title: Celiac disease is overrepresented in patients with constipation.
abstract: OBJECTIVE
  It is suggested that patients with constipation should be screened for celiac disease. Similarly, it is recommended to investigate these patients for hypothyroidism and hypercalcemia. However, no evidence for these recommendations is available so far. We therefore set out to determine the prevalence of celiac disease, hypothyroidism, and hypercalcemia in children with constipation.
  
  
  METHODS
  Prospective cohort study of 370 consecutive patients who met the Rome III criteria for constipation. These patients were referred by a general practitioner to a pediatrician because of failure of laxative treatment.
  
  
  RESULTS
  Seven of these patients had biopsy-proven celiac disease. This is significantly higher (p < 0.001) than the 1:198 prevalence of celiac disease in the Netherlands. Two patients had auto-immune thyroiditis. No patient had hypercalcemia.
  
  
  CONCLUSIONS
  We conclude that celiac disease is significantly overrepresented in patients with constipation who are referred by a general practitioner to a pediatrician because of failure of laxative treatment. All such patients should, therefore, be screened for celiac disease.
authors.affiliation: Catharina Hospital, Eindhoven, the Netherlands. rolf.pelleboer@cze.nl
authors.forename: Rolf A A
authors.initials: RA
authors.lastname: Pelleboer
authors.forename: Rob L H
authors.initials: RL
authors.lastname: Janssen
authors.forename: Judith M
authors.initials: JM
authors.lastname: Deckers-Kocken
authors.forename: Edward
authors.initials: E
authors.lastname: Wouters
authors.forename: Annemieke C
authors.initials: AC
authors.lastname: Nissen
authors.forename: Werner E A
authors.initials: WE
authors.lastname: Bolz
authors.forename: Walther E Tjon A
authors.initials: WE
authors.lastname: Ten
authors.forename: Cathelijne
authors.initials: C
authors.lastname: van der Feen
authors.forename: Koen J
authors.initials: KJ
authors.lastname: Oosterhuis
authors.forename: Mechelien H
authors.initials: MH
authors.lastname: Rövekamp
authors.forename: Peter G J
authors.initials: PG
authors.lastname: Nikkels
authors.forename: Roderick H J
authors.initials: RH
authors.lastname: Houwen
mesh_terms: D002446:Celiac Disease / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D002675:Child, Preschool; D003248:Constipation / Q000150:complications / Q000453:epidemiology*; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000453:epidemiology*; D007037:Hypothyroidism / Q000453:epidemiology*; D007223:Infant; D054368:Laxatives / Q000627:therapeutic use; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D012017:Referral and Consultation; D017211:Treatment Failure
chemical_list: D054368:Laxatives