Gluten-Free Diet Decreases Functional GI Disorders in Pediatric Celiac Disease

Gluten-free diets with reduced calories and fats decrease the prevalence of functional gastrointestinal (GI) disorders in pediatric celiac disease, according to study findings published in World Journal of Gastroenterology.

Researchers conducted a randomized controlled trial to assess the prevalence of functional GI disorders among children with celiac disease adhering to different gluten-free diets. All participants were diagnosed according to the ESPGHAN criteria.

Study participants were pediatric patients aged 1 to 18 years old with a new celiac disease diagnosis from December 2017 to January 2019. The study group included 104 children with a mean age of 7.2 years (range, 4-17 years).

Participants were randomly assigned into 2 groups with differing gluten-free diets: group A (n=55) had a gluten-free diet with processed foods and group B (n=49) had a gluten-free diet with more than 60% natural products. 

The participants and their parents filled out GI symptom questionnaires based on the Rome IV criteria and the researchers used this data to diagnose participants with functional GI disease. This questionnaire was distributed at baseline and the 12-month follow-up.

At follow-up, participants were considered in clinical remission from celiac disease if their serologic tests were negative, regardless of whether they were experiencing functional GI symptoms.

There were 30 children (54.5%) in group A and 25 children (51%) in group B who were symptomatic at baseline. The most prevalent symptoms were constipation (28.8%), abdominal pain (24%), and vomiting (4.8%).

The follow-up survey revealed that implementing a gluten-free diet lowered the frequency of GI symptoms in both groups. Additionally, 99 children (95.2%) had negative serology, 2 (1.9%) were positive, and 3 (2.9%) were borderline.

While most participants had negative serum tests, 10 (18%) in group A and 8 (16.3%) in group B experienced functional GI symptoms.

Among participants with functional GI disorders, constipation was the most prevalent symptom (7.7% in group A and 6.7% in group B) followed by postprandial distress syndrome (1.9% in group A and 1.0% in group B).

Participants with symptoms at diagnosis more frequently developed functional GI disorders compared with those who were asymptomatic at baseline.

There were no significant differences between the 2 groups at follow up (P =.78). Individual analysis of macro- and micronutrients at follow-up showed no significant differences between the study groups. There was a decreased prevalence of functional GI disorders after 1 year on a gluten-free diet (P =.05).

In both groups, there was a link between reduced calorie intake (odds ratio [OR], 0.99; 95% CI, 0.99-1) and fat intake (OR, 0.33; 95% CI, 0.65-0.9) and decreased prevalence of GI symptoms after 1 year.

Limitations of the study include a short follow up period and self-reporting bias.

“Possible explanations behind the persistence of GI symptoms could be the presence of another unrecognized GI disease, altered bowel motility due to the persistence of low-grade inflammation despite a gluten-free diet [GFD], microbiota alteration or a continuous intentional or inadvertent intake of gluten,” the study authors conclude.