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Coeliac disease more common in children with IBS

Could coeliac screening in abdominal pain be restricted to those with IBS?

Louise Prime

Tuesday, 22 April 2014

Coeliac disease is more prevalent among children with irritable bowel syndrome than among others with abdominal pain-related problems, shows research. Authors of the study*, published online today in JAMA Pediatrics, say their findings could help to select those children who need further testing.

Researchers in Italy evaluated 992 boys and girls (median age nearly 7 years) whose GPs had referred them for investigation of recurrent abdominal pain. Of these, they classified 270 as having IBS, 201 as having functional dyspepsia, and 311 as having functional abdominal pain.

They excluded the 210 children who had an organic disorder or some other functional gastrointestinal disorder (not related to abdominal pain). They then performed serological testing on the remaining 782 children – measuring concentrations of IgA, IgA antitissue transglutaminase, and endomysial antibodies – and a duodenal biopsy in case of antibody positivity.

This showed coeliac disease in 4.4% of children with IBS, compared with 1.0% of children with functional dyspepsia and just 0.3% of those with functional abdominal pain. The study authors said that because children presenting with IBS have a four times higher risk of having coeliac disease than children without IBS (odds ratio 4.19), their results could help to cut the costs of care – rather than indiscriminately testing for coeliac disease in all children with recurrent abdominal pain, this could be extended only to those with IBS.

They concluded: “The prevalence of coeliac disease among children with IBS is four times higher than among the general paediatric population. Rome III classification of abdominal pain-related functional gastrointestinal disorders might help to select children who deserve screening for celiac disease.”

The authors of a related editorial** largely concurred and suggested that, based on this study, “selective screening for celiac disease is warranted for children with IBS but not for children with other FGIDS [functional gastrointestinal disorders]”. However, they added a note of caution: “The lines distinguishing IBS from alternative FGIDS are often blurred. It is within this reality that paediatric health care providers should examine the evidence, evaluate the patient and family, weigh the likelihood of a false positive test result, and make the decision that they believe will benefit the patient most.”

* Cristofori F, Fontana C, Magistà A et al. Increased Prevalence of Celiac Disease Among Pediatric Patients With Irritable Bowel SyndromeA 6-Year Prospective Cohort Study. JAMA Pediatr. Published online April 21, 2014. doi:10.1001/jamapediatrics.2013.4984

** Squires J, Lin Fei, Cohen M. Role of Celiac Disease Screening for Children With Functional Gastrointestinal Disorders. JAMA Pediatr. Published online April 21, 2014. doi:10.1001/jamapediatrics.2013.5418

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