The clinical presentation of celiac disease in children changed in the last decades of the 20th century. To ascertain whether changes are still in progress, we analyzed symptoms at presentation and age at diagnosis in 307 children receiving diagnoses of celiac disease for the past 20 years. The prevalence of typical forms of celiac disease decreased in the past decade, particularly in the past 5 years (from 76% in 1987-1990 to 44%, P < 0.0001). Age at diagnosis (5.9 y, P = 0.01) and silent forms (10.6%, P = 0.003) have significantly increased in the past 5 years. Histological examination showed decreased subtotal and increased partial villous atrophy prevalence (P = 0.02).