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Related Concept Videos

Inflammatory Bowel Disease II: Crohn's Disease01:30

Inflammatory Bowel Disease II: Crohn's Disease

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Introduction
Inflammatory bowel disease, commonly known as IBD, refers to a collection of disorders that lead to persistent inflammation of the gastrointestinal tract. The two types of IBD are ulcerative colitis, which impacts the colon, and Crohn's disease, which can involve any part of the gastrointestinal segment.
Crohn's disease
Crohn's disease is a chronic, systemic inflammatory bowel disease (IBD) that predominantly affects the gastrointestinal tract. It is marked by...
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The gastrointestinal tract is susceptible to various disorders. If the lower esophageal sphincter is damaged, stomach acid can flow back into the esophagus, causing irritation and inflammation of the lining. This condition is called gastroesophageal reflux disease (known as heartburn) and may cause chest pain and difficulty swallowing. In the stomach, prolonged use of nonsteroidal anti-inflammatory drugs like aspirin, chronic alcohol consumption, bacterial infections such as Helicobacter...
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Various diagnostic tests are employed in the diagnostic process for Inflammatory Bowel Disease (IBD), particularly to differentiate between Crohn's disease and ulcerative colitis.
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...
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Chronic Bowel Disorders: Introduction01:17

Chronic Bowel Disorders: Introduction

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Chronic bowel diseases are a group of long-term conditions affecting the digestive tract, characterized by inflammation and damage to the gut lining. These conditions primarily include irritable bowel syndrome and inflammatory bowel disease.
Irritable Bowel Syndrome (IBS) is a common disorder affecting the gastrointestinal tract. The distinctive feature is recurrent abdominal pain associated with altered bowel movements, manifesting as constipation, diarrhea, or fluctuating between both. The...
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Chronic Pancreatitis I: Introduction01:24

Chronic Pancreatitis I: Introduction

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The pancreas, an elongated and flat gland situated behind the stomach, serves a vital function in digesting food and managing blood sugar levels.
Pancreatitis is the inflammation of the pancreas, which occurs when the immune system becomes active and causes swelling, pain, and disruptions in organ function. Pancreatitis can manifest as either an acute or chronic condition.
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Chronic Pancreatitis II: Collaborative Care01:29

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The management of chronic pancreatitis is multifaceted, involving a comprehensive approach that includes thorough assessment, diagnostic testing, and a variety of management strategies.
Assessment:
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Related Experiment Video

Updated: Feb 22, 2026

Recognition of Epidermal Transglutaminase by IgA and Tissue Transglutaminase 2 Antibodies in a Rare Case of Rhesus Dermatitis
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Refractory coeliac disease: or is it?

Chidi Amadi1, Simon Anderson1

  • 1Department of Gastroenterology, St Thomas Hospital, London, UK.

BMJ Case Reports
|September 21, 2017
PubMed
Summary

A man with refractory celiac disease experienced persistent symptoms despite a gluten-free diet. Superior mesenteric artery syndrome was diagnosed and surgically treated, leading to symptom resolution.

Area of Science:

  • Gastroenterology
  • Internal Medicine
  • Clinical Case Study

Background:

  • Coeliac disease (CD) diagnosis can be challenging, with refractory CD (RCD) presenting diagnostic and therapeutic difficulties.
  • This case highlights the importance of considering alternative diagnoses when symptoms persist despite adherence to a gluten-free diet.

Observation:

  • A 33-year-old male with initially diagnosed coeliac disease showed persistent nausea, anorexia, and weight loss despite strict gluten-free diet adherence.
  • Repeat duodenal biopsies revealed partial villous flattening and intraepithelial lymphocytosis, consistent with Type 1 refractory coeliac disease.
  • Further investigation revealed a duodenal stricture and dilatation, indicative of superior mesenteric artery syndrome.

Findings:

  • Type 1 refractory coeliac disease was diagnosed, initially treated with immunosuppressants (prednisolone, azathioprine) without symptom improvement.
Keywords:
coeliac diseasegastroenterologymalabsorption

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  • Surgical intervention with an infracolic duodenojejunostomy successfully treated the superior mesenteric artery syndrome.
  • Discontinuation of immunosuppression post-surgery was well-tolerated.

    • Implications:

    • This case underscores the critical need for comprehensive diagnostic evaluation in refractory coeliac disease.
    • Superior mesenteric artery syndrome should be considered in the differential diagnosis of persistent gastrointestinal symptoms in patients with coeliac disease.
    • Surgical management of superior mesenteric artery syndrome can lead to complete symptom resolution, even in the context of refractory coeliac disease.