Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with persistent or recurrent malabsorptive symptoms (diarrhea, weight loss, abdominal pain) despite strict adherence to a gluten-free diet (GFD) for >12 months. History of biopsy-proven celiac disease confirmed. Current GFD compliance verified via dietitian review. No evidence of dietary gluten ingestion. Symptoms refractory to standard GFD management.
Clinical Examination Findings
General: Patient appears chronically ill, evidence of weight loss. HEENT: Possible signs of nutritional deficiency (glossitis, cheilosis). Abdomen: Soft, non-tender, mild distension, hyperactive bowel sounds. Extremities: Possible peripheral edema (hypoalbuminemia), muscle wasting. Skin: Pallor or signs of vitamin deficiencies.
Treatment Protocol
1. Confirm strict GFD compliance. 2. Nutritional optimization: Supplementation of iron, B12, folate, calcium, and Vitamin D. 3. Pharmacotherapy: Initiation of budesonide or systemic corticosteroids (prednisone) to induce remission. 4. Consider immunosuppressive therapy (azathioprine or infliximab) if steroid-dependent. 5. Monitor for complications (EATL, ulcerative jejunitis). 6. Repeat duodenal biopsies and flow cytometry to exclude Type II RCD.