Case report of a patient with coeliac disease not responding to standard treatment.

What is it about?

Coeliac disease tends to cause diarrhoea, weight loss and/or anemia. It usually responds very well to a gluten free diet (avoiding foods such as wheat, barley and rye). When it doesn't it will usually respond to steroids by mouth or to an elemental diet (eg basic carbohydrates, amino acids). We report a case where it didn't probably because of poor absorption of steroids from the bowel lining. We demonstrate photos from a capsule examination performed to exclude lymphoma, a complication of coeliac disease. It shows reduced folds in the bowel wall, loss of villi (absorptive surface) and ulceration.

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Why is it important?

We discuss findings and management of severe coeliac disease not responding to standard therapies.