Impact of delay in diagnosis in patients with celiac disease: A study of 570 patients at a tertiary care centerThe clinical presentation of celiac disease (CD) is highly variable, ranging from gastrointestinal symptoms from malabsorption, extraintestinal manifestations to being asymptomatic. Consequently, a significant proportion of patients may remain undiagnosed, be misdiagnosed, or experience diagnostic delays [1]. The implications of delayed diagnosis are less well studied. Dhar et al. from the Postgraduate Institute of Medical Education and Research, Chandigarh, India, report a retrospective analysis of 570 individuals with CD [2]. Patients were divided into an early-diagnosis (≤ 3 years; 289 patients) or a late-diagnosis (> 3 years; 281 patients) group.Patients in the late-diagnosis group had lower rates of diarrhea as the presenting symptom but higher rates of anemia, pubertal delay, and menstrual irregularities as well as laboratory abnormalities with lower hemoglobin, ferritin, and vitamin D levels and higher anti-tissue transglutaminase antibody titers with higher grades of villous atrophy at presentation. Among unmet needs for CD, physician awareness of diagnostic criteria, improved access to specialist assessment, and the impact of education about gluten-free eating as well as access and availability of gluten-free foods to support adherence need further study.