Refractory celiac disease and sprue-like intestinal disease

Table 1 Some causes of biopsy changes similar to celiac disease

Causes	Diseases
Sprue syndromes	Collagenous sprue
	Mesenteric lymph node cavitation syndrome
	Oats-induced villous atrophy
	Other protein injury (soy, milk)
	Unclassified or refractory sprue
Infectious causes	Infectious gastroenteritis
	Specific infections (eg., parasite: strongyloidiasis, Protozoan: giardia, mycobacteria)
	Tropical sprue
	Stasis syndrome (contaminated small bowel syndrome)
	Whipple’s disease
Deficiency causes	Nutrients (zinc, vitamin B12, folic acid)
	Kwashiorkor
	Immunodeficiency syndromes
Others	Intestinal lymphangiectasia
	Crohn’s disease (duodenum)
	Graft-versus-host disease
	Immunoproliferative disease (lymphoma)
	Macroglobulinemia
	Zollinger-Ellison syndrome
	Drug-induced small bowel injury (eg. NSAIDs)

Table 2 Recurrent or refractory symptoms in celiac disease

Dietary non-compliance

Ubiquitous gluten source (eg., pill capsules)

Wrong initial diagnosis

Associated or second cause (eg., collagenous colitis)

Superimposed complication (eg., collagenous sprue, lymphoma)