Test for Celiac Disease in Children with Irritable Bowel Syndrome

Cornelius W. Van Niel, MD

In a large prospective study, 4% of children with IBS by Rome III criteria had celiac disease.

The overall prevalence of celiac disease in adults with irritable bowel syndrome (IBS) is reported as fourfold higher than in controls. Italian researchers examined the prevalence of celiac disease in nearly 1000 consecutive children (mean age, 7 years) referred to a tertiary gastroenterology clinic for recurrent abdominal pain.

After history, physical exam, growth evaluation, and lab tests, 13% of children were diagnosed with an organic disorder. Using Rome III criteria (≥2 months of frequent abdominal discomfort or pain and 2 of the following: relief with defecation, change in stool frequency, change in stool appearance), 27% met criteria for IBS, 20% for functional dyspepsia, and 31% for functional abdominal pain. The remaining 8% had constipation and other nonpain-related functional gastrointestinal disorders.

Celiac disease antibody testing in all 782 patients with IBS, functional dyspepsia, and functional abdominal pain was positive in 4%, 1%, and 0.3%, respectively. All 15 children with positive antibody tests also had subsequent duodenal biopsies consistent with celiac disease. These 15 children had similar age, growth, and nutrition labs as children with IBS, functional dyspepsia, or functional abdominal pain, but not celiac disease. Only the symptoms supporting Rome III diagnosis of IBS predicted increased risk for celiac disease.

Citation(s):

Cristofori F et al. Increased prevalence of celiac disease among pediatric patients with irritable bowel syndrome: A 6-year prospective cohort study. JAMA Pediatr 2014 Apr 21; [e-pub ahead of print].

Squires JE et al. Role of celiac disease screening for children with functional gastrointestinal disorders. JAMA Pediatr 2014 Apr 21; [e-pub ahead of print].