title: Refractory coeliac disease a reality: views from Pakistan.
abstract: Refractory coeliac disease (RCD) is described as persistence or recurrence of signs and symptoms of malabsorption with small-intestinal villous atrophy despite being on a strict gluten-free diet (GFD) for more than 12 months. RCD is a diagnosis of exclusion. There are two types of RCD, based upon the immunohistochemical features (presence of intraepithelial lymphocytes), response to treatment and prognosis. The treatment of RCD includes GFD and immunosuppressive agents. We hereby present a case of refractory celiac disease type II in a young man who later went on to develop Addisonian crisis and did not survive.
authors.affiliation: Postgraduate Trainee, Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
authors.forename: Rajesh M
authors.initials: RM
authors.lastname: Mandhwani
authors.affiliation: Lecturer, Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
authors.forename: Rajesh K
authors.initials: RK
authors.lastname: Wadhwa
authors.affiliation: Lecturer, Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
authors.forename: Syed Mudassir
authors.initials: SM
authors.lastname: Laeeq
authors.affiliation: Professor, Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
authors.forename: Nasir Hasan
authors.initials: NH
authors.lastname: Luck
authors.affiliation: Professor, Department of Histopathology, Sindh Institute of Urology & Transplantation, Karachi, Pakistan.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Mubarak
authors.affiliation: Postgraduate Trainee, Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan Zain88@Hotmail.com.
authors.forename: Zain
authors.initials: Z
authors.lastname: Majid
mesh_terms: D000224:Addison Disease / Q000209:etiology; D002446:Celiac Disease / Q000150:complications / Q000178:diet therapy* / Q000188:drug therapy; D003967:Diarrhea / Q000209:etiology; D055050:Diet, Gluten-Free; D004386:Duodenum / Q000473:pathology; D017809:Fatal Outcome; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D010154:Pakistan; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents
keywords: Pakistan; Refractory coeliac disease; gluten-free diet; malabsorption