Celiac disease with refractory symptoms despite the presence of persistent or recurring malabsorption symptoms and villous atrophy may be linked to an elevated risk of death and can lead to enteropathy-associated T-cell lymphoma.11 T cells produce tissue damage using interferon (IFN)-alpha, IFN-gamma, tumor necrosis factor (TNF), interleukin (IL)-4, IL-5, and IL-21, some of which have the ability to induce tissue damage.9 Celiac disease is linked to a variety of non-Hodgkin lymphomas, including enteropathy-associated T-cell lymphoma. This evidence concerns the gene TNF and celiac disease.