By Jason Clevenger
Summary: The vast majority of patients with non-responsive celiac disease are still ingesting gluten, according to a recent case analysis by a group of physicians in the United Kingdom.
The researchers examined a group of 100 patients who had been referred with non-responsive celiac disease and found, through a series of questionnaires, blood work and duodenal biopsy, that 90 percent of the patients in this group had continued gluten ingestion. Most patients in the group showed improved symptoms on a strict gluten-free diet. A minority (10 percent) of the non-responsive celiac disease patients were diagnosed with refractory celiac disease and treated accordingly. Some of the gluten-containing foods inadvertently consumed by the non-responsive patients included malted breakfast cereals, beer and cooking sauces.
Conclusion: While adequate food labeling is an important tool, patient education remains an important aspect of maintaining a gluten-free diet. Physicians should continue to aggressively evaluate patients with non-responsive symptoms to differentiate between ongoing gluten exposure and refractory celiac disease.
 “Celiac disease: Management of persistent symptoms in patients on a gluten-free diet”, D.H. Dewar, S.C. Donnelly, S.D. McLaughlin, M.W. Johnson, H.J. Ellis, P.J. Ciclitira, World Journal of Gastroenterology. 2012 March 28; 18(12): 1348-1356.