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Celiac disease can present as an intestinal or extra-intestinal condition and in some cases may even be asymptomatic. Many cases go undiagnosed due to the failure to present any symptoms.
Clinical manifestation of Celiac depends on multitude of factors such as genetics, environmental factors, age, gender, and the extent of small intestinal inflammation. Refractory Celiac Disease (RCD) is defined by persisting malabsorption and villous atrophy after about one year of strict Gluten free diet. RCD is also more frequent in women than men. RCD can be type 1 or type 2 depending upon the presence of normal intraepithelial lymphocytes, or abnormal intraepithelial lymphocytes respectively.