title: Recent advances in refractory coeliac disease: a review.
abstract: Coeliac disease (CD) is an immune-mediated disease of the small intestine caused by intolerance to gluten. Removal of gluten from the diet results in a return to normal health for the majority of patients. A significant proportion of patients do not respond to a gluten-free diet and are considered to be suffering from refractory coeliac disease (RCD). Two types of RCD are now recognized: type 1 RCD is characterized by a polyclonal population of intraepithelial lymphocytes (IELs) with a normal immunophenotype, and type 2 RCD shows monoclonal IELs with an aberrant immunoprofile. Patients with RCD have a high risk of complications such as ulcerative jejunitis (UJ) and enteropathy-type T-cell lymphoma (ETTL). RCD2 may represent an early stage in the development of overt lymphoma. The diagnosis of RCD, therefore, has important implications, but remains a challenging area. In this paper we review the latest developments in RCD, including the diagnostic approach and a discussion of the key clinical, histological, immunohistochemical and molecular features of RCD and its complications.
authors.affiliation: Department of Histopathology, Guy's and St Thomas' NHS Foundation Trust, London, UK. colanhoyen@doctors.org.uk
authors.forename: C
authors.initials: C
authors.lastname: Ho-Yen
authors.forename: F
authors.initials: F
authors.lastname: Chang
authors.forename: J
authors.initials: J
authors.lastname: van der Walt
authors.forename: T
authors.initials: T
authors.lastname: Mitchell
authors.forename: P
authors.initials: P
authors.lastname: Ciclitira
mesh_terms: D002446:Celiac Disease / Q000150:complications / Q000175:diagnosis* / Q000276:immunology / Q000628:therapy; D055050:Diet, Gluten-Free; D004751:Enteritis / Q000209:etiology; D005770:Gastrointestinal Neoplasms / Q000209:etiology; D006801:Humans; D007579:Jejunal Diseases / Q000209:etiology; D008228:Lymphoma, Non-Hodgkin / Q000209:etiology; D016399:Lymphoma, T-Cell / Q000209:etiology