The prevalence and predictive factors of overlapping disorders of gut-brain interaction and celiac disease in children

Abstract

Objectives: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Rome IV; functional abdominal pain; functional constipation; gluten‐free diet; pediatric.

Figure 1

472 of the 663 patients identified through Epic query from 2016 to 2024 with an initial gastrointestinal (GI) visit at Cincinnati Children's Hospital Medical Center and concern for celiac disease (CeD) were excluded. Of the 191 patients included, 83 subjects met Rome IV criteria for a disorder of gut–brain interaction (DGBI) while 108 did not meet DGBI criteria. TTG IgA, tissue transglutaminase immunoglobulin A.

Figure 2

Symptoms present at initial visit (A) and comorbid conditions (B) associated with a statistically significant increased or decreased risk of disorder of gut–brain interaction (DGBI) diagnosis.