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Objectives To compare celiac disease ( CD) in older and younger adults and to assess the effects of a gluten-free diet ( GFD). Design Retrospective retrieval of information prospectively entered into a structured database. Setting CD clinic, University and Spedali Civili, Brescia, Italy. Participants Two cohorts were identified (older, Group A, n = 59, >65; younger, Group B, n = 1,166, 18-64), and Group B was subgrouped ( B1, n = 600, 18-34; B2, n = 440, 35-49; and B3, n = 26, 50-64). Measurements Clinical, serological, and histological characteristics of individuals with CD studied before and during a GFD. Results At presentation, weight loss (37% vs 21%, P = .005) and dyspepsia (22% vs 12%, P = .04) were more frequent in older than younger participants. Incidence at diagnosis of non- Hodgkin's lymphoma ( NHL) was much higher in older (5%) than younger participants (0.3%, P = .003). Prevalence of osteoporosis was 67% in older and 14% in younger male participants and 70% in older and 9% in younger female participants ( P < .001). During treatment, adherence to a GFD was 90%, normal villous structure was reconstituted, and t-transglutaminase antibodies were negative in 80% of older and younger participants. Lumbar-sacral and femoral T scores increased significantly during a GFD in pooled results of 48 older and younger participants studied before and during GFD. Conclusion NHL is already present at CD diagnosis in most cases in individuals aged 50 and older, emphasizing the importance of early diagnosis. Older and younger individuals are equally adherent and equally benefit from a GFD, indicating that older age is not a barrier to dietary treatment. [ABSTRACT FROM AUTHOR]