Table 2

Aetiologies of non-responsive coeliac disease

AetiologyRepresentative case seriesDiagnostic approach
Abdulkarim10 (n=49)Leffler11 (n=99*)Fine45 (n=11†)
Gluten contamination25361Dietary review, coeliac serology
Microscopic colitis963Colonic biopsies
Bacterial overgrowth760Breath tests, culture of small bowel aspirate, antibiotics trial
Pancreatic insufficiency602Pancreatic testing, enzymes trial
Fructose/lactose intolerance172Breath tests, exclusion trial
Irritable bowel syndrome4222Clinical criteria
Refractory coeliac disease4100Discussed in this review
Other4121Miscellaneous tests
  • * 99 of 113 with confirmed aetiologies.

  • 11 of 13 with persistent diarrhea after a gluten-free diet (GFD).

  • Some patients had more than one condition likely associated with persistent symptoms.