1. Celiac Disease Slideshow
2. Gluten-Free Diet Slideshow Pictures
3. Take the Celiac Disease Quiz

Medical Author:

Jay W. Marks, MD

Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

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Medical Editor:

Bhupinder Anand, MD

In this Article

• Celiac disease facts
• What is celiac disease?
• What causes celiac disease?
• What are the signs and symptoms of celiac disease?
• How do symptoms of celiac disease differ with age of onset?
• What is latent and silent celiac disease?
• What diseases are associated with celiac disease?
• How is celiac disease diagnosed?
• What is the treatment of celiac disease?
• What if individuals don't respond to gluten free diet?
• What is refractory celiac disease?
• What is the treatment of refractory celiac disease?
• What are the complications of celiac disease?
• Can cancer risk be reduced in celiac disease?
• What's new in celiac disease?
• Celiac Disease (Celiac Sprue) FAQs
• Patient Comments: Celiac Disease - Diagnosis
• Patient Comments: Celiac Disease - Symptoms
• Find a local Gastroenterologist in your town
• Celiac Disease Index

Failure to respond to a gluten free diet can be due to several reasons:

1. The person is not following a strict gluten free diet and is still eating small amounts of gluten.
   
   
2. The person is unknowingly ingesting unsuspected sources of gluten such as starch, binders and fillers in medications or vitamins.
   
   
3. The person may have another co-existing condition such as irritable bowel syndrome, bacterial overgrowth of the small bowel, microscopic colitis, or pancreatic insufficiency that is causing the symptoms.
   
   
4. The person may have refractory disease, or complications of celiac disease.

Refractory celiac disease is a rare condition in which the symptoms of celiac disease (and the loss of villi) do not improve despite many months of a strict gluten free diet. Before making a diagnosis of refractory celiac disease it is important to exclude complications of celiac disease and other co-existing conditions that can produce similar symptoms and biopsy findings.

Refractory celiac disease is believed to consist of two different entities, one which is relatively benign and one which becomes malignant or cancerous. Special examination of intestinal tissue from patients with refractory celiac disease can differentiate between the two entities.

The treatment of refractory celiac disease is first to make sure that all gluten is eliminated from the diet. If there still is no improvement, medications are used.

• Corticosteroids such as prednisone have been used successfully in treating some patients with refractory celiac disease.
  
  
• Immuno-suppressive drugs (medications that suppress a person's immune system) such as azathioprine (Imuran, Azasan) and cyclosporine also have been used.
  
  
• Corticosteroids and immunosuppressive drugs are potent medications with potentially serious side effects. Many patients with refractory celiac disease are malnourished and have weakened immune systems, and corticosteroids and immunosuppressive agents can further increase their risk of serious infections. Thus doctors experienced with treating celiac disease should monitor treatment of refractory celiac disease.

Unfortunately in some patients with refractory celiac disease, malabsorption and malnutrition progress despite drugs. In these patients the intravenous route is the only way to deliver nutrition. Total parenteral nutrition (TPN) is a way of delivering calories, carbohydrates, amino acids, and fat in liquid solutions via a catheter that has been inserted and secured into a vein.