Children with Irritable Bowel Syndrome Are Likely to Also Have Celiac Disease

Children with irritable bowel syndrome (IBS) are 4 times more likely to have co-occurring celiac disease, according to research published online April 21, 2014 in JAMA Pediatrics.

From 2006 to 2012, a team of researchers from various hospitals in Italy studied 992 children with a median age of 6.8 years. All of the study participants had been consecutively referred to specialists by their primary care physicians (PCPs) for recurrent abdominal pain without previous investigation.

The children were classified as having either IBS, functional dyspepsia, functional abdominal pain, or abdominal migraine using Rome III criteria. The researchers were able to exclude 210 children because they had an organic disorder or a different gastrointestinal (GI) disorder unrelated to abdominal pain. Of the remaining 782 children, 270 were classified as having IBS, 201 had functional dyspepsia, and 311 had functional abdominal pain.

All of the remaining patients were serologically tested, and 15 were found to have celiac disease: 12 of the patients with IBS (4.4%), 2 of the children with functional dyspepsia (1%), and one of the participants with functional abdominal pain (0.3%).

The investigators determined children with IBS had a 4 times greater risk of having celiac disease than those without IBS.

“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 wrote.

In an accompanying editorial, James E. Squires, MD, and colleagues from the Cincinnati Children’s Hospital Medical Center in Ohio, encouraged PCPs to screen children with IBS for celiac disease, but not all abdominal or GI pain.

“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. It is within this reality that pediatric healthcare providers should examine the evidence, evaluate the patient and family, weigh the likelihood of a false positive test result, and make the decision that they believe will benefit the patient most.”

Mitchell Cohen, MD, a co-author of the accompanying editorial, added “children who have both FGIDS, eg, IBS, are at increased risk for celiac disease, and children who have both can take comfort in knowing that they are not alone.”

“Screening of children with IBS in which the pain has a strong relationship to bowel movements and is most often associated with constipation, diarrhea, or both is warranted,” Cohen wrote.