Krueger Andrew, Patel Umangi, Hardy Jennifer, Hajjat Temara, Mallon Daniel, Santucci Neha
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
J Pediatr Gastroenterol Nutr. 2025 Jun 22. doi: 10.1002/jpn3.70118.
Disorders of gut-brain interaction (DGBI) are increasing in prevalence; however, diagnosis remains challenging in the setting of organic diseases. While adult studies have shown overlap between DGBI and celiac disease (CeD), no United States studies have assessed DGBI prevalence using Rome IV criteria in pediatric CeD. This study aims to report DGBI prevalence in pediatric CeD patients adherent to gluten-free diet (GFD) with declining serologies and identify common DGBI subtypes and predictive factors for developing DGBI.
Single-center, retrospective study of children (4-21 years old) with biopsy-proven CeD who were evaluated for DGBI based on Rome IV criteria. Patients who were adherent to a GFD, demonstrated tissue transglutaminase immunoglobulin A (TTG IgA) decline, and had at least one visit 9-24-months after diagnosis with a pediatric gastroenterologist were assessed for the presence or absence of gastrointestinal symptoms at all subsequent follow-up visits. Predictive factors associated with DGBI diagnosis were evaluated.
Of the 191 pediatric patients included, 43% (n = 83) met Rome IV DGBI diagnostic criteria. Functional constipation (27/83, 33%) and functional abdominal pain (24/83, 29%) were the most common DGBI. Abdominal pain, constipation, and vomiting at initial presentation as well as comorbid joint hypermobility, headaches, and chronic musculoskeletal pain increased risk of developing DGBI after serological decline.
DGBI are common in pediatric CeD patients adherent to a GFD with declining TTG IgA. Clinicians should have a high index of suspicion for DGBI in CeD patients with persistent symptoms despite strict GFD adherence to facilitate diagnosis and management.
肠-脑互动障碍（DGBI）的患病率正在上升；然而，在器质性疾病背景下，诊断仍然具有挑战性。虽然成人研究表明DGBI与乳糜泻（CeD）之间存在重叠，但美国尚无研究使用罗马IV标准评估儿科CeD患者中DGBI的患病率。本研究旨在报告坚持无麸质饮食（GFD）且血清学指标下降的儿科CeD患者中DGBI的患病率，并确定常见的DGBI亚型以及发生DGBI的预测因素。
对经活检证实为CeD的4至21岁儿童进行单中心回顾性研究，根据罗马IV标准评估DGBI。对坚持GFD、组织转谷氨酰胺酶免疫球蛋白A（TTG IgA）下降且在诊断后9至24个月至少有一次就诊于儿科胃肠病学家的患者，在所有后续随访中评估是否存在胃肠道症状。评估与DGBI诊断相关的预测因素。
纳入的191例儿科患者中，43%（n = 83）符合罗马IV DGBI诊断标准。功能性便秘（27/83，33%）和功能性腹痛（24/83，29%）是最常见的DGBI。初始表现时的腹痛、便秘和呕吐以及合并的关节活动过度、头痛和慢性肌肉骨骼疼痛增加了血清学指标下降后发生DGBI的风险。
在坚持GFD且TTG IgA下降的儿科CeD患者中，DGBI很常见。对于尽管严格坚持GFD但仍有持续症状的CeD患者，临床医生应高度怀疑DGBI，以促进诊断和管理。
