Abstract
Coeliac disease is a common small intestinal enteropathy which manifests following ingestion of gluten in genetically susceptible individuals. Since gluten was identified as the driving factor in coeliac disease, the gluten-free diet (GFD) has remained the mainstay of treatment. While most individuals will display improvement in symptoms and signs of coeliac disease following institution of the GFD, up to 30% will continue to experience symptoms and/or have persisting intestinal inflammation. These individuals can be classified as having non-responsive coeliac disease (NRCD), which may be associated with dietary indiscretion, slow healing, refractory coeliac disease, and/or an alternative condition. The purpose of this review is to provide an overview of the causes of NRCD in adults, highlight a systematic approach to investigate these patients, and appraise the latest management aspects of this subset of coeliac disease.
Highlights
Coeliac disease (CD) is a chronic, autoimmune condition that develops in genetically susceptible individuals and has a reported prevalence of around 1% [1]
While most individuals will display improvement in symptoms and signs of CD following institution of the gluten-free diet (GFD), up to 30% will continue to experience symptoms and/or have persisting intestinal inflammation [3]. These individuals are classified as having non-responsive CD (NRCD), which may be associated with dietary indiscretion, slow healing, refractory CD (RCD), and/or an alternative diagnosis to CD [3]
We provide a comprehensive overview of the causes of NRCD in adults and highlight a systematic approach to investigate these patients
Summary
Coeliac disease (CD) is a chronic, autoimmune condition that develops in genetically susceptible individuals and has a reported prevalence of around 1% [1]. While most individuals will display improvement in symptoms and signs of CD following institution of the GFD, up to 30% will continue to experience symptoms and/or have persisting intestinal inflammation [3]. These individuals are classified as having non-responsive CD (NRCD), which may be associated with dietary indiscretion, slow healing, refractory CD (RCD), and/or an alternative diagnosis to CD [3]. Nutrients 2020, 12, 216 will help promote the correct and timely identification, multi-disciplinary appraisal, and treatment of individuals with NRCD, in order to reduce morbidity and mortality associated with this subset of CD
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