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Ulcerative Coeliac Disease

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Ulcerative coeliac diseae Coeliac disease is a small bowel mucosal injury caused by gluten in a sensible individual, and responding to glutenfree diet. If untreated, the inflammation going in in the mucosa can cause irreversible damage, a "point of no return" is reached, and after that, the response to glutenfree diet is poor or lacking. These patients are severely ill, ulcerations appear in the jejunum and ileum - and in the duodenum in our case - and malignant transformation into a T-cell lymphoma is common. Many somewhat confusing terms have been used considering this condition, e.g. ulcerative jejunitis, ulcerative jejunoileitis, refractory coeliac disease, refractory sprue and enteropathy associated T-cell lymphoma (EATL). These images show that the ulcerative lesions can occur also in the duodenum.

We would like to suggest the term ulcerative coeliac disease when considering this condition.

The main features of this condition are:

- coeliac disease, which has not been treated because the diagnose has never been made before the ulcerative manifestations cause symptoms
- ulcerative lesions that endoscopically look benign and which can occur anywhere in the small bowel
- nonresponsiveness to glutenfree diet
- nonresponsiveness to normal treatment of duodenal ulcer disease
- nonresponsiveness to other conventional treatments including corticosteroids, making the prognosis poor in many instances
- a clear association with T cell lymphoma, making this condition a premalignant and in many instances a malignant condition

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December 9, 2011