<<Disclaimer: Verify this information before applying it to your situation.>> Refractory Sprue, or Refractory Celiac Disease is the worst case scenario when the damage has gone so far that the patient does not respond to the gluten free diet at all. Of course this is after all other gastroenterology problems have been ruled out, and after the patient has also been tested first for lactose or casein problems (the most common reason), other sensitivities, and even a problem with beef protein. When all else fails the study does say they have had good luck with the "elemental diet" but some cannot stop the progression into lymphoma and death. If you want to know more about this, along with the reasons for not cheating on your diet, you will be interested in this major study, reported on Medscape by two of our best celiac docs. -vance MANAGEMENT OF REFRACTORY CELIAC DISEASE Karoly Horvath, MD, PhD, and Alessio Fasano, MD, discuss the clinical relevance of the poorly understood syndrome known as refractory sprue. Medscape Gastroenterology 3(6), 2001 http://gastroenterology.medscape.com/45793. rhtml?srcmp=gas-120701