Description:
Following things should be considered for follow up if a patient is having diagnosed celiac diseases:
A few patients do not improve on a strict diet and are said to have non-responsive coeliac disease. Many of these patients are still ingesting gluten. A few of the others may have concomitant problems, e.g. microscopic colitis, IBD, small bowel bacterial overgrowth or lactase deficiency.
A very small percentage will have the rare complication of refractory coeliac disease (RCD). In type 1 RCD, the lymphocytes are normal and the T cell receptors are polyclonal, whilst in type 2 there are abnormal clonal lymphocytes with loss of CD8 and CD3 surface markers. The 5-year survival rates are 93% and 40–60% respectively.
T cell lymphoma (EATCL) or ulcerative jejunitis can occur as part of a spectrum of neoplastic T cell disorders. Small bowel adenocarcinoma is also increased in coeliac disease which are associated with weight loss and bleeding per rectum.
Ulcerative jejunitis presents with fever, abdominal pain, perforation and bleeding.
Diagnosis for these conditions is with MRI or barium studies but laparoscopy with full-thickness small bowel biopsies is often required. Steroids and immunosuppressive agents, e.g. azathioprine, are used in ulcerative jejunitis.
Carcinoma of the oesophagus as well as extragastrointestinal cancers are also increased in incidence. Malignancy seems to be unrelated to the duration of the disease but the incidence is reduced by a gluten-free diet.
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