Diagnosis of celiac disease: where are we heading after the ESPGHAN 2012 guidelines?

The diagnostic criteria for celiac disease (CD) have undergone significant change during the past several decades following a better understanding of the pathogenesis of the disease and the identification of sensitive and specific serum markers. In 2012, the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition published new diagnostic algorithms, which for the first time questioned the need for histological evaluation in all patients, and identified specific requirements for omitting intestinal biopsies from diagnosis requirements. Here, we briefly review the evolution of the diagnostic algorithms, emerging data which may be integrated into the diagnosis algorithm in the future and suggest key points which should be considered while we continue to develop and refine the diagnostic criteria for CD in an age of personalized medicine.