Does Celiac Disease Increase Risk for Functional Abdominal Pain Disorders?

April 24, 2017

Functional abdominal pain disorders (FAPDs), such as irritable bowel syndrome and functional dyspepsia, are highly prevalent around the world. In children, these disorders are associated with multiple comorbidities, poor quality of life, school absenteeism and enormous costs of care.

A recent multinational study evaluated the prevalence of FAPDs in children with celiac disease (CD) and controls and found surprising results suggesting that not all types of gastrointestinal inflammation lead to FAPDs in children.

“The pathogenesis of FAPDs is not completely understood, and numerous studies in adults and children have shown that FAPDs are frequently preceded by intestinal inflammation,” says Miguel Saps, MD, an attending gastroenterologist in the Division of Gastroenterology, Hepatology and Nutrition at Nationwide Children’s Hospital and leader of the study, published in the Journal of Pediatrics. “Approximately one in three children who have a bacterial acute gastroenteritis develop FAPDs that may last for years. CD is a chronic gastrointestinal inflammation, and we were interested in establishing if CD, similarly to other sources of inflammation, predisposed children to develop FAPDs – a question that so far had no answer. The results of our study suggest that not every gastrointestinal inflammation increases the risk of developing FAPDs.”

The international cohort study was a collaboration among three university hospitals in Chicago, and Messina and Verona Italy. It included three groups of 4- to 18-year-old children: (1) children with CD on a gluten-free diet for more than 6 months; (2) sibling controls without CD; and (3) unrelated controls.

“This study was an expansion of our previous work also published in the Journal of Pediatrics, in which we solely examined children with CD and their siblings,” explains Dr. Saps, who is also the director of research in the Motility Center at Nationwide Children’s. “The sample size for this study was double that, with a total of 289 children and adolescents participating from 2014 to 2015.”

The Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III (QPGS-RIII), which has been successfully used to identify FAPDs in children according to the Rome III criteria, was completed for each study participant. The QPGS-RIII includes questions on frequency, intensity, location and duration of GI symptoms. A validated Italian version was used in the centers in Italy.

“We found no significant difference in prevalence of chronic abdominal pain or FAPDs among children in the three groups,” says Dr. Saps. “The findings of this collaborative research confirm the results of our previous, smaller study, which showed no increased risk of chronic abdominal pain and FAPDs in children with CD on a gluten-free diet compared with their siblings.”

This larger prospective study sheds novel insight on FAPDs in children. “Our study suggests that the mechanisms that leads to FAPDs in children may in some cases differ from those in adults,” adds Dr. Saps.

“Given the high prevalence of these chronic, recurrent disorders in children, we hope to conduct additional studies to elucidate the exact mechanisms of FAPDs in children and develop prevention strategies, something that is not currently done.”



  1. Saps M, Adams P, Bonilla S, Nichols-Vinueza D. Abdominal pain and functional gastrointestinal disorders in children with celiac disease. Journal of Pediatrics. 2013 Mar;162(3):505-509.
  2. Saps M, Sansotta N, Bingham S, Magazzu G, Grosso C, Romano S, Pusatcioglu C, Guandalini S. Abdominal pain-associated functional gastrointestinal disorder prevalence in children and adolescents with celiac disease on gluten-free diet: a multinational study. Journal of Pediatrics. 2017 Mar;182:150-154.


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