Nonresponsive celiac disease is a common problem affecting from 7% to 30% of celiac patients.
Nonresponsive celiac disease comprises varied and potentially morbid entities.
Efficient and cost-effective patient care requires knowledge of the specific causes of this disorder.
Dr Daniel Leffler and colleagues from Massachusetts determined the common etiologies of nonresponsive celiac disease in a tertiary referral center.
|Gluten exposure caused nonresponsive celiac disease in 36%|
|Clinical Gastroenterology & Hepatology|
The team evaluated 603 cases of biopsy examination-proven celiac disease seen at their institution over the preceding 5 years.
Nonresponsive celiac disease was defined as a failure to respond to at least 6 months of treatment with a gluten-free diet.
The team also included in their definition the re-emergence of symptoms or laboratory abnormalities while still on treatment with a gluten-free diet.
The researchers found that 19% of patients had nonresponsive celiac disease meeting the earlier-described criteria.
However, among patients for whom the team provided primary specialist care the incidence of nonresponsive celiac disease was 10%.
The team found gluten exposure was the most common cause of nonresponsive celiac disease, occurring in 36%.
The research team observed that irritable bowel syndrome occurred in 22% of patients, and refractory celiac disease in 10%.
Lactose intolerance was found in 8% of patients, and microscopic colitis in 6%.
The mean immunoglobulin a tissue transglutaminase level in the gluten-exposed group was 67 U/mL vs 17 U/mL for other diagnoses.
The researchers noted that weight loss and male sex were highly predictive of refractory celiac disease.
Dr Leffler's team concluded, “Nonresponsive celiac disease is a common phenomenon affecting 10% to 19% of celiac patients.”
“A limited number of etiologies account for the majority of cases.”
“Clinical factors may be used to guide evaluation.”