Refractory celiac disease

Verbeek WHM, Mulder CJJ, Zweegman S, Vivas S, et al. 2006. Alemtuzumab for refractory celiac disease. NEJM. 355 1396-1397. 

Vivas S, Morales JM, Ramos F, Suarez-Vilela D. 2006. Alemtuzumab for refractory celiac disease in a patient at risk for enteropathy-associated T-cell lymphoma. NEJM. 354 23-24. 

REFRACTORY CELIAC DISEASE Recently, immunohistochemistry has been shown to have utility in the evaluation of patients with refractory celiac disease. These patients continue to suffer from symptoms despite adherence to a gluten-free diet and are more likely to develop further complications such as ulcerative jejunoileitis and enteropathy-associated T-cell lymphoma. The group of patients with refractory sprue and loss of CDS expression in more than 50% of the CD3-positive intraepithelial lymphocytes are more likely to develop enteropathy-associated T-cell lymphoma. These patients with an abnormal T-cell phenotype are more likely to receive more aggressive immunosuppressive therapy. 

Hershko C, Hoffbrand AV, Keret D, Souroujon M, Maschler I, Monsehse Y, Lahad A. Role of autoim-mime gastritis, Helicobacter pylori and celiac disease in refractory and unexplained iron deficiency anemia. Haematologica 2005 90 585-95. 

Gray, G. (1997). Persistence of diarrhea in treated celiac sprue Refractory disease of another organ s malfunction Gastroenterology 112,2146-2147. 

FarreU RJ, Kelly CP. Celiac sprue and refractory sprue. In Feldman M, Friedman LS, Sleisenger MH, eds. Sleisenger and Fordtran s gastrointestinal and liver disease, 7th ed. Philadelphia WB Saunders, 2002 1817-41. 

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