[Thoughts on the diagnosis, treatment and long-term course of patients with gluten-induced celiac disease].

The criteria for the diagnosis of coeliac disease are the evidence of a well characterized and typical, albeit not pathognomonic lesion of the proximal small bowel mucosa in untreated patients as well as the unequivocal rapid response to a gluten free diet (GFD). The instruction and the motivation of the patients in GFD aims at an early and positive establishment of dietary habits, based on an adequate choice of gluten free foods. As coeliac disease is genetically determined, GFD should be maintained life long. The results of long term evaluations of relapses in coeliac patients confirm this postulate by demonstrating that only 6.5% of the patients show no mucosal alteration upon gluten ingestion, even after years on GFD, and that another group (12-18%) will deteriorate very slowly over years. Routine gluten challenges in patients, whose initial diagnosis was established according to the discussed criteria, seem therefore unjustified, as they represent a serious challenge of established dietary and life habits for the vast majority of patients without any positive issue for them.