Celiac Disease Linked to IBS in Kids

Celiac disease more common in children with irritable bowel syndrome

(RxWiki News) Celiac disease is not common among children, but it may have been underdiagnosed until recent years. Knowing risk factors for it may help parents.

A recent study found that children with irritable bowel syndrome were four times more likely to have celiac disease than children without irritable bowel syndrome.

The findings were based on a study of nearly 1,000 children in Italy who were assessed for stomach problems.

The study findings mean that parents of children with irritable bowel syndrome may want to ask about screening for celiac disease.

"Ask your pediatrician about celiac disease screening."

The study, led by Fernanda Cristofori, MD, of the Pediatric Section of the University of Bari and Giovanni XXIII Hospital in Italy, aimed to find out whether celiac disease was more common among children with gastrointestinal disorders.

For six years, the researchers followed 992 children who were referred by their doctors to an Italian hospital for abdominal pain.

The children were classified as having either irritable bowel syndrome, abdominal pain or upset stomach/indigestion.

Then the researchers assessed how many children with each of these diagnoses had celiac disease based on blood tests.

Among the children in the study, 270 had irritable bowel syndrome, 201 had an upset stomach/indigestion, and 311 had abdominal pain.

The remaining 210 children were excluded from the study because they ended up having a different disorder not related to abdominal pain.

In the remaining 782 children, 15 of them tested positive for celiac disease. Twelve of these children were in the group with irritable bowel syndrome, or 4.4 percent of those with irritable bowel syndrome.

Only one child with celiac disease was in the group with abdominal pain, and two were in the group with upset stomach/indigestion.

The researchers therefore determined that children with irritable bowel syndrome had four times greater odds of having celiac disease than children without the gastrointestinal disorder.

However, the overall incidence of celiac disease, even among those with irritable bowel syndrome, is still low.

"The identification of irritable bowel syndrome as a high-risk condition for celiac disease might be of help in pediatric primary care," the researchers wrote, because it can help limit how many children need to be screened for celiac.

Limiting the number of children screened for celiac is important because tests for the disease are "false-positive" about two thirds of the time, according to an editorial accompanying the study.

That means that only one third of the children who test positive for celiac disease actually have it. Therefore, testing children without a specific reason would result in treating children for a disease they do not have.

In the editorial, James Squires, MD, and two colleagues recommend that only children with irritable bowel syndrome, and not other gastrointestinal upset, be screened for celiac.

Thomas Seman, MD, a pediatrician at North Shore Pediatrics in Danvers, Mass. said that complaints about abdominal pain are very common among children coming into the pediatrician's office but that celiac disease is still not an extremely common disease.

"The study does point out that the primary care provider must consider celiac disease in mind when evaluating a child," he said. "However, when viewed the other way, 95.6 percent of children with abdominal pain and a diagnosis of irritable bowel syndrome have IBS only."

He continued, "Although it may influence the work-up somewhat when seeing a child for the first time with unexplained stomachache, I do not see that it will likely make a significant change in the treatment of IBS."

The study was published April 21 in the journal JAMA Pediatrics. The research funding was not provided. The authors reported no conflicts of interest.

Review Date: 
April 19, 2014