Treatment failure in coeliac disease: a practical guide to investigation and treatment of non-responsive and refractory coeliac disease

J Gastrointestin Liver Dis. 2012 Jun;21(2):197-203.


Coeliac disease is a common condition affecting up to 1% of the European adult population. Whilst the majority of patients will respond to a gluten free diet with resolution of symptoms and an improvement in histology, a significant minority have persistent problems. Refractory coeliac disease is a relatively uncommon cause of non-response to gluten free diet with potentially serious consequences of severe malabsorption and a high rate of progression to lymphoma. This review provides a practical guide to the investigation of patients who do not respond to a gluten free diet. We will highlight the differences between the more common non-responsive coeliac disease and the rare entity of refractory coeliac disease and discuss current management and treatment options for both non-responsive coeliac disease and refractory coeliac disease.

Publication types

  • Review

MeSH terms

  • Algorithms
  • Celiac Disease / diagnosis
  • Celiac Disease / diet therapy*
  • Diet, Gluten-Free*
  • Humans
  • Patient Compliance
  • Treatment Failure