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• W3043259056 abstract "Since December 2019, the whole world has been affected by the infection caused by the new coronavirus SARS-CoV2, which has had profound consequences for public health and the economy, but above all has left a deep mark on the peoples' minds [ [1] Wang C. Pan R. Wan X. et al. Immediate Psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health. 2020; 17: 1729https://doi.org/10.3390/ijerph17051729 Crossref PubMed Scopus (5793) Google Scholar ]. There is still no clear evidence on how the lockdown may have affected the quality of life of patients with chronic diseases, especially in children, and if this condition may have influenced the course of multifactorial pathologies in which the mental, as well as the organic component, could play an important role [ [2] Liu W. Zhang Q. Chen J. et al. Detection of COVID-19 in children in early january 2020 in Wuhan, China. N Engl J Med. 2020; 382: 1370-1371 Crossref PubMed Scopus (456) Google Scholar , [3] Lazzerini M. Barbi E. Apicella A. et al. Delayed access or provision of care in Italy resulting from fear of COVID-19. Lancet Child Adolesc Health. 2020; 4: e10-e11 Abstract Full Text Full Text PDF PubMed Scopus (838) Google Scholar . Indeed, the restrictions imposed by the COVID-19 pandemic have had a deep impact on primary healthcare, with a possible negative influence also on common and usually benign gastrointestinal disorders such as celiac disease (CD) and Functional Gastrointestinal Disorders (FGDIs). We have previously shown that children with celiac disease (CD) have an increased risk of developing functional abdominal pain disorders despite strict adherence to a classic gluten free diet [ [4] Turco R. Boccia G. Miele E. et al. The association of coeliac disease in childhood with functional gastrointestinal disorders: a prospective study in patients fulfilling Rome III criteria. Aliment Pharmacol Ther. 2011; 34: 783-789https://doi.org/10.1111/j.1365-2036.2011.04787.x Crossref PubMed Scopus (24) Google Scholar ] and our data have been confirmed by recent studies. [ [5] M. Saps, N. Sansotta, S. Bingham, et al. Abdominal pain-associated functional gastrointestinal disorder prevalence in children and adolescents with celiac disease on gluten-free diet: a multinational study; J Pediatr; http://dx.doi.org10.1016/j.jpeds.2016.11.049. Google Scholar ] Moreover, it has been demonstrated that psychological factors may play a role in the development of FGDIs. [ [6] Di Lorenzo C. Youssef N.N. Sigurdsson L. et al. Visceral hyperalgesia in children with functional abdominal pain. J Pediatr. 2001; 139: 838-843 Abstract Full Text PDF PubMed Scopus (200) Google Scholar ]. Based on these considerations, we assessed the role of psychological aspects and behavioral changes imposed by the lockdown on the development of FGIDs in CD children in remission. We conducted an observational study on a cohort of 71 pediatric patients aged 1 to 18 years with a diagnosis of CD. As part of another study, we are prospectively following a group of CD children who received a new diagnosis of celiac disease between January 2018 and March 2019. All these children were placed on a gluten free diet (GFD) and have been followed from the time of CD diagnosis till now. At the 6 months follow-up point (T1), the children were considered in clinical remission from CD if their serological test had turned from positive to negative by adhering to a strict GFD, even if they showed gastrointestinal symptoms defined as functional, according to the Rome IV criteria. Patients with persistently elevated serum tissue transglutaminase IgA antibodies after six months of gluten free diet were excluded. Between March 9th and April 24th, 2020, after at least one year of follow up, we interviewed the patients or their parents during their home stay in lockdown. The interview was conducted by phone, after obtaining informed consent, and the patients or their parents were asked to complete the Rome IV, Peds QL 4.0 General Well-Being Scale and Promis anxiety questionnaires [ [7] Abreu Paiva L.M. Gandolfi L. et al. Measuring quality of life in parents or caregivers of children and adolescents with celiac disease. Dev Content Validat Question Nutr. 2019; 11: 2302https://doi.org/10.3390/nu11102302 Crossref Scopus (7) Google Scholar , [8] A.M. Waters, E. Schilpzand, C., et al. Functional gastrointestinal symptoms in children with anxiety disorders; J Abnorm Child Psychol doi:10.1007/s10802-012-9657-0. Google Scholar . We evaluated