Celiac disease is a lifelong disorder

Celiac disease has always been considered a permanent condition. A relapse, defined on the basis of mucosal changes, occurring within 2 years of reintroducing gluten to a patient's diet (challenge) has been taken as confirmation of the permanence of the disease. Some observers have questioned whether the disease is permanent, since long periods of unexplained clinical remission occur, mainly among adolescents. However, the presence or absence of symptoms has no correlation with the histologic activity of the disease or with the results of serologic tests. With very few exceptions, patients in whom celiac disease is diagnosed during their childhood eventually have a relapse. However, in some cases, many years may elapse before a relapse; therefore, the 2-year limitation is no longer considered valid. On the other hand, there have been anecdotal observations that some patients eating a normal diet containing gluten appear to have experienced a "natural recovery." This recovery is partial and probably temporary, since there is evidence that celiac disease can be present in a latent form. Long-term randomized studies, in which morphometric and ultrastructural measurements are taken, that show villous integrity, the absence of abnormal inflammation and a lack of long-term complications of a diet containing gluten are needed before the current "zero-gluten" approach to celiac disease is altered. The individual variation in the extent and time course of celiac disease does not contradict the evidence that the disease persists throughout life, actively, silently or latently. Currently, there is no justification for recommending long-term consumption of gluten for either children or adults with celiac disease.