Italian researchers have determined that irritable bowel syndrome (IBS) in children can be a good indicator for celiac disease, meaning that soon there may be less guesswork involved in diagnosing this chronic condition.
Celiac disease can have a major impact on a child's quality of life when it goes untreated. But a common symptom of celiac disease—abdominal pain—can be hard to use as a marker for the ailment because abdominal pain in children is common. But in a new study, researchers from the Giovanni XXIII Pediatric Hospital at the University of Bari in Italy have found that “the prevalence of celiac disease among children with IBS is 4 times higher than among the general pediatric population.”
Celiac disease damages the lining of the small intestine and prevents it from absorbing necessary nutrients. It's a response to gluten, so many people who have the condition are on gluten-free diets. An estimated 1 in 133 Americans, a little more than 1 percent, have celiac disease, according to theNational Foundation for Celiac Awareness.
More Than a Stomachache
IBS is the broad term for chronic or recurring immune responses and inflammation of the gastrointestinal tract. In the largest pediatric study to investigate the prevalence of celiac disease in each symptom-based category of abdominal pain–related disorders (diagnosed according to Rome III criteria for abdominal pain), researchers evaluated nearly 1,000 children, of whom 270 had IBS. After testing for celiac disease, researchers found that within the IBS group, the incidence of celiac was 4 times higher.
Within the IBS group, 4.4 percent of children were diagnosed with celiac disease; this is strikingly high, given the fact that celiac incidence ranged from 0.3 to 1 percent in non-IBS groups.
“The most surprising finding is that among all children with recurrent abdominal pain, that is a highly frequent condition in children, only those with irritable bowel syndrome (IBS) deserve the screening for celiac disease,” said study co-author Ruggiero Francavilla, M.D., Ph.D.
All children will experience abdominal pain at some point. To determine which kids have IBS, doctors and clinicians need to look look for other clues: “Usually in children suffering from IBS there is a relation between abdominal pain and defecation,” Francavilla said. There is often an improvement with defecation, an onset associated with a change in frequency of stool, and an onset associated with a change in form (appearance) of stool, he explained.
Which Kids Should Get Tested?
If there ever was a prime time for celiac diagnosis, childhood is it. The study's findings point toward more focused testing for celiac disease. “Children who have both functional gastrointestinal disorders, e.g., IBS, are at increased risk for celiac disease. And, children who have both can take comfort in knowing that they are not alone,” said a co-author of an editorial on the study, Mitchell Cohen, M.D., an associate professor of surgery at the University of California, San Francisco."
“We as pediatricians are accustomed to consider in positive any chronic abdominal pain and then to consider it [functionally]. However, celiac disease is very common in the population, as 1 child in every 100 is affected,” Francavilla said. “With our study he have been able to identify the specific type of abdominal pain that is associated with celiac disease; this ensures that screening can be preferentially oriented where the risk of celiac disease is significantly higher."
At the moment, children with functional abdominal pain are not recommended for routine screening for celiac disease. However, these findings may support testing for celiac when IBS pain is strong. “[Selected] 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 said.
These findings show a clear path towards targeted celiac screening because the identification of IBS is a high-risk marker for celiac disease, according to Francavilla, who said, “The most clear implication of my study is that celiac screening should be addressed only to IBS children rather than all the population with abdominal pain... The identification of IBS as high-risk condition for CD might be of help in the pediatric primary care."