Purpose: Screening studies have revealed celiac disease (CD) to be common in the US, however there is scant data on the mode of presentation. We analyzed the trends in clinical presentation over the last 52 years in a large cohort of biopsy-proven patients seen in one center. Methods: Patients (n = 590) were divided into 6 groups, based on year of diagnosis (1952–2004). Groups were compared for trends in age at diagnosis, childhood diagnosis, duration of symptoms, mode of presention (diarrhea, bone disease, anemia, incidental at EGD, screening) and presence of malignancy. Results: There was a highly significant negative linear trend (p <0.001) in presention with diarrhea over time and a positive linear trend (p <0.001) in asymptomatic patients detected by screening. There was no statistical significance over time in those presenting with bone disease, anemia or incidentally at EGD. Diagnosis was at an older age since 1980 (p = 0.007) and there was a significant negative linear trend in the percentage of patients with a childhood diagnosis (p = 0.03) and malignancy (p = 0.02). When comparing those with and without diarrhea, there was no statistical difference in age (42.9 vs 43.7 yr, p = 0.59), gender (29.3% M vs 34.6% M, p = 0.59), presence of childhood CD (8.0% vs 9.8%, p = 0.43) or malignancies (9.8% vs 8.9%, p = 0.71). Lastly, over the 52 years there has been a markedly significant negative linear trend in duration of symptoms (p = 0.001). Conclusions: These trends data reveal that patients are being diagnosed with CD for the first time as adults, at an older age and with a shorter duration of symptoms. Fewer present with diarrhea and more are detected through screening. The majority of patients now present as “silent” CD.Table: Clinical Presentation of CD Patients from 1952 to 2004