Randomized Clinical Trial
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 14, 2022; 28(46): 6589-6598
Published online Dec 14, 2022. doi: 10.3748/wjg.v28.i46.6589
Prevalence of functional gastrointestinal disorders in children with celiac disease on different types of gluten-free diets
Francesca Fiori Nastro, Maria Rosaria Serra, Sabrina Cenni, Daniela Pacella, Massimo Martinelli, Erasmo Miele, Annamaria Staiano, Carlo Tolone, Renata Auricchio, Caterina Strisciuglio
Francesca Fiori Nastro, Maria Rosaria Serra, Massimo Martinelli, Erasmo Miele, Annamaria Staiano, Renata Auricchio, Department of Translational Medical Science, Section of Pediatrics, University of Naples “Federico II”, Naples 80100, Italy
Sabrina Cenni, Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples 80100, Italy
Daniela Pacella, Department of Public Health, University of Naples “Federico II”, Naples 80100, Italy
Carlo Tolone, Caterina Strisciuglio, Department of Woman, Child and General and Specialistic Surgery, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
Author contributions: Strisciuglio C, Fiori Nastro F, Serra MR, Pacella D and Cenni S were responsible for the study conception and design, data analysis and interpretation and manuscript drafting; Martinelli M, Miele E, Staiano A, Tolone C and Auricchio R critically revised the article for important intellectual content; and all authors reviewed and approved the final version to be published.
Institutional review board statement: The Institutional Review Board of the University of Naples “Federico II” approved the study.
Clinical trial registration statement: The Ethics Committee of the University of Naples “Federico II” approved the study protocol with the registration number 111/19.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code and dataset available from the corresponding author at caterina.strisciuglio@unicampania.it. Participants gave informed consent for data sharing.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Caterina Strisciuglio, Doctor, Professor, Department of Woman, Child and General and Specialistic Surgery, University of Campania “Luigi Vanvitelli”, Via Luigi de Crecchio 2, Naples 80138, Italy. caterina.strisciuglio@unicampania.it
Received: May 23, 2022
Peer-review started: May 23, 2022
First decision: June 19, 2022
Revised: July 3, 2022
Accepted: November 2, 2022
Article in press: November 2, 2022
Published online: December 14, 2022
Abstract
BACKGROUND

Functional gastrointestinal disorders (FGIDs) are common during the pediatric age. FGIDs are not related to biochemical or structural abnormalities. However, since they have a high prevalence, several studies have evaluated an overlap between FGIDs and organic diseases. Individuals with celiac disease (CD) have been shown to be at an increased risk for functional abdominal pain, even if they adhere well to a gluten-free diet (GFD). Little information is available for the pediatric age group. The aims of our study were to evaluate the prevalence of FGIDS in CD children 1 year after diagnosis and to compare the prevalence of FGIDs in CD children on a GFD with processed foods compared with those on a GFD with natural products.

AIM

To assess the prevalence of FGIDs in children with CD after 1 year of follow-up and to compare the prevalence of FGIDs in children with CD on a GFD with processed foods and in children on a GFD with natural products.

METHODS

We recruited pediatric patients aged 1-18 years with a new CD diagnosis. Participants were randomized to two groups: Group A on a GFD with processed foods (diet 1); and group B on a GFD with natural products (diet 2). Clinical monitoring, diet assessment and the questionnaire on pediatric gastrointestinal symptoms-Rome IV version were performed at diagnosis (T0) and after 12 mo of follow-up (T1). Dietary intake was assessed using a 3-d food diary record. Data from the diaries were evaluated using WinFood nutrient analysis software. We assessed the prevalence of FGIDs at T1 and the correlation with the type of GFD.

RESULTS

We registered 104 CD children, with 55 patients in group A (53.0%) and 49 patients in group B (47.0%). Initially, 30 of the 55 (54.5%) CD children were symptomatic in group A, while 25 of 49 (51.0%) were symptomatic in group B. At T1, in spite of a low or negative serology for CD, FGIDs prevalence was 10/55 (18.0%) in group A and 8/49 (16.3%) in group B, with no statistically significant difference between the two groups (P = 0.780). At T1 the macro- and micronutrient intake was similar across the two groups with no significant differences in nutrient analysis. However, in both groups at T1 we found that a lower prevalence of FGIDs (P = 0.055) was associated with an inferior caloric (odds ratio = 0.99, 95% confidence interval: 0.99-1.00) and fat (odds ratio = 0.33, 95% confidence interval: 0.65-0.95) intake.

CONCLUSION

Our results showed that CD children on a GFD have gastrointestinal symptoms with an elevated prevalence of FGIDs. Our study suggests that developing FGIDs may be linked to caloric intake and percentage of food fat, but it does not change between a GFD with processed foods or a GFD with natural products. However, long-term monitoring is required to evaluate a correlation between FGIDs and various types of GFDs.

Keywords: Functional gastrointestinal disorders, Celiac disease, Gluten free diet, Gastrointestinal symptoms, Children

Core Tip: In spite of a strict adhesion to a classic gluten-free diet, patients with celiac disease are more likely to suffer from functional abdominal pain disorders. Our findings suggest that the prevalence of functional gastrointestinal disorders may be linked to the caloric intake and fat content in the diet. However, it does not differ between a processed gluten-free diet with commercial products or a gluten free diet with natural products.