The epidemiology of coeliac disease (CD) is changing. Presentation of CD with malabsorptive symptoms or malnutrition is now the exception rather than the rule and it now affects those underweight and overweight equally. In concert with these epidemiological shifts, the incidence of CD is increasing. These changing patterns of disease presentation are challenging traditional management paradigms and clinicians need to move with these changes and respond to the demands of an increasingly well-informed consumer population. What is the gold standard for CD diagnosis? What should the goals of treatment be? How should CD be followed up? What is the place of therapeutics in CD? Should there be population screening? Should truly asymptomatic coeliac disease be treated? These are all questions that remain controversial - beginning to answer them will form the basis of this presentation.