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Objective: To determine whether there is a continued increase in the incidence of coeliac disease (CD) in the population of Cardiff and the Vale of Glamorgan between 1996 and 2005 compared with previous data for 1981-1995, and to describe the presenting features during this time., Design: Retrospective case-finding study using pathology, dietetic and clinical records held in hospitals and general practice within Cardiff and the Vale of Glamorgan. All local consultants including those at private hospitals were contacted. Incidence rates were calculated using the Welsh Assembly Government's mid-year estimates., Results: In total, 347 newly diagnosed cases of CD (42 children, 305 adults) were detected. Compared with previous published data, incidence rates in adults per 100 000 have increased from 3.08 at the end of 1995 to 11.13 in 2005. In children, the disease incidence has trebled to 6.89 per 100 000. There have been some changes in presenting symptoms, with a marked preponderance of abdominal pain and bloating in women (P<0.05). There has been a 14-fold increase in the numbers of patients undergoing coeliac serology testing from 1996 to 2005, associated with an increased absolute number of new cases. However, the proportion of new cases diagnosed compared with numbers of serological tests performed decreased from 5.8 to 1.1%., Conclusion: The incidence of CD in children and adults has markedly increased. One of the most striking features of our data in adult CD is the increasing frequency of abdominal pain and bloating in the female cohort. Incorporation of antibody testing into clinical guidelines is likely to result in a wider spectrum of individuals with nonspecific gastrointestinal symptoms being investigated and diagnosed with CD in the future.