[When gluten-free diet does not cure celiac disease]. / Kun gluteeniton ruokavalio ei korjaa keliakiaa.

ABSTRACT

Dietary deviations and continuous usage of gluten even in small amounts are the most common causes of poor treatment response for celiac disease. In rare refractory celiac disease symptoms and small bowel mucosal morphological damage do not heal despite a strict diet. In such cases it is important to distinguish between type I and II refractory celiac disease by using small bowel lymphocyte markers and clonality of inflammatory cells. Increased risk of small intestinal lymphoma is especially associated with type II disease, which has a poorer prognosis. Type I is often treated with corticosteroids and azathioprine.