Abdominal Pain and Functional Gastrointestinal Disorders in Children with Celiac Disease

doi:10.1016/j.jpeds.2012.08.032

The Journal of Pediatrics

Volume 162, Issue 3, March 2013, Pages 505-509

https://doi.org/10.1016/j.jpeds.2012.08.032 Get rights and content

Objective

To assess whether patients with celiac disease (CD) are more likely than controls to develop abdominal pain (AP) and AP-associated functional gastrointestinal disorders (FGID) in long-term follow-up.

Study design

In a retrospective study, data on children (3-22 years old) with CD diagnosed between 2000 and 2010 were obtained. Parents were contacted by telephone at least 6 months after the diagnosis of CD and invited to participate in the study. Consenting parents completed: (1) a telephone questionnaire on the presence of gastrointestinal symptoms; and (2) the parent report version of the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III for cases and selected controls.

Results

Forty-nine cases (mean 11.3 years, 20 male participants) and 48 controls (mean 11.1 years, 24 male participants) were enrolled. Twelve children in the CD group (24.5%) and 7 children in the control group (14.6%) had AP at the time of the study (P = .3). Nine children in the CD group (18.3%) and 4 children in the control group (8.3%) met criteria for an AP-associated FGID according to the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III (P = .23).

Conclusion

It was found that children with CD and controls have a similar risk of AP and AP-FGIDs. Methodologic limitations prevent generalization of results, but large prospective studies should confirm the findings.

Section snippets

Methods

Data on children (3-22 years old) with CD diagnosed at Children's Memorial Hospital between 2000 and 2010 were obtained. Charts were reviewed and the pathologic diagnosis of CD was confirmed in all cases. Children who had a wrong diagnosis or developmental delay and those from non–English-speaking families were excluded. Parents were contacted by telephone at least 6 months following the diagnosis of CD and invited to participate in the study. Consenting parents completed: (1) a telephone

Results

Forty-six families participated in the study (43 families had 1 child with CD and 3 families had 2 children with CD). Forty-nine cases (mean 11.3 years, 20 male participants) and 48 controls (mean 11.1 years, 24 male participants) were enrolled; 43 of the 49 children with CD had at least 1 sibling who was included as a control in the study (Figure). For 16 patients who lacked a sibling control, a second sibling was recruited in 13 cases and a cousin in 2 cases. Twenty-two patients who were

Discussion

This study assessed the long-term risk of AP in children with CD. The focus of our study differs from that of most studies. Although most studies have focused on the possible relation between CD and FGIDs at the time of diagnosis, we were interested in the long-term relation among CD, AP, and AP-FGIDs. Previous studies on various gastrointestinal inflammatory conditions have consistently found that children with gastrointestinal inflammation were at risk of developing AP and AP-FGIDs. Children

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Cited by (13)

