title: Increased prevalence of celiac disease among pediatric patients with irritable bowel syndrome: a 6-year prospective cohort study.
abstract: OBJECTIVE
  Recurrent abdominal pain is a prevalent health issue in childhood. Clinical criteria (ie, the Rome criteria) have been established to aid diagnosis. Studies of adults have shown an increased prevalence of celiac disease among patients with irritable bowel syndrome (IBS); few data are available with regard to children.
  
  
  OBJECTIVE
  To assess the prevalence of celiac disease among children with abdominal pain-related functional gastrointestinal disorders classified according to the Rome criteria.
  
  
  METHODS
  Six-year (2006-2012) prospective cohort study conducted in a tertiary referral center for the diagnosis and follow-up of gastrointestinal disorders in southern Italy (ie, Bari, Italy). A total of 992 children (42.8% male; median age, 6.8 years) consecutively referred for recurrent abdominal pain by their primary care physicians without previous investigation were evaluated.
  
  
  METHODS
  Patients were classified according to Rome III criteria as having IBS, functional dyspepsia, functional abdominal pain, or abdominal migraine.
  
  
  METHODS
  Prevalence of celiac disease in each category of abdominal pain-related functional gastrointestinal disorder. Concentrations of IgA, IgA antitissue transglutaminase, and endomysial antibodies were measured, and a duodenal biopsy was performed in case of antibody positivity.
  
  
  RESULTS
  A total of 992 children were evaluated: 270 were classified as having IBS, 201 as having functional dyspepsia, and 311 as having functional abdominal pain, and 210 children were excluded from the study because they had an organic disorder or some other functional gastrointestinal disorder (not related to abdominal pain). Serologic testing was performed for all 782 children included in the study, and 15 patients tested positive for celiac disease (12 of 270 patients with IBS [4.4%], 2 of 201 patients with functional dyspepsia [1%], and 1 of 311 patients with functional abdominal pain [0.3%]). Children presenting with IBS have a 4 times higher risk of having celiac disease than children without IBS (odds ratio, 4.19 [95% CI, 2.03-8.49]; P < .001).
  
  
  CONCLUSIONS
  The prevalence of celiac disease among children with IBS is 4 times higher than among the general pediatric population. Rome III classification of abdominal pain-related functional gastrointestinal disorders might help to select children who deserve screening for celiac disease.
authors.affiliation: Interdisciplinary Department of Medicine, Pediatric Section, University of Bari, Giovanni XXIII Hospital, Bari, Italy.
authors.forename: Fernanda
authors.initials: F
authors.lastname: Cristofori
authors.affiliation: Interdisciplinary Department of Medicine, Pediatric Section, University of Bari, Giovanni XXIII Hospital, Bari, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Fontana
authors.affiliation: Department of Pediatrics, Ravenna Hospital, Ravenna, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Magistà
authors.affiliation: Interdisciplinary Department of Medicine, Pediatric Section, University of Bari, Giovanni XXIII Hospital, Bari, Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Capriati
authors.affiliation: Interdisciplinary Department of Medicine, Pediatric Section, University of Bari, Giovanni XXIII Hospital, Bari, Italy.
authors.forename: Flavia
authors.initials: F
authors.lastname: Indrio
authors.affiliation: Department of Pediatrics, San Paolo Hospital, Bari, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Castellaneta
authors.affiliation: Interdisciplinary Department of Medicine, Pediatric Section, University of Bari, Giovanni XXIII Hospital, Bari, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Cavallo
authors.affiliation: Interdisciplinary Department of Medicine, Pediatric Section, University of Bari, Giovanni XXIII Hospital, Bari, Italy.
authors.forename: Ruggiero
authors.initials: R
authors.lastname: Francavilla
mesh_terms: D015746:Abdominal Pain / Q000453:epidemiology; D000293:Adolescent; D002446:Celiac Disease / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000453:epidemiology*; D007558:Italy / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires