Celiac Disease is the only autoimmune disorder where those affected can take “disease” out of their diagnosis. Healing begins when Celiacs avoid gluten.
Celiac Disease is created by a cascade of events that result in damage to an individual's small intestine. For most people diagnosed with Celiac Disease, there’s a “genetic link”–the presence of HLA markers DQ2 or DQ8. These markers are present in 30% to 40% of the population. Celiac Disease doesn’t affect everyone who has this genetic vulnerability. Only about one person in 100 acquires celiac disease during their lifetime. About 1 in 22 of the first-degree relatives of people who have Celiac Disease develop Celiac Disease themselves. First-degree relatives are a person’s parents, siblings and children.
For those diagnosed with Celiac Disease, there’s also an “environmental link.” Celiac Disease is sometimes called “gluten-sensitive enteropathy.” Enteropathy means a disease of the small intestine. In Celiac Disease, the environmental trigger causing enteropathy is gluten.
Celiac disease is “immune-mediated.” “Immune-mediated” conditions include autoimmune disorders (celiac disease is one of many), allergic diseases, and asthma. In Celiac Disease, a person’s immune system reacts to gluten, resulting in damage to the villi in the small intestine. Since villi are the finger-like projections that absorb nutrients from food into the body, undiagnosed and untreated Celiac Disease results in malabsorption, leading to malnutrition.
Once a person is diagnosed, the disease process can be halted and reversed by means of the gluten-free diet.
After a Celiac’s health is restored on a gluten-free diet, there are no clinical measures that show any difference between that Celiac and non-Celiacs.
However, the disease process reactivates if that Celiac returns to eating gluten.
Refractory Celiac Disease develops in a small portion of Celiacs. According to the Oslo definitions, refractory celiac disease refers to “persistent or recurrent malabsorptive symptoms and signs with villous atrophy despite a strict gluten free diet for more than 12 months.” In a study published in February 2013 that included 6 patients who met this definition, 5 showed recovery after 3 to 6 months on a Gluten Contamination Elimination Diet (GCED). The study also included 11 patients whose symptoms had not improved in the gluten-free diet; 9 of these also improved on the GCED. The abstract of this hopeful study can be found here. The full text is available here.
To summarize, Celiac Disease is:
triggered by fractions of protein called gluten (see what is gluten)
damaging to the villi in the small intestine (and since villi absorb nutrients into the body, undiagnosed and untreated celiac disease results in malabsorption, leading to malnutrition)
treated with a Gluten Free Diet
treated with a Gluten-Contamination Elimination Diet if necessary
not perceived clinically once celiac health has been restored on a gluten-free diet
reactivated to a disease process if a celiac returns to eating gluten