Cross-sectional imaging in refractory celiac disease

Badr Al-Bawardy, John M. Barlow, Rogerio N. Vasconcelos, Sarasa T. Kim, David H. Bruining, Stephanie L. Hansel, Shannon P. Sheedy, Joseph A. Murray, Alberto Rubio-Tapia, Elizabeth Rajan, Jeff L. Fidler, Joel G. Fletcher

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Purpose: The purpose of this study is to identify unique imaging findings of refractory celiac disease (RCD) including Type I RCD, Type II RCD versus healed celiac disease (CD). Methods: A retrospective study of patients with known CD and refractory symptoms with cross-sectional imaging was performed. We included patients who underwent T cell receptor rearrangement or T-cell immunophenotyping studies on small bowel (SB) biopsies to classify patients into: healed CD, Type I RCD, or Type II RCD. GI radiologists performed a blinded review of the imaging studies. Results: One-hundred eighteen patients (32 healed; 67 Type I RCD; 19 Type II RCD) were included (mean age 53 ± 6 years; 62% female). The presence of any fold pattern abnormality was more likely to be found in Type II and Type I RCD than healed CD (53% vs. 43% vs.16%; p = 0.009). Type II RCD patients were more likely than Type I RCD and healed CD to have imaging findings of ulcerative jejunitis (26% vs. 6% vs. 3%; p = 0.009), SB wall thickening (37% vs. 16% vs. 0%; p = 0.002) and SB dilation (26% vs. 7% vs. 6%; p = 0.04). Type II RCD demonstrated non-significant trends for decreased number of jejunal folds only, SB mass, mesenteric lymphadenopathy, localized peri-mural edema, and intramural duodenal edema. Conclusions: Fold pattern abnormalities, ulcerative jejunitis, SB wall thickening, and SB dilation are more likely to be identified in cross-sectional imaging of RCD than healed CD. SB dilatation and ulcerative jejunitis are more likely to be found in Type II than Type I RCD.

Original languageEnglish (US)
Pages (from-to)389-395
Number of pages7
JournalAbdominal Radiology
Issue number2
StatePublished - Feb 1 2017


  • CT enterography
  • Celiac disease
  • Enteropathy
  • Ulcerative jejunitis

ASJC Scopus subject areas

  • Gastroenterology
  • Urology
  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging


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