Functional Abdominal Pain Disorders and Constipation in Children on Gluten-Free Diet
2021, Clinical Gastroenterology and Hepatology
Citation Excerpt :
With the assumption that IBS would be expected in 4.2% of the general Italian pediatric population17 and in 7.3% of CD patients,18 we calculated that a sample of 371 children with CD would be required for the study to have 80% power based on a 2-sided type 1 error rate of 5%. This sample size has a 95% power based on a 2-sided type 1 error rate of 1% to identify a difference in the prevalence of FAPD in CD patients vs controls considering a prevalence of FAPD in 9% of controls17 and in 18% of CD patients.18–20 Risk models were developed using a decisional tree.
We studied the prevalence of functional abdominal pain disorders (FAPDs) and functional constipation (FC) in a large prospective cohort of children with celiac disease on a strict gluten-free diet (GFD).
We performed a prospective cohort study, from 2016 through 2018, in a tertiary care center in Italy, of 417 patients (37% male; mean age, 13.7 y) with a diagnosis of celiac disease (European Society for Paediatric Gastroenterology Hepatology, and Nutrition criteria) who had been on a strict GFD for more than 1 year and had negative results from serologic tests after being on the GFD. Parents and children (>10 y) were asked to fill in a questionnaire on pediatric gastrointestinal symptoms, according to Rome IV criteria. Patients’ closest siblings (or cousins) who had negative results from serologic test for celiac disease were used as controls (n = 373; 39% male; mean age, 13.5 y).
We found a higher prevalence of FAPDs among patients with celiac disease (11.5%) than controls (6.7%) (P < .05); the relative risk (RR) was 1.8 (95% CI, 1.1–3.0). Irritable bowel syndrome (IBS) and FC defined by the Rome IV criteria were more prevalent in patients with celiac disease (7.2% for IBS and 19.9% for FC) than controls (3.2% for IBS and 10.5% for FC) (P < .05 and P < .001, respectively); the RR for IBS was 2.3 (95% CI, 1.1–4.6) and the RR for functional constipation was 2.1 (95% CI, 1.4–3.2). We found no differences in the prevalence of other subtypes of FAPDs. A logistic regression showed that younger age (P < .05) and a higher level of anti–transglutaminase IgA at diagnosis (P < .04) were associated with FAPDs (in particular for IBS) irrespective of GFD duration.
Celiac disease is associated with an increased risk of IBS and FC. Strategies are needed to manage IBS and FC in patients with celiac disease.
Abdominal Pain-Associated Functional Gastrointestinal Disorder Prevalence in Children and Adolescents with Celiac Disease on Gluten-Free Diet: A Multinational Study
2017, Journal of Pediatrics
Citation Excerpt :
For the purpose of this study, children who had 2 months of AP as required by the Rome III criteria for the diagnosis of an AP-FGID but did not meet the frequency of symptoms required in the criteria were given a diagnosis of chronic AP. Our previous study of CD and siblings with AP-FGID required a sample size of 44 subjects per group to demonstrate a significant difference between 2 groups (CD vs each control group) based on a power of 80% and an alpha of 0.05.25 The sample size for this study was doubled empirically to improve the power of the study.
To test the hypothesis that children with celiac disease (CD) on gluten-free diet are at increased risk of abdominal pain (AP) associated-functional gastrointestinal disorders (FGIDs).
This was a multinational cross-sectional study performed from 2014 to 2015. Patients 4-18 years of age with CD on gluten-free diet for longer than 6 months were recruited from pediatric CD clinics in US and Italy. Control groups included siblings of children with CD (with normal tissue transglutaminase levels) and unrelated controls. Subjects or parents completed the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III.
Children (n = 289) were recruited (55% US, 45% Italy): 96 children with CD, 96 sibling controls, and 97 unrelated controls. Chronic AP was present in 30 (30.9%) subjects with CD, 22 (22.7%) sibling controls, and 21 (21.6%) unrelated controls (P = .26 patients with CD vs siblings; P = .18 patients with CD vs unrelated; P = .96 siblings vs unrelated). AP-FGIDs were present in 8 (8.2%) subjects with CD, 8 (8.2%) sibling controls, and 2 (2.1%) unrelated controls (P = 1.00 subjects with CD vs sibling controls; P = .06 subjects with CD vs unrelated controls; P = .06 sibling controls vs unrelated controls).
This multinational study evaluated the prevalence of chronic abdominal pain and AP-FGIDs in the pediatric population with CD. We found that subjects with CD and controls have a similar prevalence of chronic AP and AP-FGIDs. This suggests that not all types of gastrointestinal inflammation result in AP-FGIDs in children.
Prevalence of functional gastrointestinal disorders in Mexican schoolchildren
2017, Revista de Gastroenterologia de Mexico
Los trastornos funcionales gastrointestinales se encuentran entre las condiciones crónicas más comunes en niños a nivel mundial. Estudios en escolares de varios países de Latinoamérica mostraron una alta prevalencia de estos trastornos. Nuestro objetivo fue determinar la prevalencia de desórdenes funcionales gastrointestinales en escolares de México de acuerdo con los criterios de Roma III.
Escolares de escuelas privadas y públicas de Monterrey y Cuernavaca completaron en forma privada la traducción al español del Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III (QPGS-III) en clase usando los mismos métodos que han sido utilizados por nuestro grupo en otros estudios en varios países de Latinoamérica.
Un total de 362 niños y adolescentes (escuela pública 84, escuela privada 329) con una edad promedio de 11.6 ± 2.1 años completaron el QPGS-III. Noventa y nueve escolares (27.3%) conformaron los criterios para un trastorno funcional gastrointestinal de acuerdo con los criterios de Roma III. Estreñimiento funcional fue el desorden funcional gastrointestinal más común (12.6%). El síndrome de intestino irritable (6.4%) fue el desorden funcional gastrointestinal asociado con dolor más comúnmente diagnosticado. No encontramos predominio de sexo en la prevalencia de desórdenes funcionales gastrointestinales (p = 0.8).
Los trastornos funcionales gastrointestinales son comunes en niños y adolescentes mexicanos de edad escolar.
Functional gastrointestinal disorders are among the most common chronic disorders in children worldwide. Studies in schoolchildren from various Latin American countries have shown a high prevalence of functional gastrointestinal disorders, but their prevalence in Mexican schoolchildren is unknown. Our aim was to assess the prevalence of functional gastrointestinal disorders in Mexican schoolchildren in accordance with the Rome III criteria.
Children and adolescents from public and private schools in Monterrey and Cuernavaca privately completed the Spanish version of the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III Version (QPGS-III) in class, using the same methods and questionnaires of previous studies conducted by our group in other Latin American countries.
A total of 362 schoolchildren (public school 82, private school 280), with a mean age of 11.6 ± 2.1 years completed the QPGS-III. Ninety-nine schoolchildren (27.3%) met the criteria for a FGID, according to the Rome III criteria. Functional constipation was the most common FGID (12.6%). Irritable bowel syndrome (6.4%) was the most common FGID associated with abdominal pain. There was no significant difference in the prevalence of FGIDs between sexes (P=.8).
We found a high prevalence of FGIDs in Mexican school-aged children and adolescents.
Overlap between functional abdominal pain disorders and organic diseases in children
2018, Revista de Gastroenterologia de Mexico
Los trastornos funcionales de dolor abdominal tienen una alta prevalencia en los niños. Estos trastornos pueden estar presentes por sí solos o en combinación con enfermedades orgánicas, tales como la enfermedad celíaca y las enfermedades inflamatorias intestinales. La inflamación intestinal (infecciosa y no infecciosa) predispone a los niños al desarrollo de hipersensibilidad visceral que puede manifestarse como trastornos funcionales de dolor abdominal, entre ellos el síndrome de intestino irritable. La aparición de síntomas de síndrome de intestino irritable en un paciente con una enfermedad orgánica subyacente, como la enfermedad inflamatoria intestinal, es un reto clínico, dado que la misma sintomatología puede representar un periodo de exacerbación de la enfermedad inflamatoria intestinal o un trastorno de dolor abdominal funcional sobrepuesto. Así mismo, puede ser que los síntomas del síndrome de intestino irritable en un niño con diagnóstico de enfermedad celíaca ocurran por un inadecuado control de la enfermedad celíaca o por la sobreposición con un trastorno de dolor abdominal funcional. Existe poca investigación acerca de la sobreposición de los trastornos funcionales abdominales y las enfermedades orgánicas en niños. Los estudios sugieren que la sobreposición entre los trastornos funcionales de dolor abdominal y la enfermedad inflamatoria intestinal es más común en adultos que en niños. Las causas de estas diferencias de prevalencia son aún desconocidas. Solo se han publicado unos cuantos estudios que tratan el tema de la sobreposición entre la enfermedad celíaca y los trastornos funcionales abdominales en niños. El presente artículo proporciona una revisión de la literatura acerca de la sobreposición entre la enfermedad celíaca, la enfermedad inflamatoria intestinal, y los trastornos funcionales de dolor abdominal en niños, además de establecer comparaciones con estudios realizados en adultos.
Functional abdominal pain disorders are highly prevalent in children. These disorders can be present in isolation or combined with organic diseases, such as celiac disease and inflammatory bowel diseases. Intestinal inflammation (infectious and non-infectious) predisposes children to the development of visceral hypersensitivity that can manifest as functional abdominal pain disorders, including irritable bowel syndrome. The new onset of irritable bowel syndrome symptoms in a patient with an underlying organic disease, such as inflammatory bowel disease, is clinically challenging, given that the same symptomatology may represent a flare-up of the inflammatory bowel disease or an overlapping functional abdominal pain disorder. Similarly, irritable bowel syndrome symptoms in a child previously diagnosed with celiac disease may occur due to poorly controlled celiac disease or the overlap with a functional abdominal pain disorder. There is little research on the overlap of functional abdominal disorders with organic diseases in children. Studies suggest that the overlap between functional abdominal pain disorders and inflammatory bowel disease is more common in adults than in children. The causes for these differences in prevalence are unknown. Only a handful of studies have been published on the overlap between celiac disease and functional abdominal pain disorders in children. The present article provides a review of the literature on the overlap between celiac disease, inflammatory bowel disease, and functional abdominal pain disorders in children and establish comparisons with studies conducted on adults.
Is the clinical pattern of pediatric celiac disease changing? A thirty-years real-life experience of an Italian center
2021, Italian Journal of Pediatrics
Recurrent or chronic abdominal pain of digestive cause-what is useful in the diagnostics?
2020, Romanian Journal of Pediatrics

