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Celiac disease has been recently recognized as a common condi-tion with many atypical manifestations. With an estimated world-wide prevalence of 1in 266 2 and a prevalence in the United States of 1 in 133, 3 celiac disease is one of the most common inherited diseases encountered by physicians. It is certainly the most com-mon chronic intestinal inflammatory disease. Studies with sero-logic screening suggest that the vast majority of cases of celiacdisease remain undetected. Although celiac disease might be con-sidered a benign process, especially when encountered in a mini-mally symptomatic individual, that impression is probably wrongbecause it has been well established that celiac disease leads toan increased morbidity and indeed mortality. This morbidity andmortality is largely preventable by treatment with a gluten-freediet. The increased mortality is mainly due to an increase in ma-lignancies, especially lymphomas. 4,5 In addition, there is a wide variety of non-GI consequences of untreated celiac disease in-cluding anemia, low bone density, infertility, recurrent abortion,neurologic damage, psychiatric syndromes, chronic fatigue, andpossibly an increased risk of other autoimmune diseases. Beforediagnosis of celiac disease, patients have an increased rate of sur-gical procedures compared with the general population becauseof a combination of misdiagnosis as well as poor health status ofthe patients.