Diagnosis and management of refractory celiac disease: a systematic review

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Published Sep 20, 2013
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Vol. 91 No. 9 (2013): Issue Sep 2013

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Asma Labidi
Meriem Serghini
Sami Karoui
Jalel Boubaker
Azza Filali

Abstract

Background: Refractory celiac disease is defined by persisting malabsorptive symptoms in spite of a strict gluten free diet for at least 6 to 12 months. Alternatives to gluten free diet seem to be still controversial.
aim: To describe the clinical and epidemiologic aspects of refractory celiac disease, and to identify therapeutic options in this condition.
methods: Systematic review and critical analysis of observational studies, clinical trials and case reports that focused on diagnosis and management of refractory celiac disease.
results: Refractory celiac disease can be classified as type 1 or type 2 according to the phenotype of intraepithelial lymphocytes. Great complications such as enteropathy-associated T-cell lymphoma may occur in a subgroup of these patients mainly in refractory celiac disease type 2. Curative therapies are still lacking.
Conclusion: Refractory celiac disease remains a diagnosis of exclusion. Its prognosis remains still dismal by the absence yet of curative therapies. However, some new treatments seem to hold promise during few cohort-studies.

Keywords:

Celiac disease; refractory celiac disease

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