Photo Credit: Jacob Wackerhausen

One in five patients with celiac disease may not respond to a gluten-free diet and would likely be classified as having non-responsive celiac disease, according to findings published in the Journal of Gastroenterology and Hepatology. Prashant Singh, MBBS, and colleagues performed a systematic review and meta-analysis to examine the prevalence and causes of non-responsive celiac disease, examining nine studies. Five of these studies, with a total of 4,414 patients, included data on the prevalence of non-responsive celiac disease. Seven studies, with a total of 790 patients, described the causes of non-responsive celiac disease. The pooled prevalence of non-responsive celiac disease was 22% (95% CI, 11% to 35%). Among patients with non-responsive celiac disease, inadvertent exposure to gluten was the most common cause (33%), followed by functional gastrointestinal disorders including irritable bowel syndrome (16%). In 7% of patients with non-responsive celiac disease, refractory celiac disease type 2 and its premalignant and malignant sequelae were observed.