Treatment failure in coeliac disease: a practical guide to investigation and treatment of non-responsive and refractory coeliac disease.
Coeliac disease is a common condition affecting up to 1% of the European adult population. Whilst the majority of patients will respond to a gluten free diet with resolution of symptoms and an improvement in histology, a significant minority have persistent problems. Refractory coeliac disease is a relatively uncommon cause of non-response to gluten free diet with potentially serious consequences of severe malabsorption and a high rate of progression to lymphoma. This review provides a practical guide to the investigation of patients who do not respond to a gluten free diet. We will highlight the differences between the more common non-responsive coeliac disease and the rare entity of refractory coeliac disease and discuss current management and treatment options for both non-responsive coeliac disease and refractory coeliac disease.
Department of Gastroenterology, Royal Bolton Hospital, Bolton, UK. p_d_mooney@hotmail.com
Peter D
PD
Mooney
Kate E
KE
Evans
Salil
S
Singh
David S
DS
Sanders
D000465:Algorithms; D002446:Celiac Disease / Q000175:diagnosis / Q000178:diet therapy*; D055050:Diet, Gluten-Free; D006801:Humans; D010349:Patient Compliance; D017211:Treatment Failure