Rarely, people with celiac disease do not improve in response to the gluten-free diet. This condition is called unresponsive celiac disease, or refractory disease. Most often, patients with refractory disease are still eating small amounts of gluten without knowing it. These patients should seek advice from a dietitian who specializes in working with celiac patients.
It is also important to remember that not all symptoms can be blamed on gluten. Particularly at first, before the small intestine has had a chance to heal to the point where it can absorb food normally, people with celiac disease may have trouble digesting certain foods, especially fatty ones. Lactose intolerance, other food sensitivities or allergies, and even a stomach flu might imitate celiac disease symptoms.
In extremely unusual situations, the patient’s intestines have been so badly damaged by chronic inflammation that they cannot not heal despite a strictly gluten-free diet. Even on a gluten-free diet, these patients will not be able to absorb enough nutrients just by eating, and they may require intravenous nutrition and immunosuppressive medications.
Researchers are now evaluating new medical and surgical treatments for refractory celiac disease.
Sources:
American Celiac Disease Alliance.
Al-Toma A, Verbeek WH, Mulder CJ. Update on the management of refractory coeliac disease. Journal of Gastrointestinal and Liver Diseases 2007; 16: 57-63.
