Abstract
In children, functional gastrointestinal disorders (FGIDs) are common at all ages. Consumption of certain foods, particularly gluten, is frequently associated with the development and persistence of FGIDs and functional abdominal pain disorders (FAPDs) in adults and children. However, this association is not well defined. Even without a diagnosis of celiac disease (CD), some people avoid gluten or wheat in their diet since it has been shown to trigger mostly gastrointestinal symptoms in certain individuals, especially in children. The incidence of conditions such as non-celiac gluten sensitivity (NCGS) is increasing, particularly in children. On the other hand, CD is a chronic, autoimmune small intestinal enteropathy with symptoms that can sometimes be mimicked by FAPD. It is still unclear if pediatric patients with irritable bowel syndrome (IBS) are more likely to have CD. Abdominal, pain-associated FGID in children with CD does not seem to improve on a gluten-free diet. The threshold for gluten tolerance in patients with NCGS is unknown and varies among subjects. Thus, it is challenging to clearly distinguish between gluten exclusion and improvement of symptoms related solely to functional disorders.
Highlights
The association between gluten and abdominal pain is broad and can be attributed to many factors [1,2,3,4]
From 959 children ages 4 years or older included in the study, symptom-based functional gastrointestinal disorders (FGIDs) criteria were met by 25% of children and adolescents, with functional dyspepsia being the most common functional abdominal pain disorders (FAPDs), being present in 7.2% of children [19]
Among the conditions included in FAPDs, irritable bowel syndrome (IBS) has been the one most studied with regards to its relationship to diet and gluten consumption [1]
Summary
The association between gluten and abdominal pain is broad and can be attributed to many factors [1,2,3,4]. From 959 children ages 4 years or older included in the study, symptom-based FGID criteria were met by 25% of children and adolescents, with functional dyspepsia (postprandial distress syndrome) being the most common FAPD, being present in 7.2% of children [19]. As with the U.S.-based study, functional dyspepsia (postprandial distress syndrome) was the most common FAPD in 2.7% of children; it was followed closely by FAP-NOS (2.4%) and IBS (2.3%) [19,20]. Due to the lack of multicenter, large, international comparative studies, the reason for the difference in prevalence between various geographic regions is currently unknown [21] These differences can be influenced by population variability in regard to social and psychosocial factors (i.e., divorce, mental illness and other social stressors). Regardless of method, neither study author could completely assure recall accuracy [24]
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