Celiac disease is a disorder of acquired loss of immune tolerance to cereal proteins and affects approximately 1% of the world's population. The clinical picture is variable, including gastrointestinal symptoms, extraintestinal manifestations, and asymptomatic forms detected by screening. The basis of the diagnosis is serological testing with a diet containing gluten. Untreated disease leads to complications such as nutritional deficiency, osteoporosis, infections and rarely malignancies. Screening, diagnostic and monitoring procedures differ nationally and internationally for children and adults. This heterogeneity, along with the unanswered questions highlighted in the review by Doyle and colleagues in The BMJ, presents a challenge. Coordinated research on the effectiveness of mass screening, the role of serology and novel biomarkers in diagnosis and management is needed to address knowledge gaps.