Etiology of nonresponsive celiac disease: Results of a systematic approach

Ahmad S. Abdulkarim, Lawrence J. Burgart, Jacalyn See, Joseph A Murray

Research output: Contribution to journalArticle

222 Citations (Scopus)

Abstract

OBJECTIVES: Nonresponse or relapse of symptoms is common in patients with celiac disease treated with gluten free diet. Refractory sprue (RS) is defined as initial or subsequent failure of a strict gluten-free diet to restore normal intestinal architecture and function in patients who have celiac-like enteropathy. The aims of this study were: 1) to identify causes of persistent symptoms in patients referred with presumed diagnosis of nonresponsive celiac disease (NCD); and 2) to characterize patients with true RS. METHODS: Patients were identified who had been systematically evaluated for NCD between January 1997, and May 2001. Patient records and small bowel biopsy results were reviewed. RESULTS: A total of 55 patients were referred with a presumed diagnosis of NCD. Six did not have celiac disease and had other diseases responsible for their symptoms. Diarrhea, abdominal pain, and weight loss were the most common reasons for evaluation in cases of NCD, whereas weight loss, steatorrhea, and diarrhea were the most common presenting features of RS (nine patients). Of the 49 patients with celiac disease, 25 were identified as having gluten contamination. Additional diagnoses accounting for persistent symptoms included: pancreatic insufficiency, irritable bowel syndrome, bacterial overgrowth, lymphocytic colitis, collagenous colitis, ulcerative jejunitis, T-cell lymphoma, pancreatic cancer, fructose intolerance, protein losing enteropathy, cavitating lymphadenopathy syndrome, and tropical sprue. CONCLUSIONS: Based on this study, we conclude the following: 1) gluten contamination is the leading reason for NCD; 2) of NCD cases, 18% are due to RS; and 3) alternative diseases or those coexistent with celiac disease and gluten contamination should be ruled out before a diagnosis of RS is made.

Original languageEnglish (US)
Pages (from-to)2016-2021
Number of pages6
JournalAmerican Journal of Gastroenterology
Volume97
Issue number8
DOIs
StatePublished - Aug 2002

Fingerprint

Celiac Disease
Glutens
Gluten-Free Diet
Weight Loss
Diarrhea
Tropical Sprue
Lymphocytic Colitis
Fructose Intolerance
Collagenous Colitis
Protein-Losing Enteropathies
Steatorrhea
Exocrine Pancreatic Insufficiency
AIDS-Related Complex
T-Cell Lymphoma
Irritable Bowel Syndrome
Pancreatic Neoplasms
Abdomen
Abdominal Pain

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Etiology of nonresponsive celiac disease : Results of a systematic approach. / Abdulkarim, Ahmad S.; Burgart, Lawrence J.; See, Jacalyn; Murray, Joseph A.

In: American Journal of Gastroenterology, Vol. 97, No. 8, 08.2002, p. 2016-2021.

Research output: Contribution to journalArticle

Abdulkarim, Ahmad S. ; Burgart, Lawrence J. ; See, Jacalyn ; Murray, Joseph A. / Etiology of nonresponsive celiac disease : Results of a systematic approach. In: American Journal of Gastroenterology. 2002 ; Vol. 97, No. 8. pp. 2016-2021.
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abstract = "OBJECTIVES: Nonresponse or relapse of symptoms is common in patients with celiac disease treated with gluten free diet. Refractory sprue (RS) is defined as initial or subsequent failure of a strict gluten-free diet to restore normal intestinal architecture and function in patients who have celiac-like enteropathy. The aims of this study were: 1) to identify causes of persistent symptoms in patients referred with presumed diagnosis of nonresponsive celiac disease (NCD); and 2) to characterize patients with true RS. METHODS: Patients were identified who had been systematically evaluated for NCD between January 1997, and May 2001. Patient records and small bowel biopsy results were reviewed. RESULTS: A total of 55 patients were referred with a presumed diagnosis of NCD. Six did not have celiac disease and had other diseases responsible for their symptoms. Diarrhea, abdominal pain, and weight loss were the most common reasons for evaluation in cases of NCD, whereas weight loss, steatorrhea, and diarrhea were the most common presenting features of RS (nine patients). Of the 49 patients with celiac disease, 25 were identified as having gluten contamination. Additional diagnoses accounting for persistent symptoms included: pancreatic insufficiency, irritable bowel syndrome, bacterial overgrowth, lymphocytic colitis, collagenous colitis, ulcerative jejunitis, T-cell lymphoma, pancreatic cancer, fructose intolerance, protein losing enteropathy, cavitating lymphadenopathy syndrome, and tropical sprue. CONCLUSIONS: Based on this study, we conclude the following: 1) gluten contamination is the leading reason for NCD; 2) of NCD cases, 18{\%} are due to RS; and 3) alternative diseases or those coexistent with celiac disease and gluten contamination should be ruled out before a diagnosis of RS is made.",
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