Functional Constipation and IBS More Common in Pediatric Celiac Disease

child on toilet, bathroom
Celiac disease in children leads to an increased risk for functional constipation and irritable bowel syndrome compared with healthy controls.

Children with celiac disease are at an increased risk for functional constipation and irritable bowel syndrome (IBS) compared with healthy controls, despite a strict adherence to gluten-free diet, according to study results published in Clinical Gastroenterology and Hepatology.

Functional abdominal pain disorders — including functional dyspepsia, IBS, abdominal migraine, and functional abdominal pain not otherwise specified — are more common in children. Previous studies have reported a 5-fold increased risk for celiac disease in patients with IBS, and more than a third of patients with celiac disease present symptoms compatible with IBS.

The objective of the current study was to determine the prevalence of functional abdominal pain disorders and functional constipation in children with celiac disease on a long-term gluten-free diet.

Investigators conducted a prospective observational cohort study that included patients aged 4 to16 years with a diagnosis of celiac disease. All participants were on a strict gluten-free diet for at least a year, with persistent negative celiac serology on the strict diet.

A total of 417 children (37% boys, mean age 13.7 years) with celiac disease and 373 healthy controls (39% boys, mean age 13.5 years) were included in the study. Parents and children older than 10 years completed a Diagnostic Questionnaire for Pediatric functional abdominal pain disorders, according to Rome IV criteria.

Children with celiac disease were at a significantly increased risk for functional abdominal pain disorders compared with controls (11.5% vs. 6.7%, respectively; relative risk [RR], 1.8; 95% CI, 1.1-3; P <.05). There was no difference between groups in the prevalence of functional diarrhea, abdominal migraine, or functional abdominal pain disorder not otherwise specified.

The prevalence of IBS was also significantly higher among patients with celiac disease compared with controls (7.2% vs. 3.2%; RR, 2.3; 95% CI, 1.1-4.6; P <.05).

The most frequent functional abdominal pain disorder in both groups was functional constipation, but the prevalence was significantly higher in those with celiac disease, than controls (19.9% vs. 10.5%, respectively; RR, 2.1; 95% CI, 1.4-3.2; P <.001).

On logistic regression analysis, younger age and higher levels of celiac antibodies at diagnosis were associated with increased risk for developing functional abdominal pain disorders and IBS, irrespective of gluten-free diet duration.

The study had several limitations, including the absence of a follow-up endoscopy to confirm compliance, and inability to assess whether the amount of processed gluten free foods, fructose, or fat content had a role in persistence of IBS symptoms.

“Celiac disease is associated with an increased risk of IBS and [functional constipation]. Strategies are needed to manage IBS and [functional constipation] in patients with celiac disease,” concluded the researchers.


Cristofori F, Tripaldi M, Lorusso G, et al. Functional abdominal pain disorders and constipation in children on gluten-free diet. Published online September 2, 2020. Clin Gastroenterol Hepatol. doi: 10.1016/j.cgh.2020.09.001