Azathioprine and prednisone combination therapy in refractory coeliac disease

@article{Goerres2003AzathioprineAP,
  title={Azathioprine and prednisone combination therapy in refractory coeliac disease},
  author={Marije S. Goerres and Jos W. R. Meijer and P. J. Wahab and J A Kerckhaert and Patricia J.T.A. Groenen and J Han van Krieken and Chris J. Mulder},
  journal={Alimentary Pharmacology \& Therapeutics},
  year={2003},
  volume={18}
}
Introduction:  Refractory coeliac disease (RCD) is a rare syndrome with a poor prognosis, defined by malabsorption due to gluten‐related enteropathy after initial or subsequent failure of a strict gluten‐free diet and after exclusion of any disorder mimicking coeliac disease. 
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We report a patient with life-threatening refractory sprue who was dependent on high doses of corticosteroids to prevent severe diarrhea, malabsorption, and villous atrophy. Azathioprine allowed
Cyclosporin in the treatment of adults with refractory coeliac disease—an open pilot study
To evaluate the effect of cyclosporin treatment on clinical and histological parameters in adult patients with refractory coeliac disease.
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Five patients with adult coeliac disease were treated with prednisolone for four to five weeks while continuing a normal gluten-containing diet. A prompt histological, ultrastructural and enzymic
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TLDR
A substantial minority of patients with coeliac disease fail to respond to treatment with a gluten‐free diet, and other causes to be considered include intolerances to dietary constituents other than gluten and ulcerative jejunitis.
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TLDR
It is speculated that RCD may appear in a subgroup of coeliacs with persisting histologic abnormalities, and azathioprine and steroids in RCD without aberrant T-lymphocytes in their mucosa are suggested.
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TLDR
A patient with refractory sprue-like disease who after failing to respond to corticosteroids and TPN was in a critical condition is reported, who responded promptly to cyclosporine and made a remarkable recovery.
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TLDR
In this pilot, non-randomized, open label study, IL-10 in the given dosage was not overall effective in the study group of RCD patients, and in only one patient did the authors see a normalization of villous architecture.
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TLDR
A patient with severe sprue who was unresponsive to a gluten-free diet and corticosteroid therapy experienced remission after receiving cyclosporine therapy, and the patient's neuropsychiatric status and blood test results became normal.
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