Celiac disease more prevalent in children with irritable bowel syndrome

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1. The prevalence of celiac disease in children with Irritable bowel syndrome (IBS) was found to be four times higher as compared to the general population. 

Evidence Rating Level: 1 (Excellent)    

Study Rundown: Recurrent abdominal pain in school-aged children results in a large number of visits to the pediatric gastroenterologists and general pediatricians.  A recent meta-analysis examining the prevalence of celiac disease in the adult population found a 4-fold increase in prevalence of celiac disease in patients with IBS.  In this study, the researchers assessed the prevalence of celiac disease in each symptom based functional gastrointestinal disorder as categorized by the Rome III criteria.

The researchers found that the prevalence of celiac disease in children categorized as having IBS was significantly increase while patients in the categories of functional dyspepsia and functional abdominal pain did not have a significant increase in prevalence as compared to the general pediatric population.  Readers should be aware that there was no control group in this study.  However, larger epidemiologic studies establishing the rates of celiac disease in Italian children have been done before.  Moreover, the children studies in this trial were patients referred to a specialty clinic.  Therefore, there is always concern for referral bias.

Click to read the study in JAMA Pediatrics

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

In-Depth [prospective cohort]:  This study was conducted at the University hospital of Bari, Italy over a 6-year period.  A total of 992 patients between the ages of 4 and 16 were seen and classified according to the Rome III criteria.  270 were classified as having IBS.  201 children were categorized under functional dyspepsia and 311 were diagnosed with functional abdominal pain.  210 were excluded from the study, for organic gastrointestinal disease or other functional gastrointestinal diseases.  All the included children had serologic testing performed, and patients with serology suggestive of celiac disease received endoscopy and biopsy.  4.4% [95% CI (2.5-7.6)] of patients with IBS were diagnosed with celiac disease, while 1% [95% CI (0.2-3.5)] and 0.3% [95% CI (0.1-1.7)] of the functional dyspepsia and functional abdominal pain groups respectively were diagnosed with celiac disease.

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