[How and why is the diagnostic approach to celiac disease changing]

The first classic description of celiac disease (CD) was published in 1888. The introduction in the clinical practice of the jejunal biopsy, in 1957, offered a powerful tool for a more objective approach to the disease. The correct diagnostic procedure for CD was finally established by a document of the European Society for Pediatric Gastro-enterology and Nutrition (ESPGAN) in 1970, and the ESPGAN suggestions were rapidly adopted by the scientific community. During these years, alternative and non-invasive diagnostic approaches were developed such as non-immunological (tests of intestinal absorption and permeability) and immunological (anti-reticulin, anti-endomysium and anti-gliadin antibodies, HLA antigens) tests. Due to the increased reliability of some of these laboratory investigations and to the increased knowledge about CD, it has been recently proposed that a simplification of the usual ESPGAN protocol should be eventually adopted in well defined subjects suspected to have CD.