Recognising and Managing Refractory Coeliac Disease: A Tertiary Centre Experience
AbstractRefractory 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
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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.
Nasr I, Nasr I, Beyers C, Chang F, Donnelly S, Ciclitira PJ. Recognising and Managing Refractory Coeliac Disease: A Tertiary Centre Experience. Nutrients. 2015; 7(12):9896-9907.Chicago/Turabian Style
Nasr, Ikram; Nasr, Iman; Beyers, Carl; Chang, Fuju; Donnelly, Suzanne; Ciclitira, Paul J. 2015. "Recognising and Managing Refractory Coeliac Disease: A Tertiary Centre Experience." Nutrients 7, no. 12: 9896-9907.