title: Cross-sectional imaging in refractory celiac disease.
abstract: The purpose of this study is to identify unique imaging findings of refractory celiac disease (RCD) including Type I RCD, Type II RCD versus healed celiac disease (CD).
  
  
  
  A retrospective study of patients with known CD and refractory symptoms with cross-sectional imaging was performed. We included patients who underwent T cell receptor rearrangement or T-cell immunophenotyping studies on small bowel (SB) biopsies to classify patients into: healed CD, Type I RCD, or Type II RCD. GI radiologists performed a blinded review of the imaging studies.
  
  
  
  One-hundred eighteen patients (32 healed; 67 Type I RCD; 19 Type II RCD) were included (mean age 53 ± 6 years; 62% female). The presence of any fold pattern abnormality was more likely to be found in Type II and Type I RCD than healed CD (53% vs. 43% vs.16%; p = 0.009). Type II RCD patients were more likely than Type I RCD and healed CD to have imaging findings of ulcerative jejunitis (26% vs. 6% vs. 3%; p = 0.009), SB wall thickening (37% vs. 16% vs. 0%; p = 0.002) and SB dilation (26% vs. 7% vs. 6%; p = 0.04). Type II RCD demonstrated non-significant trends for decreased number of jejunal folds only, SB mass, mesenteric lymphadenopathy, localized peri-mural edema, and intramural duodenal edema.
  
  
  
  Fold pattern abnormalities, ulcerative jejunitis, SB wall thickening, and SB dilation are more likely to be identified in cross-sectional imaging of RCD than healed CD. SB dilatation and ulcerative jejunitis are more likely to be found in Type II than Type I RCD.
authors.affiliation: Department of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street, S.W., Rochester, MN, 55905, USA. albawardy.badr@mayo.edu.
authors.forename: Badr
authors.initials: B
authors.lastname: Al-Bawardy
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Barlow
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Rogerio N
authors.initials: RN
authors.lastname: Vasconcelos
authors.affiliation: Mayo Medical School, Mayo Clinic, Rochester, MN, USA.
authors.forename: Sarasa T
authors.initials: ST
authors.lastname: Kim
authors.affiliation: Department of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street, S.W., Rochester, MN, 55905, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Bruining
authors.affiliation: Department of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street, S.W., Rochester, MN, 55905, USA.
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Hansel
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Shannon P
authors.initials: SP
authors.lastname: Sheedy
authors.affiliation: Department of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street, S.W., Rochester, MN, 55905, USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Murray
authors.affiliation: Department of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street, S.W., Rochester, MN, 55905, USA.
authors.forename: Alberto
authors.initials: A
authors.lastname: Rubio-Tapia
authors.affiliation: Department of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street, S.W., Rochester, MN, 55905, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Rajan
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Jeff L
authors.initials: JL
authors.lastname: Fidler
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Joel G
authors.initials: JG
authors.lastname: Fletcher
mesh_terms: D001706:Biopsy; D002446:Celiac Disease / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D016130:Immunophenotyping; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: CT enterography; Celiac disease; Enteropathy; Ulcerative jejunitis