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Gut feeling: Is gluten cause of abdominal discomfort?

September 13, 2022

Editor's note: For more coverage of the 2022 AAP National Conference & Exhibition, visit https://bit.ly/AAPNationalConference2022.

Interest in gluten has exploded among researchers over the last two decades.

The number of articles with “gluten” in the title in PubMed increased from 262 in 2000 to 1,133 in 2020, said Justin C. Wheeler, M.D., FAAP, a pediatric gastroenterologist at Primary Children's Hospital in Salt Lake City and assistant professor of pediatric gastroenterology at the University of Utah College of Medicine.

Public awareness of gluten also has skyrocketed, with many people blaming their abdominal symptoms on intolerance to the protein found in wheat, barley and rye.

“So we've seen this exponential growth and interest in gluten,” Dr. Wheeler said. “And it might be vilified unfairly, but it is certainly in the medical literature a lot more and in popular culture.”

Dr. Wheeler will discuss what this increased awareness means for pediatricians during the session “Truth About Gluten” (S4010) from 7:30-8:30 a.m. PDT Monday, Oct. 10 in rooms 156/160 of the convention center. The session also will be livestreamed.

An estimated 0.5% to 1% of the pediatric population has celiac disease, and it is two times more common in females than males, Dr. Wheeler said.

“Celiac disease is surprisingly common we found these days,” he said.

During the session, Dr. Wheeler will define what gluten is, who pediatricians should screen for celiac disease and how to do those screenings.

He also will explain the differences between celiac disease and nonceliac gluten sensitivity, which is the inability to tolerate gluten in the absence of allergy or inflammation.

The incidence of nonceliac gluten sensitivity is unclear due to the subjective nature of the disease and its significant overlap with other conditions like irritable bowel syndrome, Dr. Wheeler said. He will describe nonceliac gluten sensitivity as a clinical entity and how pediatricians can approach the management of patients.

It’s important to identify whether gluten is the source of a patient’s symptoms because avoiding foods with gluten can have negative consequences, Dr. Wheeler said.

“You might be eating foods that are much higher in things like high fructose corn syrup or have their own kind of risk factors,” he said. “And then there's significant social implications for taking gluten out of your diet long term.”

The goal of the session is to help pediatricians feel comfortable making a diagnosis and knowing when to refer to a gastroenterologist.

“The take-home message,” he said, “is that gluten is often identified as a potential source of illness, and clinically that very well may not be the case. But knowing when to identify it as a possible suspect — hopefully this talk will help people be able to answer that question.”

For more information on the National Conference, visit https://www.aapexperience.org. View the conference schedule at https://www.eventscribe.net/2022/AAPexperience/

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