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Refractory celiac disease in a country with a high prevalence of clinically-diagnosed celiac disease

This month's issue of the Alimentary Pharmacology & Therapeutics investigates refractory celiac disease in a country with a high prevalence of clinically-diagnosed celiac disease.

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Refractory celiac disease is thought to be a rare disorder, but the accurate prevalence is unknown.

Dr Collin and colleagues from Finland identified the prevalence of and the risk factors for developing refractory celiac disease in a Finnish population where the clinical detection rate of celiac disease is high.

The study involved 11 hospital districts in Finland where the number of treated refractory celiac disease patients, clinically diagnosed celiac disease patients and adult inhabitants was known.

Clinical characteristics at diagnosis of celiac disease between the refractory celiac disease patients and patients with uncomplicated disease were compared.

At diagnosis of celiac disease, 54% had diarrhea
Alimentary Pharmacology & Therapeutics

The research team found that the prevalence of refractory celiac disease was 0.31% among diagnosed celiac disease patients, and 0.002% in the general population.

Of the enrolled 44 refractory celiac disease patients, 68% had type I, and 23% type II.

The research team found that in 9% the type was undetermined.

Comparing 886 patients with uncomplicated celiac disease with these 44 patients that developed refractory celiac disease later in life, the latter were significantly older, more often males and seronegative at the diagnosis of celiac disease.

The researchers found that patients with evolving refractory celiac disease had more severe symptoms at the diagnosis of celiac disease, including weight loss in 36%, and diarrhea in 54%.

Dr Collin's team comments, "Refractory celiac disease is very rare in the general population."

"Patients of male gender, older age, severe symptoms or seronegativity at the diagnosis of celiac disease are at risk of future refractory celiac disease and should be followed up carefully."

Aliment Pharmacol Ther 2014: 39(4): 418–425
06 February 2014

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