Author(s): Leffler DA, Dennis M, Hyett B, Kelly E, Schuppan D,
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Abstract BACKGROUND & AIMS: Nonresponsive celiac disease (NRCD) is a common problem affecting from 7\% to 30\% of celiac patients. Because NRCD comprises varied and potentially morbid entities, efficient and cost-effective patient care requires knowledge of the specific causes of this disorder. The aim of this study was to determine the common etiologies of NRCD in a tertiary referral center. METHODS: All cases of biopsy examination-proven celiac disease (CD) seen at our institution over the preceding 5 years were included in this study. NRCD was defined as a failure to respond to at least 6 months of treatment with a gluten-free diet or the re-emergence of symptoms or laboratory abnormalities typical of CD while still on treatment with a gluten-free diet. RESULTS: A total of 113 patients with NRCD meeting the earlier-described criteria were seen from a total of 603 patients with CD (19\%), however, among patients for whom we provided primary specialist care the incidence of NRCD was 10\% (P < .001). Gluten exposure was the most common cause of NRCD (36\%), followed by irritable bowel syndrome (22\%), refractory CD (10\%), lactose intolerance (8\%), and microscopic colitis (6\%). The mean immunoglobulin A tissue transglutaminase level in the gluten-exposed group was 67 vs 17 U/mL (normal, <20) for other diagnoses (P < .05). Weight loss and male sex were highly predictive of refractory CD (P < .05 and < .001, respectively). CONCLUSIONS: NRCD is a common phenomenon affecting 10\%-19\% of celiac patients. A limited number of etiologies account for the majority of cases. Clinical factors may be used to guide evaluation.
This article was published in Clin Gastroenterol Hepatol
and referenced in Journal of Allergy & Therapy