In some patients with celiac disease, intestinal symptoms and mucosal damage continue despite strict, sustained adherence to a gluten-free diet. This specific situation — refractory coeliac disease type 1 (RCD-I) — requires a structured treatment approach distinct from standard dietary management.
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 identifiable causes. A key diagnostic criterion is a normal (polyclonal or oligoclonal) intraepithelial lymphocyte immunophenotype — this distinguishes type 1 from the more aggressive type 2 form and informs the therapeutic strategy.
The structured protocol for RCD-I involves corticosteroid-based pharmacological therapy — the full regimen, including specific agent selection and clinical criteria for escalation, is detailed in the complete protocol.
DOI: 10.1002/ueg2.70195
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.
0.5–1 mg/kg body weight may be needed for few weeks in cases of no response to budesonide.
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