Childhood celiac disease--gluten-sensitive enteropathy--is defined in its most salient form by malabsorption and disturbed growth in association with a specific histologic lesion of the small intestine. Celiac disease occurs in response to grain consumption in susceptible individuals. Although subtotal villus atrophy with crypt hyperplasia has, in the past, been considered essential for the diagnosis, a spectrum of histologic lesions are now appreciated. The advances in the field of diagnosis (specifically, the recent development of serologic diagnostic tests) have been instrumental in correlating the histopathology of patients with subtle clinical features of the disease. Through observations, an expansion of the clinical findings associated with the condition has evolved that has helped to unfold the pathophysiology. As a result, celiac disease is now recognized as an autoimmune enteropathy of the small intestine with a broad spectrum of clinical manifestations.