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Is Celiac Disease Testing Necessary in Functional Abdominal Disorders? A Study in Predominantly Latino Children
Ana C Falcon1, Amanda C Fifi, Lilibet Fernandez Valdes
1Department of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Miami Miller School of Medicine, Miami, FL.
Insights
Celiac disease (CD) testing in children with functional abdominal pain disorders (FAPDs) may not be as beneficial as previously thought. This study found a low prevalence of CD in pediatric FAPDs patients, similar to the general population.
Area of Science:
- Pediatric Gastroenterology
- Celiac Disease Research
- Functional Abdominal Pain Disorders
Background:
- Functional abdominal pain disorders (FAPDs) are common in pediatric consultations.
- Rome IV criteria suggest celiac disease (CD) testing for IBS-D, but discretion for other FAPDs.
- Previous studies showing increased CD in IBS patients may not apply to diverse populations.
Purpose of the Study:
- To determine the prevalence of celiac disease (CD) in children with FAPDs.
- To evaluate the necessity of CD screening in pediatric FAPDs patients.
Main Methods:
- Retrospective chart review of pediatric patients with FAPDs at a tertiary care center.
- Analysis of demographics, diagnoses, and CD testing results.
- Inclusion of patients from January 2016 to November 2019.
Main Results:
- 181 children with FAPDs underwent celiac testing.
- Low prevalence of CD confirmed: 1 out of 181 children (0.55%).
- No CD cases in children with Irritable Bowel Syndrome (IBS).
Conclusions:
- The prevalence of CD in pediatric FAPDs is similar to the general community.
- Routine CD testing for all FAPDs, including IBS, may not be cost-effective.
- Further research with larger, diverse populations is needed to confirm these findings.
Background:
Functional abdominal pain disorders (FAPDs) are among the most common causes of consultation in general pediatrics and pediatric gastroenterology. The Rome IV criteria recommend testing for celiac disease (CD) in children with irritable bowel syndrome-diarrhea (IBS-D) and leaves testing in cases of other FAPDs to the practitioner's discretion. These recommendations were based on a single study that showed a 4-fold increase of CD among patients with IBS in Italy. It is unclear if these findings can be extrapolated to other populations. Understanding whether those results are reproducible in areas with different racial/ethnic backgrounds can optimize patient care.
Aim:
The aim of the study was to assess the prevalence of CD in a sample of children consulting for FAPDs to a tertiary care center in Miami.
Methods:
The charts of all pediatric patients consulting for FAPDs from January 2016 to November 2019 at the University of Miami were reviewed. Demographics, diagnosis, and CD testing for each child were analyzed.
Results:
One hundred eighty-one children with FAPDs and celiac testing were seen. Mean age of 12.89 years, girls 61.34%. 84 (46.40%) had a diagnosis of IBS and 97 (53.59%) had a diagnosis of other FAPD. One of 181 children with FAPDs (0/84 with IBS and 1/97 with other FAPDs) had positive CD serological testing and EGD confirmation.
Conclusions:
Our study suggests that the prevalence of CD among children with FAPDs is similar to the community prevalence. This data questions the benefit of testing all children FAPDS (including IBS) for CD. Studies with larger sample size and various racial/ethnic makeup should be done to confirm our findings.
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