Are there some celiacs who do not respond to the gluten-free diet?
A few patients have a poor clinical and/or histologic (biopsy) response to the diet. An important step in assessing patients who are non-responders is to confirm the diagnosis of celiac disease by review of the original biopsy, preferably by an expert gastrointestinal pathologist. However, the most common cause of a poor response is continued gluten ingestion, which may be intentional or unintentional. An intolerance to other foods, such as lactose and fructose or soy can be a reason for lack of improvement. Some non-responders may have reversible pancreatic insufficiency or bacterial overgrowth, requiring treatment. Colonoscopy might indicate other causes of the failure to respond, such as microscopic colitis or inflammatory bowel disease. Though rare, other causes of failure to respond to a gluten-free diet include lymphoma, ulcerative jejunitis, collagenous sprue, autoimmune enteropathy or refractory sprue. Please visit the FAQ section in the coming months for more answers to your q
