Celiac Disease (cont.)

Failure to respond to a gluten free diet can be due to several reasons:

1. The person is not following a strict gluten free diet and is still eating small amounts of gluten.
   
   
2. The person is unknowingly ingesting unsuspected sources of gluten such as starch, binders and fillers in medications or vitamins.
   
   
3. The person may have another co-existing condition such as irritable bowel syndrome, bacterial overgrowth of the small bowel, microscopic colitis, or pancreatic insufficiency that is causing the symptoms.
   
   
4. The person may have refractory disease, or complications of celiac disease.

Refractory celiac disease is a rare condition in which the symptoms of celiac disease (and the loss of villi) do not improve despite many months of a strict gluten free diet. Before making a diagnosis of refractory celiac disease it is important to exclude complications of celiac disease and other co-existing conditions that can produce similar symptoms and biopsy findings.

Refractory celiac disease is believed to consist of two different entities, one which is relatively benign and one which becomes malignant or cancerous. Special examination of intestinal tissue from patients with refractory celiac disease can differentiate between the two entities.

The treatment of refractory celiac disease is first to make sure that all gluten is eliminated from the diet. If there still is no improvement, medications are used.

• Corticosteroids such as prednisone have been used successfully in treating some patients with refractory celiac disease.
  
  
• Immuno-suppressive drugs (medications that suppress a person's immune system) such as azathioprine (Imuran, Azasan) and cyclosporine also have been used.
  
  
• Corticosteroids and immunosuppressive drugs are potent medications with potentially serious side effects. Many patients with refractory celiac disease are malnourished and have weakened immune systems, and corticosteroids and immunosuppressive agents can further increase their risk of serious infections. Thus doctors experienced with treating celiac disease should monitor treatment of refractory celiac disease.

Unfortunately in some patients with refractory celiac disease, malabsorption and malnutrition progress despite drugs. In these patients the intravenous route is the only way to deliver nutrition. Total parenteral nutrition (TPN) is a way of delivering calories, carbohydrates, amino acids, and fat in liquid solutions via a catheter that has been inserted and secured into a vein.

Source: MedicineNet.com
http://www.medicinenet.com/celiac_disease/article.htm