Celiac Disease Screening Should Focus on Kids With IBS

Marcia Frellick

April 21, 2014

Children with irritable bowel syndrome (IBS) were 4 times more likely to have celiac disease than the general pediatric population, researchers report in a study published online April 21 in JAMA Pediatrics. According to the findings from the prospective study, screening should focus on children with IBS instead of generally among children reporting recurrent abdominal pain, the authors advise.

Previous studies of adults have shown a strong link between celiac disease and IBS, but few data were available on children.

Fernanda Cristofori, MD, from the University of Bari, Italy, and colleagues note that recurrent abdominal pain affects 10% to 15% of school-aged children and accounts for more than 50% of the consultations in pediatric gastroenterology and 2% to 4% of all general pediatric office visits.

To estimate the prevalence of celiac disease in children with recurrent abdominal pain, the researchers tested 782 children who presented with abdominal, pain-related disorders: 270 with IBS, 201 with functional dyspepsia, and 311 with functional abdominal pain.

The prospective observational study was conducted between 2006 and 2012 at the university hospital of Bari, which is the tertiary referral center for gastrointestinal disorders in the region. The researchers used serum tests for immunoglobulin A, immunoglobulin A antitissue transglutaminase, and endomysial antibodies as an initial screen for celiac disease and confirmed the diagnosis with upper endoscopy, including multiple duodenal biopsies.

Fifteen patients tested positive for celiac: 12 (4.4%; 95% confidence interval [CI], 2.5% - 7.6%) of the children with IBS, 2 (1.0%; 95% CI, 0.2% - 3.5%) of those with functional dyspepsia, and 1 (0.3%; 95% CI, 0.1% - 1.7%) of the children with functional abdominal pain.

"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," the authors write.

In an accompanying editorial, James E. Squires, MD, from the Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center in Ohio, and colleagues 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 [functional gastrointestinal disorders (FGIDs)]. However, the lines distinguishing IBS from alternative FGIDs are often blurred."

Noting that the blood tests have a relatively high false-positive rate in the general pediatric population, the researchers recommend that pediatricians weigh the possible benefits against the risks, including endoscopy, and consider environmental factors in decisions to screen.

This study was sponsored by the Commonwealth Fund and Aetna. The authors have disclosed no relevant financial relationships.

JAMA Pediatrics. Published online April 21, 2014.


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