CELIAC-DISEASE IS A LIFELONG DISORDER

Celiac disease has always been considered a permanent condition. A rel apse, defined on the basis of mucosal changes, occurring within 2 year s of reintroducing gluten to a patient's diet (challenge) has been tak en as confirmation of the permanence of the disease. Some observers ha ve questioned whether the disease is permanent, since long periods of unexplained clinical remission occur, mainly among adolescents. Howeve r, the presence or absence of symptoms has no correlation with the his tologic activity of the disease or with the results of serologic tests . With very few exceptions, patients in whom celiac disease is diagnos ed during their childhood eventually have a relapse. However, in some cases, many years may elapse before a relapse; therefore, the 2-year l imitation is no longer considered valid. On the other hand, there have been anecdotal observations that some patients eating a normal diet c ontaining gluten appear to have experienced a ''natural recovery.'' Th is recovery is partial and probably temporary, since there is evidence that celiac disease can be present in a latent form. Long-term random ized studies, in which morphometric and ultrastructural measurements a re taken, that show villous integrity, the absence of abnormal inflamm ation and a lack of long-term complications of a diet containing glute n are needed before the current ''zero-gluten'' approach to celiac dis ease is altered. The individual variation in the extent and time cours e of celiac disease does not contradict the evidence that the disease persists throughout life, actively, silently or latently. Currently, t here is no justification for recommending long-term consumption of glu ten for either children or adults with celiac disease.