Nonresponse or relapse of symptoms is common in patients with celiac disease treated with gluten free diet. Refractory sprue (RS) is defined as initial or subsequent failure of a strict gluten-free diet to restore normal intestinal architecture and function in patients who have celiac-like enteropathy. The aims of this study were: 1) to identify causes of persistent symptoms in patients referred with presumed diagnosis of nonresponsive celiac disease (NCD); and 2) to characterize patients with true RS.Patients were identified who had been systematically evaluated for NCD between January 1997, and May 2001. Patient records and small bowel biopsy results were reviewed.A total of 55 patients were referred with a presumed diagnosis of NCD. Six did not have celiac disease and had other diseases responsible for their symptoms. Diarrhea, abdominal pain, and weight loss were the most common reasons for evaluation in cases of NCD, whereas weight loss, steatorrhea, and diarrhea were the most common presenting features of RS (nine patients). Of the 49 patients with celiac disease, 25 were identified as having gluten contamination. Additional diagnoses accounting for persistent symptoms included: pancreatic insufficiency, irritable bowel syndrome, bacterial overgrowth, lymphocytic colitis, collagenous colitis, ulcerative jejunitis, T-cell lymphoma, pancreatic cancer, fructose intolerance, protein losing enteropathy, cavitating lymphadenopathy syndrome, and tropical sprue.Based on this study, we conclude the following: 1) gluten contamination is the leading reason for NCD; 2) of NCD cases, 18% are due to RS; and 3) alternative diseases or those coexistent with celiac disease and gluten contamination should be ruled out before a diagnosis of RS is made.

Ahmad S. Abdulkarim

Lawrence J. Burgart

Jacalyn See

Joseph A. Murray

The American Journal of Gastroenterology

目标和范围AJG 代表美国胃肠病学会 (ACG) 出版。作为涵盖胃肠病学和肝病学的领先临床期刊，美国胃肠病学杂志 (AJG) 为临床医生处理最常见的胃肠病学疾病提供实用和专业的支持在患者中。出版时考虑到临床医生，该杂志旨在易于访问，按主题组织其内容，包括在线和印刷。主题包括：结肠和小肠内窥镜检查食道功能性胃肠道疾病炎症性肠病肝胰腺和胆道病理学儿科营养/肥胖症胃病 AJG 致力于及时发表胃肠病学和肝病学的医学研究：著名的红色版块通过总结《红色杂志》中的热门话题和发表文章来开始每一期, 辩论和社论，涵盖技术、方法、伦理、实践管理和其他国际临床社区关注的重要问题。最高水平的原创研究涵盖临床胃肠病学和肝病学，包括关于新兴发展的最新临床研究。研究亮点在特定文章中总结当前知识和新提供的信息 - 对忙碌的临床医生来说是一个有用的工具。突出国际胃肠病学和肝病学重要问题的社论。热门热门临床评论胃肠病学和肝病学中的 ICS.ACG 实践指南介绍了诊断和治疗影响胃肠道的一系列疾病的最佳实践。CME 信用机会，每期都提供。许多文章随附的在线补充材料可在线免费获取，包括可下载POWERPOINT 幻灯片和视频。每年的每一次订阅都会得到补充。

The American Journal of Gastroenterology (AJG) is a leading clinical journal published by the American College of Gastroenterology (ACG), focusing on gastroenterology and hepatology. This journal provides practical and professional support for clinicians dealing with the most common gastrointestinal diseases. The content is easily accessible and organized by topic, available in both online and print formats. Key topics include: colon and small intestine endoscopy, esophageal functional gastrointestinal disorders, inflammatory bowel disease, liver, pancreas, and biliary pathology, pediatric nutrition/obesity, and gastric diseases. AJG is committed to timely publication of medical research in gastroenterology and hepatology. Each issue begins with a red section summarizing popular topics and published articles from the 'Red Journal', covering important issues of technology, methodology, ethics, practice management, and other concerns of the international clinical community. The journal features high-level original research covering the latest developments in clinical gastroenterology and hepatology. Research highlights summarize current knowledge and new information in specific articles, serving as a useful tool for busy clinicians. Additionally, the journal publishes editorials on significant issues in international gastroenterology and hepatology, as well as popular clinical reviews. ACG practice guidelines present best practices for diagnosing and treating a range of diseases affecting the gastrointestinal tract. CME credit opportunities are available in each issue, and many articles come with online supplementary materials, including downloadable PowerPoint slides and videos. Each annual subscription includes supplementary materials.

《American Journal of Gastroenterology》是由美国胃肠病学会（ACG）出版的领先临床期刊，专注于胃肠病学和肝病学。该期刊为临床医生提供实用和专业的支持，帮助他们处理最常见的胃肠疾病。期刊内容易于访问，并按主题组织，包括在线和印刷版。主要主题包括：结肠和小肠内窥镜检查、食道功能性疾病、炎症性肠病、肝脏、胰腺和胆道病理学、儿科营养/肥胖症以及胃病。AJG致力于及时发表胃肠病学和肝病学的医学研究。每期的红色版块总结了《红色杂志》中的热门话题和发表的文章，涵盖技术、方法、伦理、实践管理及其他国际临床社区关注的重要问题。期刊还包括最高水平的原创研究，涉及临床胃肠病学和肝病学的最新发展。研究亮点在特定文章中总结当前知识和新提供的信息，为忙碌的临床医生提供有用的工具。此外，期刊还发表关于国际胃肠病学和肝病学重要问题的社论，以及热门的临床评论。ACG实践指南介绍了影响胃肠道的一系列疾病的最佳诊断和治疗实践。每期提供CME学分机会，许多文章附带在线补充材料，包括可下载的PPT幻灯片和视频。每年的订阅都会附赠补充材料。

American Journal of Gastroenterology

Etiology of nonresponsive celiac disease: results of a systematic approach

Gluten contamination is the leading reason for NCD; of NCD cases, 18% are due to RS; and alternative diseases or those coexistent with celiac disease and gluten contamination should be ruled out before a diagnosis of RS is made.

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医学	1
医学, 胃肠肝病学	2

Etiology of nonresponsive celiac disease: results of a systematic approach

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Category	Quartile
GASTROENTEROLOGY & HEPATOLOGY	1