failure to respond to a gluten-free diet can be due to several reasons: patients are not following a strict gluten-free diet and are still eating small amounts of gluten. patients are unknowingly ingesting unsuspected sources of gluten such as starch binders and fillers in medications or vitamins. patients may have another co-existing condition such as irritable bowel syndrome bacterial overgrowth of the small bowel microscopic colitis or pancreatic insufficiency that is causing the symptoms. patients may have refractory disease or complications of celiac disease.
what if patients with celiac disease don't respond to a gluten-free diet?