Increased prevalence of celiac disease in children with irritable bowel syndrome

Recurrent abdominal pain affects 10 percent to 15 percent of school-aged children. The prevalence of celiac disease is as high as 1 percent in European countries and patients can present with a wide spectrum of symptoms, including abdominal pain, although the disease is often asymptomatic.

The authors assessed the prevalence of celiac disease in 992 children with abdominal pain-related disorders: IBS, functional dyspepsia (indigestion) and functional abdominal pain. 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 the children and 15 patients tested positive for celiac: 12 (4.4 percent) of the children with IBS, 2 (1 percent) of the children with functional dyspepsia and 1 (0.3 percent) of the children with functional abdominal pain. The prevalence of celiac among children with IBS was four times higher than the general pediatric population.

"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."

Editorial: Role of Celiac Disease Screening for Children with Functional Gastrointestinal Disorders

In a related editorial, James E. Squires, M.D., and colleagues from Cincinnati Children's Hospital Medical Center, Ohio, write: "Based on the study by Cristofori et al, we suggest that selective screening for celiac disease is warranted for children with IBS but not for children with other FGIDS [functional gastrointestinal disorders]. However, the lines distinguishing IBS from alternative FGIDS are often blurred. It is within this reality that pediatric 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."