{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T16:14:34Z","timestamp":1790784874903,"version":"4.1.0"},"reference-count":28,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2014,1,6]],"date-time":"2014-01-06T00:00:00Z","timestamp":1388966400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2014,2]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Refractory coeliac disease (<jats:styled-content style=\"fixed-case\">RCD<\/jats:styled-content>) is thought to be a rare disorder, but the accurate prevalence is unknown.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>We aimed to identify the prevalence of and the risk factors for developing <jats:styled-content style=\"fixed-case\">RCD<\/jats:styled-content> in a Finnish population where the clinical detection rate of coeliac disease is high.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The study involved 11 hospital districts in Finland where the number of treated <jats:styled-content style=\"fixed-case\">RCD<\/jats:styled-content> patients (<jats:italic>n<\/jats:italic>\u00a0=\u00a044), clinically diagnosed coeliac disease patients (<jats:italic>n<\/jats:italic>\u00a0=\u00a012\u00a0243) and adult inhabitants (<jats:italic>n<\/jats:italic>\u00a0=\u00a01.7 million) was known. Clinical characteristics at diagnosis of coeliac disease between the <jats:styled-content style=\"fixed-case\">RCD<\/jats:styled-content> patients and patients with uncomplicated disease were compared.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The prevalence of <jats:styled-content style=\"fixed-case\">RCD<\/jats:styled-content> was 0.31% among diagnosed coeliac disease patients and 0.002% in the general population. Of the enrolled 44 <jats:styled-content style=\"fixed-case\">RCD<\/jats:styled-content> patients, 68% had type I and 23% type <jats:styled-content style=\"fixed-case\">II<\/jats:styled-content>; in 9% the type was undetermined. Comparing 886 patients with uncomplicated coeliac disease with these 44 patients that developed <jats:styled-content style=\"fixed-case\">RCD<\/jats:styled-content> later in life, the latter were significantly older (median 56 vs 44\u00a0years, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001), more often males (41% vs. 24%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.012) and seronegative (30% vs. 5%, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001) at the diagnosis of coeliac disease. Patients with evolving <jats:styled-content style=\"fixed-case\">RCD<\/jats:styled-content> had more severe symptoms at the diagnosis of coeliac disease, including weight loss in 36% (vs. 16%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.001) and diarrhoea in 54% (vs. 38%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.050).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">Refractory coeliac disease<\/jats:styled-content> is very rare in the general population. Patients of male gender, older age, severe symptoms or seronegativity at the diagnosis of coeliac disease are at risk of future <jats:styled-content style=\"fixed-case\">refractory coeliac disease<\/jats:styled-content> and should be followed up carefully.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.12606","type":"journal-article","created":{"date-parts":[[2014,1,6]],"date-time":"2014-01-06T08:05:27Z","timestamp":1388995527000},"page":"418-425","source":"Crossref","is-referenced-by-count":81,"title":["Refractory coeliac disease in a country with a high prevalence of clinically\u2010diagnosed coeliac disease"],"prefix":"10.1111","volume":"39","author":[{"given":"T.","family":"Ilus","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Alimentary Tract Surgery Tampere University Hospital and School of Medicine University of Tampere Tampere Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Kaukinen","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Alimentary Tract Surgery Tampere University Hospital and School of Medicine University of Tampere Tampere Finland"},{"name":"Department of Medicine Sein\u00e4joki Central Hospital Sein\u00e4joki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. J.","family":"Virta","sequence":"additional","affiliation":[{"name":"Research Department The Social Insurance Institution Turku Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Huhtala","sequence":"additional","affiliation":[{"name":"School of Health Sciences University of Tampere Tampere Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"M\u00e4ki","sequence":"additional","affiliation":[{"name":"Centre for Child Health Research University of Tampere and Tampere University Hospital Tampere Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Kurppa","sequence":"additional","affiliation":[{"name":"Centre for Child Health Research University of Tampere and Tampere University Hospital Tampere Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Heikkinen","sequence":"additional","affiliation":[{"name":"Kuopio University Hospital Kuopio Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Heikura","sequence":"additional","affiliation":[{"name":"North Karelia Central Hospital Joensuu Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Hirsi","sequence":"additional","affiliation":[{"name":"South Karelia Central Hospital Lappeenranta Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Jantunen","sequence":"additional","affiliation":[{"name":"Kymenlaakso Central Hospital Kotka Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V.","family":"Moilanen","sequence":"additional","affiliation":[{"name":"Satakunta Central Hospital Pori Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Vaasa Central Hospital Vaasa Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Puhto","sequence":"additional","affiliation":[{"name":"Mikkeli Central Hospital Mikkeli Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"P\u00f6lkki","sequence":"additional","affiliation":[{"name":"L\u00e4nsi\u2010Pohja\u2032s Central Hospital Kemi Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I.","family":"Vihri\u00e4l\u00e4","sequence":"additional","affiliation":[{"name":"Keski\u2010Pohjanmaa\u2032s Central Hospital Kokkola Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Collin","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Alimentary Tract Surgery Tampere University Hospital and School of Medicine University of Tampere Tampere Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,1,6]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2002.05917.x"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2006.12.006"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v18.i12.1348"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2009.195131"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2012.06.003"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)02481-8"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2006.114512"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2008.09.069"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/MEG.0b013e328307c20c"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2008.10.013"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1159\/000066757"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1067\/mge.2003.54"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1309\/EVXT-851X-WHLC-RLX9"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2006-925178"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2559.2007.02621.x"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2009.03992.x"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcq076"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2036.1996.66237000.x"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2008.11.026"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2011.104"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0b013e31828a3c44"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1080\/00365520903030795"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mcg.0000212618.12455.a8"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1159\/000341416"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.52.7.960"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2012.219"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2005.071514"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-230X-13-40"}],"container-title":["Alimentary Pharmacology &amp; Therapeutics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fapt.12606","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/apt.12606","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,4]],"date-time":"2023-10-04T00:07:59Z","timestamp":1696378079000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/apt.12606"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,1,6]]},"references-count":28,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2014,2]]}},"alternative-id":["10.1111\/apt.12606"],"URL":"https:\/\/doi.org\/10.1111\/apt.12606","archive":["Portico"],"relation":{},"ISSN":["0269-2813","1365-2036"],"issn-type":[{"value":"0269-2813","type":"print"},{"value":"1365-2036","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,1,6]]}}}