Background:
In pediatric patients with celiac disease, adherence to a strict gluten-free diet (GFD) typically results in clinical and histologic remission. However, a subset of patients demonstrates persistent villous blunting despite confirmed dietary compliance, posing diagnostic and therapeutic challenges. The role of anti-inflammatory therapies such as budesonide in this population remains underexplored.
Objective:
To describe the clinical course and histologic response of pediatric celiac disease patients with persistent enteropathy despite a strict GFD who were treated with budesonide.
Methods:
This is a case series of pediatric patients diagnosed with celiac disease based on serologic and histologic criteria, who maintained strict adherence to a GFD as confirmed by dietetic assessment. Due to persistent positive serologies or symptoms on follow-up duodenal biopsies was performed. Alternative causes of enteropathy were excluded. Patients were treated with oral budesonide, and clinical symptoms, serologic markers, and histologic findings were monitored.
Results:
All patients demonstrated persistent villous blunting despite adherence to a GFD. Following initiation of budesonide, patients showed significant clinical improvement, including resolution of gastrointestinal symptoms and improved serology. Histologic reassessment revealed improvement in villous architecture, with partial to complete mucosal recovery. No significant adverse effects related to budesonide were observed during the treatment period.
Conclusion:
Budesonide may be an effective therapeutic option in pediatric celiac disease patients with persistent villous atrophy despite strict adherence to a GFD, after exclusion of ongoing gluten exposure and other causes of enteropathy. These findings suggest a potential role for localized corticosteroid therapy in select cases of non-responsive celiac disease. Further prospective studies are needed to better define indications, duration, and long-term outcomes of budesonide use in this population.