title: Coeliac disease not responding to a gluten-free diet in children: case studies and literature review.
abstract: We presented the cases of three children with coeliac disease who despite good adherence to a glutenfree diet remained non-responsive to treatment. Two patients, one of them with IgA deficiency, were successfully treated by complete gluten exclusion with enteral nutrition. However the third child with a severe coeliac disease did not achieve clinical and histologic improvement, even on immunosuppressive treatment. If no hidden sources of gluten can be identified, other causes of persistent villous atrophy, dierent from coeliac disease, have to be considered. They include e.g. inflammatory, immune and endocrine diseases of the digestive tract. In severe cases of childhood coeliac disease not responding to a gluten free diet, autoimmune enteropathy and refractory coeliac disease must be taken into account.
authors.affiliation: Department of Gastroenterology, Hepatology and Eating Disorders, The Children's Memorial Health Institute, Warsaw, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Janczyk
authors.affiliation: Department of Pediatrics Leiden University Medical Center, The Netherlands.
authors.forename: J H C
authors.initials: JH
authors.lastname: de Roo
authors.affiliation: Department of Pediatrics Leiden University Medical Center, The Netherlands.
authors.forename: Joachim
authors.initials: J
authors.lastname: Schweizer
authors.affiliation: Department of Gastroenterology, Hepatology and Eating Disorders, The Children's Memorial Health Institute, Warsaw, Poland.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Socha
authors.affiliation: Department of Gastroenterology, Hepatology and Eating Disorders, The Children's Memorial Health Institute, Warsaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Socha
authors.affiliation: Department of Pediatrics Leiden University Medical Center, The Netherlands.
authors.forename: M Luisa
authors.initials: ML
authors.lastname: Mearin
mesh_terms: D002446:Celiac Disease / Q000178:diet therapy*; D002648:Child; D055050:Diet, Gluten-Free; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D017211:Treatment Failure