There has been considerable interest in celiac disease both in specialized and lay audiences during the past two decades, after it was shown to be much more prevalent in general population than previously thought. This disease can have a wide variety of clinical presentations, ranging from a silent form to a full-blown, sometimes severe disease. The diagnosis of celiac disease requires a high degree of suspicion, is fraught with potential pitfalls, and is a very rigorous process, given the protean nature of the disease. Clinicians should perform appropriate serum testing and conclude with the diagnostic “gold standard”: documenting the hallmark histological findings in a small bowel biopsy. This paper reviews potential causes of celiac disease misdiagnosis. Abstract available from the publisher.