Clinical outcome of constipation as the presenting symptom in children with celiac disease

Constipation is a common gastrointestinal concern in children, often prompting screening for celiac disease (CeD), particularly in refractory cases. However, limited data exist on the clinical course of constipation in children with CeD following treatment with a gluten-free diet.

We reviewed electronic health records from the Mayo Clinic between 1994 and 2024 for children (<18 years) who presented with constipation and then diagnosed with CeD. Children were classified into groups based on the symptoms at the time of presentation. Constipation outcome was considered resolved by the documentation of improvement on a gluten-free diet without ongoing laxative use, while unresolved cases required continued laxative therapy. A sub-analysis was performed for children with encopresis.

We identified 248 children with CeD, 177 (71%) had biopsy-confirmed CeD, and 56 (23%) were diagnosed with serology-only criteria. The mean age at diagnosis was 7.8 years (±4.98), with most being White (99%) and female (68%). Constipation was the main presenting symptom, but most children also exhibited additional symptoms at the time of diagnosis. Over an average of 5.3 years (±2.1) of follow-up, constipation was resolved in 32% of children, while 68% required ongoing laxatives, in the subgroup of children with encopresis, only 29% had documented resolution. Tissue transglutaminase antibody normalization was slower in children with unresolved constipation. Trends were observed toward a higher prevalence of anxiety, depression (42% vs. 30%) and thyroid disorders (13% vs. 9%) in the unresolved group. We also noticed a trend to a higher likelihood of constipation resolution in children with type 1 diabetes mellitus (14% vs. 4%), but none reached statistical significance.

Many children with CeD continue to experience persistent unresolved constipation despite adherence to a gluten-free diet. Comorbidities are associated with a lower rate of constipation resolution.