Refractory celiac disease — defined as persistent villous atrophy despite strict gluten-f...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-CELIAC-REFRACTORY-EATL-PREVENTION`
Type	Red flag
Status	reviewed 2026-05-18 \| pending_clinical_signoff
Diseases	`DIS-EATL`
Sources	`SRC-NCCN-BCELL-2025`

Red Flag Origin

Definition	Refractory celiac disease — defined as persistent villous atrophy despite strict gluten-free diet for ≥1 year, OR aberrant intraepithelial lymphocyte (IEL) clonality on flow cytometry (refractory celiac type 2 — RCD2), OR recurrent symptoms with ulcerative jejunitis. Refractory celiac type 2 carries ~50% lifetime EATL (enteropathy-associated T-cell lymphoma) risk. Engine routes to PreventionPlan recommending intensive monitoring + small-bowel surveillance imaging + immunosuppression discussion. Prevention-persona RedFlag (§20 ratification, v0.3 chronic-condition).
Clinical direction	investigate
Category	other

Trigger Logic

{
  "any_of": [
    {
      "finding": "celiac_disease_refractory_type_2",
      "value": true
    },
    {
      "finding": "celiac_disease_with_persistent_villous_atrophy_despite_gluten_free_diet_ge_1y",
      "value": true
    },
    {
      "finding": "celiac_disease_with_aberrant_iel_clonality",
      "value": true
    }
  ],
  "type": "lab_value"
}

Notes

Prevention-persona RedFlag for refractory celiac → EATL prevention. Fires on persistent villous atrophy / aberrant IEL clonality / RCD2 features. STUB pending two-Clinical-Co-Lead signoff per CHARTER §6.1 dev-mode.

Used By

Indications

IND-CELIAC-REFRACTORY-EATL-PREVENTION-OBSERVATION - IND-CELIAC-REFRACTORY-EATL-PREVENTION-OBSERVATION
IND-CELIAC-REFRACTORY-EATL-PREVENTION-SURVEILLANCE - IND-CELIAC-REFRACTORY-EATL-PREVENTION-SURVEILLANCE