View all citing articles on Scopus

: The authors declare no conflicts of interest.

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Original ArticleAbdominal Pain and Functional Gastrointestinal Disorders in Children with Celiac Disease

Objective

Study design

Results

Conclusion

Section snippets

Methods

Results

Discussion

J Pediatr

Am J Gastroenterol

Gastroenterology

Clin Gastroenterol Hepatol

J Biol Chem

Am J Gastroenterol

A prospective community-based study of gastroenterological symptoms in school-age children

J Pediatr Gastroenterol Nutr

Celiac sprue

N Engl J Med

Coeliac disease presenting with symptoms of irritable bowel syndrome

Aliment Pharmacol Ther

Yield of diagnostic tests for celiac disease in individuals with symptoms suggestive of irritable bowel syndrome: systematic review and meta-analysis

Arch Intern Med

The prevalence of occult celiac disease among patients with functional dyspepsia: a study from the western region of Iran

Gastroenterol Res Pract

Prevalence of celiac disease among dyspeptic patients: a community-based case-control study

Turk J Gastroenterol

Prevalence of celiac disease in adult patients with refractory functional dyspepsia: value of routine duodenal biopsy

World J Gastroenterol

A million-dollar work-up for abdominal pain: is it worth it?

J Pediatr Gastroenterol Nutr

Recurrent abdominal pain and irritable bowel syndrome in children

J Pediatr Gastroenterol Nutr

Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

J Pediatr Gastroenterol Nutr

European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease

J Pediatr Gastroenterol Nutr

Original Article
Abdominal Pain and Functional Gastrointestinal Disorders in Children with Celiac Disease