdominal Radiology
Issue number2
StatePublished - Feb 1 2017


  • Celiac disease
  • CT enterography
  • Enteropathy
  • Ulcerative jejunitis

ASJC Scopus subject areas

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


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