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
ARTICLE HIGHLIGHTS
Research background

When an organic disorder, like celiac disease (CD), is present, functional gastrointestinal disorders (FGIDs) cannot be diagnosed. However, these disorders have a high prevalence. Therefore, a number of studies have assessed the possibility of overlap between FGIDs with organic disorders.

Research motivation

Few data are available regarding the risk of FGIDs in children strictly adhering to a conventional gluten free diet (GFD).

Research objectives

The objectives of this study were to estimate the prevalence of FGIDs in patients affected by CD at the moment of the diagnosis (T0) and after 1 year of follow-up (T1) comparing two different types of GFD.

Research methods

This study involved 104 celiac pediatric patients (aged 1 year to 18 years) randomized to: Group A, on a GFD with processed foods; and group B, on a GFD with natural products. Clinical follow-up, a 3-d dietary diary evaluation and a questionnaire based on the Rome IV criteria were completed for each child at T0 and T1. We examined the FGIDs after 12 mo and the relationship to the type of GFD.

Research results

At the time of enrollment, 54.5% of CD children had symptoms in group A, and 51.0% of CD children had symptoms in group B. At T1, in spite of low or negative CD serology, the prevalence of FGIDs was 18.0% in group A and 16.3% in group B (P = 0.780). In both groups after 12 mo of a GFD an intraindividual analysis showed a significantly lower prevalence of FGIDs (P = 0.055) in patients lower calorie and fat intake.

Research conclusions

Many children still have gastrointestinal symptoms and FGIDs despite a strict GFD, and it could be linked to the caloric intake and the amount of fat in the diet. However, it does not seem affected by a GFD with commercial or natural products.

Research perspectives

To evaluate the correlation between FGIDs and different types of GFDs, long-term monitoring is necessary.