Recognising and Managing Refractory Coeliac Disease: A Tertiary Centre Experience

Area of Science:

• Gastroenterology
• Immunology
• Oncology

Background:

• Refractory coeliac disease (RCD) is a rare complication of coeliac disease (CD), characterized by malabsorption and villous atrophy despite a strict gluten-free diet (GFD).
• RCD is classified into type 1 (normal intra-epithelial lymphocytes) and type 2 (aberrant, clonal intra-epithelial lymphocytes).
• RCD type 2 carries significant risks, including ulcerative jejunitis and enteropathy-associated lymphoma (EATL), with a 5-year mortality of 50% for EATL.

Purpose of the Study:

• To evaluate the effectiveness of prednisolone and azathioprine treatment for refractory coeliac disease type 2 (RCD2).
• To assess the response rates and histological recovery in RCD2 patients treated at a tertiary center.

Main Methods:

• Retrospective analysis of RCD2 patients treated with prednisolone and azathioprine.
• Assessment of treatment response based on clinical symptoms, histological recovery, and complications.

Main Results:

• Prednisolone and azathioprine treatment resulted in good response and histological recovery in 56.6% of treated individuals.
• The study highlights the efficacy of this treatment regimen in managing RCD2.

Conclusions:

• Prednisolone and azathioprine represent a viable treatment option for refractory coeliac disease type 2.
• Further research is warranted to optimize management strategies for RCD2 and its associated complications.