Review for "Refractory Celiac Disease Type II: An Atypical Case Highlighting Limitations of the Current Classification System"

2020 ◽  
Vol 38 (3) ◽  
pp. 399-405
Author(s):  
Craig R. Soderquist ◽  
Susan Hsiao ◽  
Mahesh M. Mansukhani ◽  
Bachir Alobeid ◽  
Peter H. Green ◽  
...  

2016 ◽  
Vol 25 (3) ◽  
pp. 385-388 ◽  
Author(s):  
Yvette H. Van Beurden ◽  
Tom Van Gils ◽  
Nienke A. Van Gils ◽  
Zain Kassam ◽  
Chris J.J. Mulder ◽  
...  

Treatment of refractory celiac disease type II (RCD II) and preventing the development of an enteropathy associated T-cell lymphoma in these patients is still difficult. In this case report, we describe a patient with RCD II who received fecal microbiota transfer as treatment for a recurrent Clostridium difficile infection, and remarkably showed a full recovery of duodenal villi and disappearance of celiac symptoms. This case suggests that altering the gut microbiota may hold promise in improving the clinical and histological consequences of celiac disease and/or RCD II. Abbreviations: CDI: Clostridium difficile infection; EATL : enteropathy associated T-cell lymphoma; FMT: fecal microbiota transfer; IEL: intraepithelial lymphocytes; RCD II: refractory celiac disease type II; TPN: total parenteral nutrition.


2018 ◽  
Vol 1 (suppl_2) ◽  
pp. 354-354
Author(s):  
R Chibbar ◽  
J Nostedt ◽  
D Mihalicz ◽  
R Mclean ◽  
J deschenes ◽  
...  

2010 ◽  
Vol 46 (6) ◽  
pp. 840-846 ◽  
Author(s):  
G J Tack ◽  
M J Wondergem ◽  
A Al-Toma ◽  
W H M Verbeek ◽  
A Schmittel ◽  
...  

2020 ◽  
Vol 38 (6) ◽  
pp. 490-499 ◽  
Author(s):  
Carlota García-Hoz ◽  
Laura Crespo ◽  
Natalia Lopez ◽  
Ana De Andrés ◽  
Raquel Ríos León ◽  
...  

<b><i>Background:</i></b> Refractory celiac disease type II (RCD-II) is a very rare yet severe complication of celiac disease (CD) with a 50% rate of progression to Enteropathy-associated T-cell lymphoma (EATL). Timely diagnosis and treatment of RCD-II is of the essence and requires the identification of a population of frequently clonal, phenotypically aberrant intraepithelial lymphocytes (IELs). Flow Cytometry of intestinal IELs is the recommended method to identify the aberrant surface CD3-negative (sCD3<sup>–</sup>) intracytoplasmic CD3-positive (icCD3ε<sup>+</sup>) IELs, and a proportion of &#x3e;20% is diagnostic of RCD-II. There is substantial heterogeneity in the clinical course of RCD-II, and insufficient information on prognostic factors. <b><i>Aim:</i></b> To establish flow cytometric predictors of the clinical evolution of RCD-II, to help guide treatment approaches. <b><i>Patients and Methods:</i></b> Retrospective single-center study of clinical and immunological features of 6 RCD-II patients and a control group, both identified from a 2,000-patient cohort over 16 years. IEL subset frequencies and the intensity of staining for surface (s) and intracytoplasmic (ic) CD3ε+ on IEL subsets were quantified and correlated with the clinical outcome. <b><i>Results:</i></b> Unexpectedly, the frequency of aberrant sCD3<sup>–</sup> icCD3ε<sup>+</sup> cells at diagnosis did not correlate with histological or clinical affection. However, a higher intensity of icCD3ε<sup>+</sup> staining in the aberrant IELs relative to expression on normal IELs correlated with monoclonality and with worse clinical outcomes. <b><i>Conclusion:</i></b> The ratio of icCD3ε<sup>+</sup> on aberrant IELs vs. normal IELs appears to be a useful indicator of prognosis at the time of diagnosis, and may represent a novel tool in the follow-up of RCD-II patients after therapy.


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