Interdisciplinary Department of Medicine, Paediatric Section, University of Bari, Giovanni XXIII Hospital, Bari, Italy.
San Giacomo Hospital, Monopoli (BA), Italy.
Clin Gastroenterol Hepatol. 2021 Dec;19(12):2551-2558. doi: 10.1016/j.cgh.2020.09.001. Epub 2020 Sep 3.
BACKGROUND & AIMS: We studied the prevalence of functional abdominal pain disorders (FAPDs) and functional constipation (FC) in a large prospective cohort of children with celiac disease on a strict gluten-free diet (GFD).
We performed a prospective cohort study, from 2016 through 2018, in a tertiary care center in Italy, of 417 patients (37% male; mean age, 13.7 y) with a diagnosis of celiac disease (European Society for Paediatric Gastroenterology Hepatology, and Nutrition criteria) who had been on a strict GFD for more than 1 year and had negative results from serologic tests after being on the GFD. Parents and children (>10 y) were asked to fill in a questionnaire on pediatric gastrointestinal symptoms, according to Rome IV criteria. Patients' closest siblings (or cousins) who had negative results from serologic test for celiac disease were used as controls (n = 373; 39% male; mean age, 13.5 y).
We found a higher prevalence of FAPDs among patients with celiac disease (11.5%) than controls (6.7%) (P < .05); the relative risk (RR) was 1.8 (95% CI, 1.1-3.0). Irritable bowel syndrome (IBS) and FC defined by the Rome IV criteria were more prevalent in patients with celiac disease (7.2% for IBS and 19.9% for FC) than controls (3.2% for IBS and 10.5% for FC) (P < .05 and P < .001, respectively); the RR for IBS was 2.3 (95% CI, 1.1-4.6) and the RR for functional constipation was 2.1 (95% CI, 1.4-3.2). We found no differences in the prevalence of other subtypes of FAPDs. A logistic regression showed that younger age (P < .05) and a higher level of anti-transglutaminase IgA at diagnosis (P < .04) were associated with FAPDs (in particular for IBS) irrespective of GFD duration.
Celiac disease is associated with an increased risk of IBS and FC. Strategies are needed to manage IBS and FC in patients with celiac disease.
我们研究了在严格无麸质饮食（GFD）下患有乳糜泻的大量前瞻性队列儿童中功能性腹痛障碍（FAPD）和功能性便秘（FC）的患病率。
我们在意大利的一家三级保健中心进行了一项前瞻性队列研究，纳入了 417 名（37%为男性；平均年龄 13.7 岁）诊断为乳糜泻（欧洲小儿胃肠病学、肝病学和营养学会标准）的患者，他们已接受 GFD 治疗超过 1 年，且在接受 GFD 后血清学检查结果为阴性。根据罗马 IV 标准，父母和（年龄>10 岁的）儿童填写胃肠道症状问卷。将乳糜泻血清学检查结果为阴性的患者最近的兄弟姐妹（或表亲）作为对照组（n=373；39%为男性；平均年龄 13.5 岁）。
我们发现乳糜泻患者中 FAPD 的患病率高于对照组（11.5% vs 6.7%）（P<.05）；相对风险（RR）为 1.8（95%CI，1.1-3.0）。乳糜泻患者中肠易激综合征（IBS）和罗马 IV 标准定义的 FC 更为常见（IBS 为 7.2%，FC 为 19.9%），而对照组为（IBS 为 3.2%，FC 为 10.5%）（P<.05 和 P<.001）；IBS 的 RR 为 2.3（95%CI，1.1-4.6），功能性便秘的 RR 为 2.1（95%CI，1.4-3.2）。我们未发现其他类型 FAPD 的患病率存在差异。逻辑回归显示，年龄较小（P<.05）和诊断时抗转谷氨酰胺酶 IgA 水平较高（P<.04）与 FAPD（尤其是 IBS）相关，而与 GFD 持续时间无关。
乳糜泻与 IBS 和 FC 的风险增加相关。需要制定策略来管理乳糜泻患者的 IBS 和 FC。
