Introduction: CD is a permanent intolerance to gluten genetically-determined, characterized by the typical duodenal villous atrophy. The introduction of new diagnostic approaches for CD expanded impressively the clinical features associated to the disease. From the clinical suspect through antigliadin (AGA), then using antiendomysium (AEA) and finally antitransglutaminase (tTG) antibodies, the iceberg of CD patients emerged little by little. Aim: to draw the clinical picture of CD at the present, improving the case-finding screening methodology in diagnosing CD patients. Methods: We described the experience of diagnosis of CD in the Pediatric Departement of a tertiary level teaching hospital in the last 25 years, from 1977–2002. The clinical charts of 625 consecutive diagnosed CD patients has been retrospectively analyzed. The diagnosis of CD has been made according to the ESPGHAN criteria. Symptoms at presentation has been classified as typical (failure to thrive/weight loss, diarrhea, abdominal pain, stipsi), atypical (anemia, osteoporosis, dental enamel defects, aphtous stomatitis, neuropsychiatric symptoms), autoimmune (dermatitis herpetiformis, IDDM, Basedow, alopecia, vitiligo, autoimmune epatitis), asymptomatic (relatives of CD patients, population screening). Results: We diagnosed 625 celiac patients (375M, 250F; mean age 11y; age range 5m-72y). 301/625 (48%) patients presented with gastrointestinal symptoms, while 208/625 (33%) patients presented with atypical features. The typical manifestation is more common in children younger that 2 years of age (130/152 children, 85.5%). We diagnosed also 196 adults (31%), despite our role of pediatricians. The most frequent extraintestinal markers of subclinical CD were iron-deficiency anemia (102/198), dermatitis herpetiformis (16/57), IDDM (10/57), short stature (17/198). 49/625 (7.8%) patients presented an autoimmune disorder at the moment of CD diagnosis, while 8 subjects developed autoimmunity after CD diagnosis (mean age at CD diagnosis of 10.3 y). Along the years, the number of diagnosis impressively increased ranging from 91 in 1977–1987, to 226 in 1988–1997 and to 308 in 1998–2002. In the past the CD patients were referred mostly because of gastrointestinal symptoms; more recently atypical manifestation and autoimmunity has been associated to CD. Conclusion: This study confirms the extremely polymorphic nature of this condition that can affect several organs and apparatus even without gastrointestinal symptoms. CD should be role out in any case of unexplained or unresponsive disease. In particular patients with autoimmune disorder should be consider at risk for CD.