A small percentage of subjects (<5%) is non-responsive to a GFD, which is defined as refractory celiac disease14. The RCD is rare, and can cause high morbidity and mortality. RCD is rare, and can cause high morbidity and mortality. RCD is diagnosed once other intestinal diseases with villous atrophy have been dismissed. RCD is classified into two types (types 1 and 2)15, according to the phenotype of intraepithelial lymphocytes in the duodenal mucosa. Type 2 symptoms are the most severe.
RCD treatment firstly consists of nutritional support together with a strict GFD. Accidental gluten intake or voluntary consumption must be prevented. This is one of the main uses of the products developed by Biomedal as they control GFD adherence through the detection of GIP in stools. Secondly, type 1 RCD treatment includes corticosteroids, azathioprine, etc., while no treatment has been established for type 2 RCD15, although a new therapy is under evaluation.