Failure to respond to treatment
Failure to respond may be a result of:
- dietary lapse - consultation with a dietician to discover whether the patient is eating (possibly unwittingly) any forbidden foods. If necessary anti-alpha-gliadin antibodies can be measured to monitor adherence to diet
- exclude alcoholism, diabetes mellitus, hyperthyroidism
- associated intolerence of lactose may be present - a trial milk-free diet should be undertaken
- vitamin or mineral deficiency (Zn, Cu) should be excluded
- malignancy - lymphoma should be excluded
- other possible diagnoses should be considered:
- chronic giardiasis (note history if pet owner)
- concurrent pancreatic insufficiency
- Zollinger-Ellison syndrome
- bacterial overgrowth
- AIDS complex
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