Refractory coeliac disease: About five cases

Refractory coeliac disease (RCD) is defined by persistent or recurrent malabsorptive symptoms and villous atrophy despite strict adherence to a gluten-free diet (GFD) for at least 6–12 months in the absence of other causes of non-responsive treated coeliac disease and overt malignancy. Symptoms are often severe and require additional therapeutic intervention besides a GFD. RCD can be classified as type 1 which usually improves after treatment with a combination of aggressive nutritional support, adherence to a GFD, and alternative pharmacological therapies. By contrast, clinical response to alternative therapies in RCD type 2 is less certain and the prognosis is poor. Severe complications such as ulcerative jejunitis and enteropathy-associated T cell lymphoma may occur in a subgroup of patients with RCD. The aim of this article is to describe the profile of patients with RCD, their management, and their evolution in a series of 284 patients with celiac disease. *Correspondence to: Ghita Bennani, Department of Diseases of the Digestive System, Medicine C, CHU IBN SINA-Souissi Med University, V-Rabat, Morocco, Tel: +212 5376-76464; E-mail: ghita_med5@yahoo.fr