Diagnosis and management of refractory celiac disease: a systematic review.
Study Goal
To describe the clinical and epidemiologic aspects of refractory celiac disease and identify therapeutic options beyond a gluten-free diet.
Results Summary
Refractory celiac disease persists despite a strict gluten-free diet, with type 2 posing higher risks of complications like lymphoma. No curative therapies exist, but some new treatments show promise in limited studies.
Population
Patients with refractory celiac disease (persisting symptoms despite 6-12 months of gluten-free diet).
Effective Dosage
Not specified
Duration
At least 6-12 months of gluten-free diet prior to refractory diagnosis
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
gluten free diet | no change | malabsorptive symptoms | patients with refractory celiac disease | - | persisting malabsorptive symptoms in spite of | #1 |
Alternatives to gluten free diet | no change | therapeutic efficacy | patients with refractory celiac disease | - | seem to be still controversial | #2 |
Curative therapies | no change | disease cure | patients with refractory celiac disease | - | are still lacking | #3 |
some new treatments | increase | therapeutic efficacy | patients with refractory celiac disease | - | seem to hold promise | #4 |
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.