Childhood Celiac Disease and Functional Gastrointestinal Disorders
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Due to the fact that gluten-induced gut inflammation is reversible by dietary manipulation, celiac disease may offer a useful model for examining the role of inflammatory triggers in various functional gastrointestinal disorders.
Gut inflammation is a well-known cause of functional and structural changes in the central nervous system. Researchers suspect that the culprit is an abnormal afferent input from the gut. Psychological factors may play a role in triggering overt symptoms.
A research team recently set out to examine connections between childhood celiac disease and functional gastrointestinal disorder in children meeting Rome III criteria. The team included R. Turco, G. Boccia, E. Miele; E. Giannetti, R. Buonavolontà, P. Quitadamo, R. Auricchio, and A. Staiano.
Their goal was to assess the prevalence of functional gastrointestinal disorders at one year, along with the role of psychological aspects on the development of functional gastrointestinal disorders in celiac disease children.
For the study, the team enrolled a group of 36 boys and 64 girls (Total = 100 children) with celiac disease, and followed them for one year. They also assembled a control group of 56 children, 25 boys and 31 girls.
The team had all children and/or their parents complete validated questionnaires for GI symptoms, depression, and anxiety. The team then compared GI symptoms at diagnosis and after 1 year of gluten-free diet.
The team was able to follow up on 82 of the patients with celiac disease who followed a gluten-free diet for at least one year. Of those, 23 patients (28%) met Rome III criteria for functional gastrointestinal disorders compared with 5 of 56 (8.9%) patients from the control group (P = 0.008; χ2 = 6.8; OR: 3.97; 95% CI: 1.40–11.21).
Most of those children who met Rome III criteria for functional gastrointestinal disorders after one year on a gluten-free diet complained of GI symptoms alone; 21 of 52 children (40.3%) overall.
Children with celiac disease with FGDIs showed substantially higher levels of anxiety and depression compared to control subjects, and to celiac disease children without functional gastrointestinal disorders (P = 0.02).
The study shows that children with celiac disease, who follow a gluten-free diet for a year, have much higher rates of functional GI symptoms than do non-celiac control subjects.
The risk may be due to residual chronic inflammation, and/or to psychological factors, but further study is needed to make that determination.
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