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Improving outcomes of refractory celiac disease – current and emerging treatment strategies

Authors Woodward J

Received 4 March 2016

Accepted for publication 24 May 2016

Published 3 August 2016 Volume 2016:9 Pages 225—236

DOI https://doi.org/10.2147/CEG.S87200

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 4

Editor who approved publication: Professor Andreas M Kaiser


Jeremy Woodward

Department of Gastroenterology and Clinical Nutrition, Addenbrooke’s Hospital, Cambridge, UK

Abstract: Intestinal inflammation and symptoms of celiac disease (CD) usually respond well to gluten withdrawal, but rare cases are refractory to diet. Two types of refractory CD are discriminated on the basis of the presence or absence of an atypical population of mucosal lymphocytes that may progress to enteropathy-associated T-cell lymphoma. Challenges remain in the secure diagnosis of both types of refractory disease, and evidence on which to base treatment recommendations is flawed by the small numbers of reported patients and the use of different diagnostic strategies. Recent advances in our understanding of the mechanisms of the condition in conjunction with the development of immunomodulatory agents for managing other inflammatory diseases are helping to shape future approaches to targeted therapy. Progression will depend on collaboration and recruitment to trials. In the meantime, there is evidence to suggest that earlier diagnosis and better follow-up and management of CD may prevent the development of refractoriness.

Keywords: celiac disease, gluten, small intestine, lymphoma, lymphocytes

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