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In the world of celiac disease, complications are like sharp rocks in the ocean: rare but dangerous, especially for those diagnosed in adulthood. Factors predisposing to the development of such complications include late diagnosis and poor adherence to a gluten-free diet.
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Refractory Celiac Disease: This is the terrain of the most arduous challenges. Refractory celiac disease, characterized by the lack of histological and clinical improvement despite a year of gluten-free diet, presents two often untamable variants. The first, Type 1, is linked to other autoimmune diseases and requires treatment with immunosuppressants. The second, Type 2, is a preneoplastic form, a dangerous breeding ground for intestinal lymphoma. Distinguishing between these variants requires specialized experience and resources, but sometimes the line between the two becomes blurred, leaving room for future changes in the treatment path.
T-Cell Lymphoma: This is the monster that lurks in the shadows. Frequently located in the small intestine, T-cell lymphoma manifests as ulcerated nodules, often complicated by strictures and perforations. Warning signs include sudden weight loss, abdominal pain, returning diarrhea, and other symptoms that call attention to this threat. Diagnosis often occurs during surgery, but survival prospects remain poor, averaging less than 15% at five years.
Spleen Atrophy: Another hidden challenge is spleen atrophy. To be suspected in patients with late diagnoses or additional complications, this condition is confirmed by ultrasound examination revealing a shrunken spleen, often accompanied by cavitating mesenteric lymph nodes, a sign of a broader disorder of the lymphatic system.
Considering the complexity and severity of these complications, it is essential to address them with care and competence at specialized reference centers.
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