Treatment of Celiac Disease When Symptoms Persist After 12 Months on a Strict Gluten-Free Diet: Refractory Coeliac Disease Type 1

A subset of patients with coeliac disease continues to experience symptoms and intestinal villous damage despite prolonged, strict adherence to a gluten-free diet. When other causes have been excluded and the intraepithelial lymphocyte profile is normal, this presentation defines a specific clinical sub-type requiring a targeted management approach.

Clinical scenario

Refractory coeliac disease type 1 (RCD-I) is defined by the persistence or recurrence of symptoms and villous atrophy after at least 12 months on a strict gluten-free diet, in the absence of other causes, with a normal (polyclonal or oligoclonal) intraepithelial lymphocyte immunophenotype. This distinguishes RCD-I from other refractory presentations and informs the choice of therapy.

Therapeutic approach

Retrospective and longitudinal evidence supports open-capsule budesonide as first-line pharmacological therapy for RCD-I, with nutritional support added when clinically needed. The complete regimen — including sequencing and the full clinical algorithm — is available in the structured protocol below.

Instant Access to Structured Evidence-Based Regimens

References

RCD is defined by the persistence or recurrence of symptoms and villous atrophy after at least 12 months on a strict GFD, in the absence of other causes.
RCD‑I: The immunophenotype of IELs is normal.
Based on retrospective and longitudinal evidence, open‑capsule budesonide is considered first‑line therapy for RCD‑I.

DOI: 10.1002/ueg2.70195

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