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To the Editor: Celiac disease (CD), also called celiac sprue or gluten-sensitive enteropathy, has a wide spectrum of clinical presentations and includes abdominal pain, diarrhea, constipation, and bloating which mimics Irritable Bowel Syndrome (IBS) [1]. The evidence is still inconclusive, but celiac screening is frequently ordered for children with chronic abdominal pain.
A cross-sectional study was conducted among 126 children aged 4 to 18 y with chronic abdominal pain. A detailed history, clinical examination, and Level I and Level II investigations were done. The children, for whom the cause was not found, were looked up for Functional Gastrointestinal Disorders (FGIDS) as per Rome IV criteria [2]. All enrolled children were also screened for celiac disease using anti-tissue transglutaminase IgA antibody.
The mean age of the enrolled children was 9.33 ± 3.23 y (51.6% males; 48.4% females). The periumbilical site was the most common site seen in 73 patients (57.9%). Organic causes were found in 34 (27.0%) while 92 (73.0%) were functional. A total of 40 children were classified as Irritable Bowel Syndrome as per Rome –IV criteria (IBS-D: 23; IBS-C: 12; combined: 5). Overall, out of 126 children, 9 children (7.1%) were diagnosed with celiac disease, however out of these majority (8 /9) belonged to Irritable Bowel Syndrome-D. Only one child (1.2%) with chronic abdominal pain without fulfilling the criteria of IBS was found to have celiac disease.
Thus, our study showed the maximum yield of celiac screening when it is limited to Irritable Bowel Syndrome-D. If it is done in chronic abdominal pain without IBS, prevalence is almost same as per general population (1.2% vs. 1%) [3]. Our result is in confirmation with the study conducted by Irvine et al. who also reported a significantly higher prevalence of celiac disease in IBS as compared to healthy controls [4].
References
Steele R; CRF. Diagnosis and management of coeliac disease in children. Postgrad Med J. 2011;87:19–25.
Zeevenhooven J, Koppen IJ, Benninga MA. The new Rome IV criteria for functional gastrointestinal disorders in infants and toddlers. Pediatr Gastroenterol Hepatol Nutr. 2017;20:1–13.
Makharia GK, Verma AK, Amarchand R, et al. Prevalence of celiac disease in the northern part of India: a community based study. J Gastroenterol Hepatol. 2011;26:894–900.
Irvine AJ, Chey WD, Ford AC. Screening for celiac disease in irritable bowel syndrome: an updated systematic review and meta-analysis. Am J Gastroenterol. 2017;112:65–76.
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Thamilarasan, S., Basu, S. & Kumar, P. Point Prevalence of Celiac Disease in Children Aged 4 to 18 years with Chronic Abdominal Pain – A Cross Sectional Study. Indian J Pediatr 91, 422 (2024). https://doi.org/10.1007/s12098-023-04854-9
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DOI: https://doi.org/10.1007/s12098-023-04854-9