No popular authors found.
Ads by Google:

Categories

No categories found.


Get Celiac.com's E-Newsletter





Ads by Google:


Follow / Share


  FOLLOW US:
Twitter Facebook Google Plus Pinterest RSS Podcast Email  Get Email Alerts
SHARE:

Popular Articles

No popular articles found.
Celiac.com Sponsors:

Refractory Celiac Disease

The following post is from Dr. Joseph Murray, one of the leading USA physicians in the diagnosis of celiac disease (CD) and dermatitis herpetiformis (DH). Dr. Murray (murray.joseph@mayo.edu) of the Mayo Clinic Rochester, MN, is a gastroenterologist who specializes in treating Celiac disease:

A recent poster asked about refractory celiac disease. This is a highly complex area and is the most challenging in dealing with celiac disease. While refractory celiac disease can be defined as a patient with celiac disease whose symptoms do not respond to a gluten-free diet there are several important questions and issues in coming to the determination that the patient is really suffering from true refractory disease. To make the diagnosis conclusively, first one must be satisfied that there is not another cause for the problem. Though rare, there are other conditions that can mimic, or coexist with celiac disease, and cause continued problems. The second issue is whether the patient is truly gluten-free, and have they been so long enough to conclude that there has been a failure with the diet? To make this determination I have the patient keep a complete and detailed dietary record for 3-4 weeks listing every single item they ate and have them save the wrapper or carton for review. If the dietitian or myself feel that there is any possibility of contamination then we exclude that item and wait longer. Sometimes the patient is exposed to a higher risk of gluten contamination by eating out a lot, where they do not have true control over the food preparation. We also check medications that the patient takes regularly. I also check the endomysial

Ads by Google:

molecular weight proteins which are produced by specialized B cells in the lymph nodes after stimulation by an antigen which act specifically against the antigen in an immune response. They typically consist of four sub-units that include two heavy and two light chains. Also known as immunoglobulin.'); return false">antibodies and gliadin antibodies. These should be negative if the patient has been gluten free for at least 6 months. The gliadin IgG may persist longer but usually its levels drop. If these are positive, this makes me think that they have had significant gluten in the diet in the recent past (Note: there still may be gluten in the diet if the test is negative). The original and follow-up biopsies should be compared to see if there has been any improvement. Assuming that these criteria are met, then one can proceed to consider the patient to have refractory disease. At that point it is important to check for complications such as lymphoma, lymphocyctic colitis and possibly pancreatic insufficiency. I treat the patient with a course of antibiotics and consider adding in pancreatic supplements to see if that will help the patients symptoms. It is only at this point that I consider some suppression of the immune system, such as with steroids or some other agent. Rarely will the patient be so ill that one must accelerate the decision to treat with steroids. Steroids are powerful medicines that can be very helpful, and even lifesaving in many cases, but have attendant risks that should be discussed prior to use. This is not medical advice and should not be used as such.

Celiac.com welcomes your comments below (registration is NOT required).












Related Articles



1 Response:

 
e
Rating: ratingfullratingfullratingfullratingfullratingfull Unrated
said this on
24 Nov 2007 11:31:10 AM PDT
Very clear explanation of the diagnostic process and treatment options.




Rate this article and leave a comment:
Rating: * Poor Excellent
Your Name *: Email (private) *:




In Celiac.com's Forum Now:


9 years ago I was over 200lbs, health started going down hill in college and dropped to under 125 3 years ago. Gaining weight again and now it is muscle. I found I had to add in KAL nutritional yeast to my meals at least 2-6tbsp a meal for the stuff I was not getting due to food intolerance ...

Once your tTg is in the normal range, and it's only 1 point away from that, that would be considered excellent results. tTg just has to be in the normal range to be called a success. The number you want to be as low as possible within the normal range is the DGP or AGA testing, as that tests fo...

I started a topic a couple of weeks ago about my type 1 daughter with a ttg iga result of greater than 100 being suspected of having celiac. She saw the GI and has her biopsy scheduled for this coming Tuesday. Seems like there is no doubt that it will show celiac but we will know soon. I have ...

Hi all, my TTG/iga came back. It was 4. 0-3 is considered negative and 4-10 is weak positive. In January it was 12 and before my endoscopy in October it was >100. it plummeted those first 2 months but seems to be taking more time to get lower. Should I feel optimistic? I guess 4 s...

Yes, i was 230 lbs upon diagnosis. My crp had been high for over 10 yrs. The first year i lost 70 lbs of water. Then i started to realize my continued irratic gi problems were more intollernces from processed foods as well as things like dairy and legumes. I went on an elimination diet and lost 2...