Overlapping Disorders of Gut–Brain Interaction and Celiac Disease in Children

Celiac.com 08/08/2025 - Celiac disease is a serious autoimmune condition that causes the body to attack its own small intestine when gluten is consumed. For children diagnosed with celiac disease, following a strict gluten-free diet often leads to improvement in symptoms and a decline in antibodies that indicate inflammation, such as tissue transglutaminase immunoglobulin A. However, not all children experience complete relief. Many continue to have lingering stomach issues even with excellent dietary adherence.

This study focused on understanding why that happens. Specifically, it examined whether disorders of gut–brain interaction—chronic gastrointestinal symptoms with no clear structural cause—were responsible for the ongoing discomfort in these children. The research looked at how common these disorders were in children with managed celiac disease and identified factors that might predict their development.

What Are Gut–Brain Interaction Disorders?

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Disorders of gut–brain interaction (formerly called functional gastrointestinal disorders) are conditions where the brain and the digestive system do not work together as they should, leading to symptoms like abdominal pain, constipation, nausea, and bloating. These symptoms can be long-lasting and significantly affect a child's quality of life, even when no physical damage is found during medical tests.

While these conditions are increasingly recognized in the general population, they can be especially hard to detect in people with other known gastrointestinal issues like celiac disease. That's because symptoms overlap—abdominal pain, diarrhea, and fatigue are common to both. This study was the first in the United States to specifically look at these gut–brain disorders in children who have celiac disease and who are otherwise managing the condition well.

Key Findings: Nearly Half Had Gut–Brain Disorders

The researchers studied 191 children between the ages of 4 and 21 who had biopsy-confirmed celiac disease. All of these children were sticking to a gluten-free diet and had improving antibody levels, which suggested that their celiac disease was under control. Despite this, 43 percent of them met the medical criteria for a gut–brain disorder.

The most common types found were:

• Functional constipation (33% of those with a disorder)
• Functional abdominal pain (29%)
• Other types included nausea, irritable bowel syndrome, and delayed stomach emptying.

Interestingly, many children who were still experiencing these symptoms after their celiac diagnosis had shown the same issues even before they started a gluten-free diet. This makes it unclear whether the symptoms were initially caused by celiac disease, a gut–brain disorder, or both.

Early Symptoms and Risk Factors

The study found that certain symptoms and conditions increased the likelihood of developing a gut–brain disorder, even after celiac disease was being properly managed. These included:

• Abdominal pain, vomiting, and constipation at the time of diagnosis
• Nighttime stomach pain
• Joint hypermobility (very flexible joints)
• Frequent headaches and body pain
• Symptoms of anxiety or depression
• Poor growth or low body weight at diagnosis
• More severe small intestine damage (villous blunting) seen during initial biopsy

Children with these issues were more likely to develop ongoing gut-related problems, even when their celiac disease appeared to be under control. This highlights a need for doctors to watch these children more closely after diagnosis and provide support beyond just a gluten-free diet.

Why Gut–Brain Disorders Are Easy to Miss

Diagnosing gut–brain disorders in children with celiac disease is challenging because standard follow-up care often focuses only on antibody levels. These tests are important but not perfect. Some children with normal lab results still have persistent symptoms, which are often brushed off or blamed on gluten exposure.

However, this study suggests that these symptoms may not be from eating gluten at all. Instead, they may come from a gut–brain disorder that needs its own diagnosis and treatment. That means children with celiac disease who continue to feel sick—despite following all the rules—deserve a deeper look and possibly a different kind of care.

What This Means for Families and Healthcare Providers

For families dealing with celiac disease, the results of this study offer both clarity and a new path forward. If a child continues to have digestive issues after switching to a gluten-free diet, it may not mean they’re doing something wrong. Instead, the problem might be a disorder of gut–brain interaction—something that can and should be diagnosed and treated separately.

Healthcare providers should take lingering symptoms seriously and consider screening for gut–brain disorders during follow-up visits. Early diagnosis could help families better understand what’s going on and avoid unnecessary anxiety about hidden gluten or dietary mistakes.

Doctors can also offer more balanced guidance during the initial diagnosis. Letting families know that some symptoms may continue—and that this is not uncommon—can help manage expectations and reduce the fear of long-term damage.

Conclusion: A Broader View of Celiac Disease Management

This study highlights the importance of looking beyond just gluten when managing celiac disease in children. Nearly half of the children in this study experienced ongoing gut problems even though their disease markers were improving. These symptoms were often due to disorders of gut–brain interaction, not continued celiac activity.

Recognizing this opens the door for better care, more accurate diagnosis, and much-needed relief for families. It also suggests that future guidelines for celiac disease management should include screening for gut–brain disorders, especially in children who had severe symptoms at the start or have other related health issues.

In the end, this research shows that managing celiac disease is not just about avoiding gluten—it's about understanding the whole person and treating all of the symptoms, not just the lab results.

Read more at: onlinelibrary.wiley.com