the presence of gastrointestinal symptoms at the time of the diagnosis of CD (T0) and the proportion of patients with FGIDs after six months (T1) of gluten-free diet. Finally, we compared the prevalence of FGIDs between T1 and during the lockdown for COVID-19 (T2). We also evaluated the quality of life and anxiety of our patients during T2. At enrolment, 52 of 71 (73.2%) CD children were symptomatic. Among the symptoms, abdominal pain was the most prevalent (49%), followed by constipation (29%), diarrhea (27%), nausea (15%) and vomiting (9%). After 6 months of GFD (T1), 16 of 71 (22,5%) CD patients with negative serology for CD fulfilled the Rome IV Criteria for FGDIs, they all had GI symptoms present at diagnosis. None of the children without GI symptoms at CD diagnosis developed FGIDs at T1. Among the CD children with FGIDs, functional constipation (FC) was the most prevalent symptom: 12 patients (16,9%), followed by post prandial distress syndrome: 4 patients (5.6%), with an overlap of FGIDs in 2/16 (12,5%) of these patients. At T2, during the lockdown for COVID-19, we found a reduced prevalence of all FGIDs compared to T1: from 16 (22,5%) to 12(16.9%): specifically, patients with functional constipation decreased from 12 (16.9%) to 9 (12.6%) and the patients with post prandial distress syndrome decreased from 4 (5.6%) to 3 (4.2%) (Fig. 1a). However, these differences between the two time points were not statistically significant (p = 0.302 Mc Nemar test), probably due to the small sample size. The median total score of the General Well-being scale was 80.13 (64,28–100) showing an overall good quality of life in our patients (Fig. 1b). Moreover, the majority of patients, 52/71 (73%) did not show anxiety according to the Promis anxiety questionnaires. (Fig. 1c). The pathogenesis of FGIDs is still unclear. The biopsychosocial model, a framework that integrates the biological and psychosocial processes, is the most accepted paradigm. In our study we confirmed that a high proportion of children who had gastrointestinal symptoms at the time of CD diagnosis developed a FGIDs on a gluten free diet. This is possibly due to the persistence of a low grade of inflammation, even though the serum tissue transglutaminase IGA antibody became negative [ [9] Murray J.A. Watson T. Clearman B. Mitros F Effect of a gluten‐free diet on gastrointestinal symptoms in celiac disease. Am J Clin Nutr. 2004; 79: 669-673 Crossref PubMed Scopus (215) Google Scholar ]. However, the prevalence of FGIDs seems to have decreased during the COVID-19 lockdown, probably due to a good quality of life and a low state of anxiety, despite the lockdown, as was reported also in a study in adults [ [10] M. Siniscalchi, F. Zingone, E.V. Savarino, COVID-19 pandemic perception in adults with celiac disease: an impulse to implement the use of telemedicine: COVID-19 and CeD, Dig Liver Dis doi:10.1016/j.dld.2020.05.014. Online ahead of print. Google Scholar ]. In our children the satisfying social functioning may be related to the positive effects of reducing stressful events, such as school, as well as to an increased parental closeness, which may have influenced the occurrence of GI symptoms and the related FGIDs. It could be also speculated that the decreased frequency of FGIDs observed after one year of GFD, compared to six months, is related to a more marked reduction in inflammation due to a longer period of GFD. However, in our previous study we have demonstrated that the prevalence of FGIDS was high even after one year of GFD [ [4] Turco R. Boccia G. Miele E. et al. The association of coeliac disease in childhood with functional gastrointestinal disorders: a prospective study in patients fulfilling Rome III criteria. Aliment Pharmacol Ther. 2011; 34: 783-789https://doi.org/10.1111/j.1365-2036.2011.04787.x Crossref PubMed Scopus (24) Google Scholar ]. This finding would support the hypothesis that the psychosocial aspects play a particularly important role at the basis of the FGIDs, despite the presence of a residual low-grade chronic inflammatory process." @default.
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• W3043259056 date "2020-10-01" @default.
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• W3043259056 title "Prevalence of functional gastrointestinal disorders in children with celiac disease during the COVID-19 lockdown" @default.
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• W3043259056 doi "https://doi.org/10.1016/j.dld.2020.06.030" @default.
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