Yield of coeliac screening in abdominal pain-associated functional gastrointestinal system disorders

AimChronic abdominal pain (CAP) in childhood is common and in the majority functional. While CAP is one of the complaints of coeliac disease (CD), whether CAP as a sole complaint is indicative of CD is unclear. Our aim was to evaluate the relationship between CAP and CD. MethodsThe study was conducted on 1047 children (61.1% female, mean age 9.6 4.1 years) with CAP. Patients were evaluated according to the Rome III criteria. Patients with alarm symptoms and conditions known to be associated with CD were excluded. Patients were screened for CD using a rapid tissue transglutaminase (tTG) test; positive cases were tested by tTG ELISA, and duodenal biopsies were obtained if tTG was above the normal limit. ResultsFunctional dyspepsia (FD), irritable bowel syndrome (IBS) and functional abdominal pain (FAP) were diagnosed in 384 (36.7%), 274 (26.2%) and 389 (37.2%) patients, respectively. In 13 patients, the tTG rapid test was positive; 10 were also positive for tTG by ELISA and histopathological evaluations diagnosed CD in all 10 patients. The overall prevalence of CD was 0.95% (2.2%, 0.5% and 0.5% in patients with IBS, FD and FAP, respectively). The prevalence of CD in patients with IBS was higher than expected but with borderline statistical significance (P = 0.053). ConclusionsCD is found as common in children with FD and FAP as in the general population. CD was more commonly diagnosed in IBS patients with borderline statistical significance. We suggest that particular attention be paid to children with IBS. The effects of nitrogen supplement on mesophyll conductance and its response to rapid environmental changes are poorly known. This study demonstrated a profound impact of nitrogen supplement on mesophyll conductance and its response to rapidly changing CO2 concentration, temperature and light in rice leaves. The improved mesophyll conductance under high nitrogen supplement condition attributed to the changes of leaf structure and aquaporin. Our results also highlighted the importance role of aquaporin in mesophyll conductance response to environmental changes.