Ever since gluten was identified as the causative antigen of celiac disease (CD) in the 1950s, the mainstay of therapy has been life-long gluten elimination. Its success in reversing the severe malabsorption and reducing the sizeable mortality rate not uncommonly seen in young children half a century ago ironically has limited rigorous and systematic evaluation of the gluten-free diet (GFD) as a therapy. Instead, research has focused on improving diagnosis and understanding disease epidemiology. However, with the growing understanding of the clinical burden of untreated or poorly treated CD,1,2 efforts now should be harnessed toward establishing exactly what constitutes appropriate CD management and follow-up evaluation. Current guidelines are vague and/or not evidence-based. With such a background, it not surprising that the study by Herman et al revealed haphazard and deficient follow-up evaluation of patients in a population-based study.