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March 07-08, 2019 | London, UK

Journal of Diabetology | Volume 3

Annual Summit on

Diabetes, Obesity & Heart

Diabetes, Endocrinology and Metabolic Syndrome

International Conference on

Joint Event

Refractory Coeliac Disease in Diabetes Mellitus

Paul J Ciclitira

University of East Anglia, United Kingdom

oeliac disease (CD, gluten-sensitive enteropathy) affects 1%

of people in the EU and USA including 6% of subjects with

type one diabetes mellitus. The pathogenesis of CD involves

aberrant immune response, both adaptive and innate to gluten

proteins from wheat and related cereals in the small intestinal

mucosaof affectedsubjects. Refractorycoeliacdisease (RCD) isa

complication of coeliac disease (CD) and involves malabsorption

and villous atrophy despite adherence to a strict gluten-free diet

(GFD) forat least12months intheabsenceof another cause. RCD

is classified based on the phenotype of the T-cell morphology

within the small intestinal intra-epithelial lymphocytes (IEL), into

type 1 with normal polyclonal T cell receptors (TCR) of the IEL

and type 2 with aberrant monoclonal TCR by PCR (polymerase

chain reaction) for TCR at the β/γ loci. RCD type 1 is made do

with strict nutritional and pharmacological administration.

RCD type 2 can proceed to ulcerative jejunitis or enteropathy

associated lymphoma (EATL), the latter resulting in a 50% five-

year mortality of subjects with RCD2. Management options for

RCD type 2 and response to treatment vary between centres;

there have been debates over the best treatment options.

Therapy that have been utilized consists mycophenylate,

azathioprine and steroids, cyclosporine, methotrexate campath

and cladribine or fluadribine with or without autologous stem

cell transplantation. We have treated RCD2 with prednisilone

and azathioprine, replacing the latter with mycophenylate

when there is azathioprine sensitivity in the treatment of RCD2.

Our results employing prednisilone and azathioprine reveal a

good response with histological recovery in 56.6% of treated

individuals and without any mortality.

Notes: