Next Article in Journal
Greater Calcium Intake is Associated with Better Bone Health Measured by Quantitative Ultrasound of the Phalanges in Pediatric Patients Treated with Anticonvulsant Drugs
Next Article in Special Issue
Gliadin-Specific T-Cells Mobilized in the Peripheral Blood of Coeliac Patients by Short Oral Gluten Challenge: Clinical Applications
Previous Article in Journal
Dietary Nitrates, Nitrites, and Nitrosamines Intake and the Risk of Gastric Cancer: A Meta-Analysis
Previous Article in Special Issue
Increased Intraepithelial Vα24 Invariant NKT Cells in the Celiac Duodenum
Article Menu

Export Article

Open AccessArticle
Nutrients 2015, 7(12), 9896-9907; doi:10.3390/nu7125506

Recognising and Managing Refractory Coeliac Disease: A Tertiary Centre Experience

1
Gastroenterology Department, Guys and St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, UK
2
Allergy and Immunology Department, Pathology and Pharmacy Building, Royal London Hospital, 80 Newark Street, London E1 2ES, UK
3
Department of Pathology, Guys and St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, UK
These authors contributed equally to this work.
*
Author to whom correspondence should be addressed.
Received: 22 October 2015 / Revised: 10 November 2015 / Accepted: 16 November 2015 / Published: 1 December 2015
(This article belongs to the Special Issue Gluten Related Disorders: People Shall not Live on Bread Alone)
View Full-Text   |   Download PDF [1173 KB, uploaded 1 December 2015]   |  

Abstract

Refractory coeliac disease (RCD) is a rare complication of coeliac disease (CD) and involves malabsorption and villous atrophy despite adherence to a strict gluten-free diet (GFD) for at least 12 months in the absence of another cause. RCD is classified based on the T-cells in the intra-epithelial lymphocyte (IEL) morphology into type 1 with normal IEL and type 2 with aberrant IEL (clonal) by PCR (polymerase chain reaction) for T cell receptors (TCR) at the β/γ loci. RCD type 1 is managed with strict nutritional and pharmacological management. RCD type 2 can be complicated by ulcerative jejunitis or enteropathy associated lymphoma (EATL), the latter having a five-year mortality of 50%. Management options for RCD type 2 and response to treatment differs across centres and there have been debates over the best treatment option. Treatment options that have been used include azathioprine and steroids, methotrexate, cyclosporine, campath (an anti CD-52 monoclonal antibody), and cladribine or fluadribine with or without autologous stem cell transplantation. We present a tertiary centre’s experience in the treatment of RCD type 2 where treatment with prednisolone and azathioprine was used, and our results show good response with histological recovery in 56.6% of treated individuals. View Full-Text
Keywords: non-responsive coeliac disease (NRCD); refractory coeliac disease (RCD); gluten free diet (GFD); enteropathy associated T-cell lymphoma (EATL); ulcerative jejunitis; villous atrophy; T-cell receptor (TCR); clonality; polymerase chain reaction (PCR); intra-epithelial cell lymphocytes (IEL) non-responsive coeliac disease (NRCD); refractory coeliac disease (RCD); gluten free diet (GFD); enteropathy associated T-cell lymphoma (EATL); ulcerative jejunitis; villous atrophy; T-cell receptor (TCR); clonality; polymerase chain reaction (PCR); intra-epithelial cell lymphocytes (IEL)
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

Scifeed alert for new publications

Never miss any articles matching your research from any publisher
  • Get alerts for new papers matching your research
  • Find out the new papers from selected authors
  • Updated daily for 49'000+ journals and 6000+ publishers
  • Define your Scifeed now

SciFeed Share & Cite This Article

MDPI and ACS Style

Nasr, I.; Nasr, I.; Beyers, C.; Chang, F.; Donnelly, S.; Ciclitira, P.J. Recognising and Managing Refractory Coeliac Disease: A Tertiary Centre Experience. Nutrients 2015, 7, 9896-9907.

Show more citation formats Show less citations formats

Related Articles

Article Metrics

Article Access Statistics

1

Comments

[Return to top]
Nutrients EISSN 2072-6643 Published by MDPI AG, Basel, Switzerland RSS E-Mail Table of Contents Alert
Back to Top