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Pediatric IBS increases the likelihood of celiac disease

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Four times higher risk among children with irritable bowel syndrome

Recurrent abdominal pain is a common 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), but few studies are available concerning children.

Chronic or recurrent bellyaches are common and affect 10% of all school age children. The prevalence of celiac disease is as high as one percent in European countries with similar rates in the United States. There are more than 300 symptoms of celiac disease, and symptoms may vary among different people. Symptoms include abdominal pain, constipation and fatigue.

In this new study Dr. Fernanda Cristofori, MD, of the University of Bari, Italy, and colleagues assessed the prevalence of celiac disease among children with abdominal pain; IBS, functional dyspepsia (indigestion) and functional abdominal pain.

The study included 992 children with an average age of 6.8 years and 42.8% were male. Among the children 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. The final study group included 782 children: 270 with IBS, 201with functional dyspepsia and 311 with functional abdominal pain.

Blood tests were performed on all children, 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%]).

Among children with IBS the prevalence of celiac disease was four times higher in comparison to the general pediatric population.

In their conclusion the researchers write ““The identification of IBS as a high-risk condition for celiac disease might be of help in pediatric primary care because it might have become routine to test for celiac disease indiscriminately in all children with recurrent abdominal pain, although our finding suggests that the screening should be extended only to those with IBS. This new approach might have important implications for the cost of care because it has been estimated that in children with FGIDs, screening tests are common, costs are substantial, and the yield is minimal.”

Dr. James E. Squires, MD and colleagues from Cincinnati Children's Hospital Medical Center, Ohio, in a related editorial write “A study in this issue of JAMA Pediatrics by Cristofori et al tries to address this paucity of knowledge. The authors extend recent discoveries in the adult population to the pediatric population and report a 4-fold higher prevalence of celiac disease among children who meet clinical criteria for irritable bowel syndrome (IBS). With this important new information arises the obvious question: is celiac disease screening warranted for all children with a suspected functional etiology for their abdominal pain?

This study is published in JAMA Pediatrics,

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