Diagnostic et traitement de la maladie coeliaque refractaire: une revue systematique de la litterature
Mots-clés :
Maladie coeliaque ; maladie coeliaque réfractaireRésumé
Prérequis : La maladie coeliaque réfractaire est définie par la persistance des symptômes de malabsorption en dépit d’une adhérence stricte au régime sans gluten pendant au moins 6 à 12 mois.But : Décrire les aspects cliniques et épidémiologiques de la maladie coeliaque réfractaire, et d’identifier les options thérapeutiques au cours de cette pathologie.
méthodes : Une revue systématique et une analyse critique des études observationnelles, essais cliniques et cas cliniques à propos du diagnostic et du traitement de la maladie coeliaque réfractaire.
résultats : La maladie coeliaque réfractaire peut être classée en type 1 ou type 2 selon le phénotype des lymphocytes intraépithéliaux. De graves complications comme le lymphome T associé à l’entéropathie, peuvent émailler l’évolution de cette pathologie chez un sous-groupe de ces patients, notamment porteurs du type 2.
Conclusion : La maladie coeliaque réfractaire est un diagnostic d’élimination. Le pronostic reste encore sombre en l’absence de thérapies curatives. Toutefois, certains traitements semblent prometteurs au cours de quelques études de cohorte.
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