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Table of Contents
Vol. 25, No. 3, 2007
Issue release date: September 2007
Section title: Small Bowel
Dig Dis 2007;25:230–236

The Management of Complicated Celiac Disease

Al-toma A. · Verbeek W.H.M. · Mulder C.J.J.
Department of Gastroenterology, VU University Medical Center, Amsterdam, The Netherlands
email Corresponding Author

Prof. C.J.J. Mulder

University Medical Center, Department Gastroenterology

PO Box 7057, NL–1005 MB Amsterdam (The Netherlands)

Tel. +31 20 444 0613, Fax +31 20 444 0554

E-Mail cjmulder@vumc.nl

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Refractory celiac disease (RCD) is being defined as persisting or recurring villous atrophy with crypt hyperplasia and increased intraepithelial lymphocytes (IELs) in spite of a strict gluten-free diet (GFD) for >12 months or when severe persisting symptoms necessitate intervention independent of the duration of the GFD. RCD may not respond primarily or secondarily to GFD. All other causes of malabsorption must be excluded and additional features supporting the diagnosis of CD must be looked for, including the presence of antibodies in the untreated state and the presence of celiac-related HLA-DQ markers. In contrast to patients with a high percentage of aberrant T-cells, patients with RCD I seem to profit from an immunosuppressive treatment. RCD II is usually resistant to medical therapies. Response to corticosteroid treatment does not exclude underlying enteropathy-associated T-cell lymphoma. Cladribine seems to have a role, although it is less than optimal in the treatment of these patients. It may be considered, however, as the only treatment thus far studied that showed significant reduction of aberrant T cells, seems to be well tolerated, and may have beneficial long-term effects in a subgroup of patients showing significant reduction of the aberrant T-cell population. Autologous stem cell transplantation (ASCT) seems promising in those patients with persisting high percentages of aberrant T cells. The first group of patients treated with ASCT showed improvement in the small intestinal histology, together with an impressive clinical improvement. However, it remains to be proven if this therapy delays or prevents lymphoma development.

© 2007 S. Karger AG, Basel

Article / Publication Details

First-Page Preview
Abstract of Small Bowel

Published online: September 10, 2007
Issue release date: September 2007

Number of Print Pages: 7
Number of Figures: 0
Number of Tables: 0

ISSN: 0257-2753 (Print)
eISSN: 1421-9875 (Online)

For additional information: http://www.karger.com/DDI

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