PREVALENCE OF DISORDERS OF GUT-BRAIN INTERACTION IN TREATED CELIAC DISEASE: A SYSTEMATIC REVIEW.

BACKGROUND

22-30% of celiac disease (CD) patients on a strict gluten-free diet (GFD) experience persistent symptoms, defined as non-responsive CD (NRCD). Disorders of gut-brain interaction (DGBI), including irritable bowel syndrome (IBS) and functional dyspepsia, may contribute to persistent symptoms, but their prevalence in patients with CD remains unclear. We aimed to assess the prevalence of DGBI in CD patients and identify potential predisposing factors.

METHODS

A systematic review was conducted according to PRISMA guidelines using PubMed (2016-2026). Studies including adult patients with coeliac disease on a gluten-free diet and reporting specific DGBI diagnosed according to Rome III or Rome IV criteria or through a documented clinical diagnostic assessment were included in the systematic analysis. Studies reporting gastrointestinal symptom scores without establishing specific DGBI diagnoses were considered only as descriptive contextual evidence. The primary outcome was the prevalence of DGBI in patients with CD; secondary outcomes included the identification of potential predisposing risk factors.

RESULTS

Six studies (n = 1,361 CD patients) were included. Rome IV-defined DGBI were reported in up to 51% of patients with optimal GFD adherence. In one longitudinal study, the prevalence of Rome III-defined IBS and dyspepsia after 12 months of a GFD was 22% and 8%, respectively. A retrospective long-term follow-up study also identified clinician-adjudicated functional gastrointestinal disorders as a frequent cause of clinically relevant events. Two randomized trials suggested that a low-FODMAP GFD may improve persistent gastrointestinal symptoms compared with a standard GFD alone.

CONCLUSIONS

DGBI are highly prevalent in CD patients, particularly IBS and functional dyspepsia. Exclusion of ongoing gluten exposure and confirmation of disease remission are essential for an accurate diagnosis. Management requires a multidisciplinary approach involving gastroenterologists and dietitians. Further prospective studies are needed to better define the prevalence and predisposing factors of this overlapping condition.