SAVED
File name .JPG
File alt. text
Image should be px wide x px tall.
Select Image
home - Small Bowel - Coeliac Disease - Refractory Coeliac Disease Written by Dr Sebastian Zeki

Refractory Coeliac Disease

Written by Dr Sebastian Zeki Therapeutic Options for Refractory CD:Strict gluten-free diet.Elemental Diet- only anecdotal evidence for this.Total Parenteral Nutrition- can be useful.Steroids-This can be successful in patients who do not have the abnormal clonal IEL phenotype (described previously).Steroids usually 1 month of treatment then taper.Interferon-alpha- not useful.Azathioprine.-a variable outcome.Cyclosporine- one study shows it may be useful. Imaging Studies:CT. EndoscopyMay miss ulcerative jejunoileitis on routine OGD. Preferable to do OGD and colonoscopy at same sitting. Molecular StudiesIn patients with uncomplicated CD, IELs express CD3+, CD8+ (this is predominant), gamma/delta, and alpha/beta T-cell receptors (TCR).In RS there are abnormal CD3 chain(c) + CD8- IEL phenotype and TCR-gamma gene rearrange-ments.75% of patients with RS have an immunopheno-typically aberrant clonal intraepithelial T-cell population. Histology Colon. There is a strong association between RS and lymphocytic colitis, the T-cells of which dont show the normal CD8+ marker usually seen in this condition. Duodenum. Subcryptal chronic inflammation Marked mucosal thinning Subepithelial collagen deposition Jejunum.Ulcerative jejunoileitis only present in 30%- diagnosis with enteroscopy only Diagnosis And Management of Refractory Coeliac DiseaseBoth RS and EATL are characterized by the presence of a monoclonal T-cell population in the intestinal mucosa. In EATL, a similar monoclonal population that shows clonal identity with the lymphoma itself is also present in the enteropathic mucosa. Other patients have evident mucosal atrophy on endoscopy.

Related Stories

•Self-Related Cognitive Schemas, Negative Self-View, and Perceived Psychosocial Burden in Adults with Celiac Disease: A Cross-Sectional Comparative Study

•Shared Fryers May Not Always Be as Risky for Gluten Cross-Contact in Celiac Disease as Dietary Guidance Suggests

•Steatotic Liver Disease in Newly Diagnosed and Gluten-Free Diet-Treated Adults with Celiac Disease

•Immunomodulatory Effects of MSC-Derived ExtracellularVesicles in Celiac Disease

•Correction: Morcillo Serrano et al. Effect of a Gluten-Free Diet on the Intestinal Microbiota of Women with Celiac Disease. Antibiotics 2025, 14, 785