We studied the prevalence of functional abdominal pain disorders (FAPDs) and functional constipation (FC) in a large prospective cohort of children with coeliac disease on strict gluten free diet (GFD).
We performed a prospective cohort study, from 2016 through 2018, in a tertiary care center in Italy, of 417 patients (37% male; mean age, 13.7 years) with a diagnosis of coeliac disease (ESPGHAN criteria) who had been on a strict GFD for more than 1 year and had negative results from serologic tests after being on the GFD. Parents and children (older than 10 years) were asked to fill in a questionnaire on paediatric gastrointestinal symptoms, according Rome IV criteria. Patients’ closest siblings (or cousins) who had negative results from serologic test for coeliac disease were used as controls (n=373; 39% male; mean age, 13.5 years).
We found a higher prevalence of FAPDs among patients with coeliac disease (11.5%) than controls (6.7%) (P<0.05); the relative risk (RR) was 1.8 (95% CI, 1.1-3.0). Irritable bowel syndrome (IBS) and functional constipation (FC) defined by the Rome IV criteria, were more prevalent in patients with coeliac disease (7.2% for IBS and 19.9% for FC) than controls (3.2% for IBS and 10.5% for FC) (P<.05 and P<.001); the RR for IBS was 2.3 (95% CI, 1.1-4.6) and the RR for functional constipation was 2.1 (95% CI, 1.4-3.2). We found no differences in the prevalence of other subtypes of FAPDs. A logistic regression showed that younger age (P<.05) and a higher level of anti-transglutaminase IgA at diagnosis (P<.04) were associated with FAPDs (in particular for IBS) irrespective of GFD duration.
Coeliac disease is associated with an increased risk of IBS and FC. Strategies are needed to manage IBS and FC in patients with coeliac disease.
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