Refractory celiac disease type 1 (RCD1) describes a distinct clinical situation in which a patient continues to have malabsorptive symptoms and intestinal villous atrophy despite confirmed strict adherence to a gluten-free diet for more than 12 months, and biopsy reveals a polyclonal — not clonal — intestinal T-cell population.
This protocol is indicated when celiac disease presents as RCD type 1: persistent or recurrent malabsorptive symptoms and signs, small-intestinal villous atrophy on biopsy, strict gluten-free diet maintained for more than 12 months, and a polyclonal intestinal T-lymphocyte population confirmed (no abnormal or clonal T-cells). RCD type 1 likely has a heterogeneous group of etiologies, including inadvertent gluten exposure.
Management in this setting may involve further dietary restriction — eliminating nearly all processed foods for a defined period — along with specific medications selected for refractory disease; the complete regimen is detailed in the structured protocol.
Partial overview only — the full evidence-based regimen is available via the link below.RCD refers to ongoing symptoms and/or signs of malabsorption with intestinal villus atrophy despite the evidence of strict adherence to a GFD for at least 12 months.
RCD type 1, characterized by a polyclonal T-cell population, likely has a heterogeneous group of etiologies, including inadvertent gluten exposure; as such, it may be managed with further dietary restriction, eliminating nearly all processed foods for a defined period.
Medications that have been used to treat RCD include open-capsule budesonide, prednisone, immunomodulators, mesalamine, and biologics, although placebo-controlled data are lacking.
DOI: 10.14309/ajg.0000000000002075
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