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Original Investigation |

Increased Prevalence of Celiac Disease Among Pediatric Patients With Irritable Bowel Syndrome:  A 6-Year Prospective Cohort Study

Fernanda Cristofori, MD1; Claudia Fontana, MD1; Annamaria Magistà, MD2; Teresa Capriati, MD1; Flavia Indrio, MD1; Stefania Castellaneta, MD3; Luciano Cavallo, MD1; Ruggiero Francavilla, MD, PhD1
[+] Author Affiliations
1Interdisciplinary Department of Medicine, Pediatric Section, University of Bari, Giovanni XXIII Hospital, Bari, Italy
2Department of Pediatrics, Ravenna Hospital, Ravenna, Italy
3Department of Pediatrics, San Paolo Hospital, Bari, Italy
JAMA Pediatr. 2014;168(6):555-560. doi:10.1001/jamapediatrics.2013.4984.
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Importance  Recurrent abdominal pain is a prevalent health issue in childhood. Clinical criteria (ie, the Rome criteria) have been established to aid diagnosis. Studies of adults have shown an increased prevalence of celiac disease among patients with irritable bowel syndrome (IBS); few data are available with regard to children.

Objective  To assess the prevalence of celiac disease among children with abdominal pain–related functional gastrointestinal disorders classified according to the Rome criteria.

Design, Setting, Participants  Six-year (2006-2012) prospective cohort study conducted in a tertiary referral center for the diagnosis and follow-up of gastrointestinal disorders in southern Italy (ie, Bari, Italy). A total of 992 children (42.8% male; median age, 6.8 years) consecutively referred for recurrent abdominal pain by their primary care physicians without previous investigation were evaluated.

Exposure  Patients were classified according to Rome III criteria as having IBS, functional dyspepsia, functional abdominal pain, or abdominal migraine.

Main Outcomes and Measures  Prevalence of celiac disease in each category of abdominal pain–related functional gastrointestinal disorder. Concentrations of IgA, IgA antitissue transglutaminase, and endomysial antibodies were measured, and a duodenal biopsy was performed in case of antibody positivity.

Results  A total of 992 children were evaluated: 270 were classified as having IBS, 201 as having functional dyspepsia, and 311 as having functional abdominal pain, and 210 children were excluded from the study because they had an organic disorder or some other functional gastrointestinal disorder (not related to abdominal pain). Serologic testing was performed for all 782 children included in the study, and 15 patients tested positive for celiac disease (12 of 270 patients with IBS [4.4%], 2 of 201 patients with functional dyspepsia [1%], and 1 of 311 patients with functional abdominal pain [0.3%]). Children presenting with IBS have a 4 times higher risk of having celiac disease than children without IBS (odds ratio, 4.19 [95% CI, 2.03-8.49]; P < .001).

Conclusions and Relevance  The prevalence of celiac disease among children with IBS is 4 times higher than among the general pediatric population. Rome III classification of abdominal pain–related functional gastrointestinal disorders might help to select children who deserve screening for celiac disease.

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