Clinical—Alimentary TractClinical Staging and Survival in Refractory Celiac Disease: A Single Center Experience
Section snippets
Patients
The study group included patients with RCD treated at the Mayo Clinic Rochester between June 1998, when the first patient was included, and October 2007, the cutoff date for entry into this report. Most patients (>96%) were evaluated and treated in the Celiac Clinic (by J.A.M.).
Diagnostic Criteria for RCD
The internationally accepted criteria for classification of RCD (and subtypes) were used to maximize the correct allocation of patients by categories.4, 5, 6, 11 The operational definition of RCD case required major and
Patients
A total of 57 patients (67% female) with a median age at refractory state diagnosis of 59 years (range, 30–76 years) were included. Forty-two (74%; 29 female) and 15 (26%; 9 female) patients had RCD I and RCD II, respectively. Fifty-two (91%) patients were white, 3 were Hispanic, and 2 were African American. Forty-eight (84%) patients were evaluated for RCD because of persistent villous atrophy and the development of new symptoms or recurrence of diarrhea after initial clinical response to a
Discussion
The principal findings are (1) RCD I and RCD II are associated with high rates of mortality especially during the first 2 years after the diagnosis of the refractory state (5-year cumulative survival for the entire cohort, 70%) and (2) a new staging system for RCD is proposed based on the cumulative effect on survival of 5 prognostic factors scored at the time of the refractory state diagnosis: albumin ≤3.2 g/dL, hemoglobin ≤ 11 g/dL deciliter, age ≥65 years, the presence of aberrant
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The authors disclose the following: Supported by the National Institutes of Health (NIH) under Ruth L. Kirschstein National Research Service Award/Training Grant in Gastrointestinal Allergy and Immunology (T32 AI-07047) (to A.R.–T) and NIH grants DK-57892 and DK-070031 (to J.A.M).