Celiac disease:Management of persistent symptoms in patients on a gluten-free diet

作     者：David H Dewar Suzanne C Donnelly Simon D McLaughlin Matthew W Johnson H Julia Ellis Paul J Ciclitira 

作者机构：King's College LondonDivision of Diabetes and Nutritional SciencesDepartment of GastroenterologyThe Rayne InstituteSt Thomas' HospitalLondon SE1 7EHUnited Kingdom 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2012年第18卷第12期

页      面：1348-1356页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Celiac disease Non-responsive celiac disea-se Refractory celiac disease Gluten Gluten-free diet 

摘      要：AIM:To investigate all patients referred to our center with non-responsive celiac disease (NRCD),to establish a cause for their continued ***:We assessed all patients referred to our center with non-responsive celiac disease over an 18-mo *** individuals were investigated to establish the eitiology of their continued *** patients were first seen in clinic where a thorough history and examination were performed with routine blood work including tissue transglutaminase antibody *** were also referred to a specialist gastroenterology dietician to try to identift any lapses in the diet and sources of hidden gluten ingestion.A repeat small intestinal biopsy was also performed and compared to biopsies from the referring hospital where ***,lactulose hydrogen breath testing,pancreolauryl testing and computed tomography scan of the abdomen were undertaken if the symptoms *** clinical progress was followed over a minimum of 2 ***:One hundred and twelve consecutive patients were referred with *** were found not to have celiac disease (CD).Of the remaining 100 patients,45% were not adequately adhering to a strict gluten-free diet,with 24 (53%) found to be inadvertently ingesting gluten,and 21 (47%) admitting *** colitis was diagnosed in 12% and small bowel bacterial overgrowth in 9%.Refractory CD was diagnosed in 9%.Three of these were diagnosed with intestinal *** 2 years,78 patients remained well,eight had continuing symptoms,and four had ***:In individuals with NRCD,a remediable cause can be found in 90%:with continued gluten ingestion as the leading *** propose an algorithm for investigation.