Refractory coeliac disease

Curr Opin Oncol. 2013 Sep;25(5):445-51. doi: 10.1097/01.cco.0000432526.47228.b6.


Purpose of review: Concept of refractory coeliac disease (RCD) emerged in the past decade and refers to persistence of malnutrition and intestinal villous atrophy for more than 1 year strict gluten-free diet in coeliac patients. Diagnosis of this condition remains difficult and conditions treatment and follow-up.

Recent findings: RCD has been subdivided into two subgroups according to the normal [type I RCD (RCDI)] or abnormal phenotype of intraepithelial lymphocytes [type II RCD (RCDII)]. RCDII is considered as a low-grade intraepithelial lymphoma and has a very poor prognosis, leading to intractable ulcerative jejunitis, gastrointestinal and extra-intestinal dissemination of the abnormal intraepithelial lymphocytes, and to their frequent transformation into a high-grade invasive lymphoma.

Summary: Herein, we review here the distinctive diagnostic features of RCDI and RCDII, the risk of developing overt lymphoma and different therapeutic approaches.

Publication types

  • Review

MeSH terms

  • Celiac Disease / classification
  • Celiac Disease / diagnosis*
  • Celiac Disease / pathology
  • Celiac Disease / therapy
  • Diet, Gluten-Free / adverse effects
  • Humans
  • Lymphoma / diagnosis
  • Lymphoma / etiology
  • Lymphoma / therapy
  • Stomach Neoplasms / diagnosis
  • Stomach Neoplasms / etiology
  • Stomach Neoplasms / therapy