{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T23:47:04Z","timestamp":1788479224304,"version":"build-2803163510"},"reference-count":39,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,11,18]],"date-time":"2024-11-18T00:00:00Z","timestamp":1731888000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2024,11,18]],"date-time":"2024-11-18T00:00:00Z","timestamp":1731888000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Gastro and Hepatol"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aim<\/jats:title>\n                    <jats:p>Non\u2010responsive celiac disease (NRCD) is defined as ongoing symptoms despite 6\u201312\u00a0months of gluten\u2010free diet (GFD), the only known treatment for celiac disease (CeD). There is inconsistency in studies describing the proportion of patients having NRCD and its various causes among patients with CeD. We therefore conducted a systematic review and meta\u2010analysis to determine the prevalence and causes of NRCD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The PubMed, Embase, Cochrane Library, Scopus, and Web of Science databases were searched for original studies reporting the proportion of patients with persistent symptoms after \u2265\u00a06\u00a0months of GFD. Studies reporting the etiologies of NRCD were also identified. The systematic review was conducted as per the Meta\u2010analysis of Observational Studies in Epidemiology guidelines. Statistical analysis was performed in STATA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 2965 search results, nine studies met the inclusion and exclusion criteria. Five studies (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a04414) reported data on prevalence, and seven studies (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0790) reported the causes of NRCD. The pooled prevalence of NRCD was 22% (95% confidence interval, 11\u201335%). Among patients with NRCD, inadvertent exposure to gluten was the most common cause (33%), followed by functional gastrointestinal disorders including irritable bowel syndrome in 16%. Refractory CeD type II along with its premalignant and malignant sequelae was observed in 7% of patients with NRCD.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>One in five patients with CeD may not respond to GFD and would likely be classified as NRCD. Inadvertent gluten exposure was the cause of ongoing symptoms in one\u2010third of patients with NRCD. Improving adherence to GFD along with developing novel therapeutics to mitigate symptoms due to ongoing gluten exposure is critical.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgh.16808","type":"journal-article","created":{"date-parts":[[2024,11,18]],"date-time":"2024-11-18T22:39:28Z","timestamp":1731969568000},"page":"101-107","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Prevalence and etiologies of non\u2010responsive celiac disease: A systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2153-7478","authenticated-orcid":false,"given":"Nishant","family":"Aggarwal","sequence":"first","affiliation":[{"name":"Department of Internal Medicine William Beaumont University Hospital  Royal Oak Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Unnati","family":"Bhatia","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine William Beaumont University Hospital  Royal Oak Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vignesh","family":"Dwarakanathan","sequence":"additional","affiliation":[{"name":"Department of Community Medicine Employees' State Insurance Corporation Hospital  Chennai India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9094-1071","authenticated-orcid":false,"given":"Achintya Dinesh","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, MetroHealth Medical Center Case Western Reserve University  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prashant","family":"Singh","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1577-0118","authenticated-orcid":false,"given":"Vineet","family":"Ahuja","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Human Nutrition All India Institute of Medical Sciences  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2474-2194","authenticated-orcid":false,"given":"Govind K","family":"Makharia","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Human Nutrition All India Institute of Medical Sciences  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,11,18]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2017.06.037"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41575-021-00552-z"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2019.00193"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000002075"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v27.i13.1311"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2006.12.006"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2002.05917.x"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu14132776"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/ctg.2016.70"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0000000000000392"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2009.195131"},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2011.104"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2022.07.086"},{"key":"e_1_2_5_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11894-020-0756-8"},{"key":"e_1_2_5_16_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgast-2022-000914"},{"key":"e_1_2_5_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000001634"},{"key":"e_1_2_5_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0b013e31821a23d0"},{"key":"e_1_2_5_19_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v18.i12.1348"},{"key":"e_1_2_5_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2008.05.011"},{"key":"e_1_2_5_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2010.10.011"},{"key":"e_1_2_5_22_1","first-page":"196","article-title":"Benefit on health\u2010related quality of life of adherence to gluten\u2010free diet in adult patients with celiac disease","volume":"107","author":"Casellas F","year":"2015","journal-title":"Rev. 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