This page was translated automatically from Turkish. Read the original

Bu sayfa, 26. Dünya Psikiyatri Kongresi'nde sunulan çalışmanın yapay zekâ desteğiyle hazırlanmış Türkçe özetidir. Çalışmanın sahibi sunan yazarlardır; atıf için orijinal kaynağa başvurun.

EV0288

Undiagnosed celiac disease in children with attention-deficit/hyperactivity disorder: the effect of a gluten-free diet on clinical symptoms

UNDIAGNOSED CELIAC DISEASE IN CHILDREN WITH ATTENTION-DEFICIT/HYPERACTIVITY DISORDER: IMPACT OF A GLUTEN-FREE DIET ON CLINICAL SYMPTOMS

Children with attention-deficit/hyperactivity disorder should be evaluated for celiac disease if gastrointestinal and nutritional warning signs are present; in confirmed celiac disease, a gluten-free diet may improve somatic and some cognitive symptoms but does not replace treatment for attention-deficit/hyperactivity disorder.

The aim of the study is to compare practice-based clinical experience of undiagnosed celiac disease (CeD) in children with attention-deficit/hyperactivity disorder (ADHD) with the current pediatric literature; it notes that celiac disease affects approximately 1% of the population, often remains undiagnosed, and in pediatric patients may present without classic diarrhea, with manifestations such as fatigue, headache, irritability, abdominal pain, constipation, iron deficiency, vitamin deficiencies, and attention difficulties, including extraintestinal symptoms. The method involves a retrospective, observational, anonymized clinical series of children and adolescents with ADHD or attention-related symptoms accompanied by gastrointestinal, nutritional, autoimmune, or growth-related indicators; the series was compared with an updated narrative review of guidelines and pediatric studies from 2020 to 2026, and gastrointestinal symptoms, sleep, irritability, energy, nutritional assessment, growth, laboratory findings, celiac serology, and family and school reports were evaluated. The current evidence section reports that a 2022 systematic review examined 23 studies and identified a possible but heterogeneous and inconclusive association between celiac disease and ADHD; that a 2026 controlled study compared 64 children with celiac disease with 64 controls and found significantly higher ADHD and cognitive disengagement syndrome scores in the celiac group; and that, in a 2023 systematic review, 7 of 20 pediatric neuropsychiatric studies evaluated a gluten-free diet (GFD), with 5 reporting statistically significant benefits. Regarding diagnosis, it states that a gluten-free diet should not be started before diagnostic testing, that total IgA and tissue transglutaminase IgA (tTG-IgA) should be measured as first-line tests, that IgG-based tests should be used if IgA is low or deficient, that a diagnosis without biopsy may be considered under the ESPGHAN 2020 guidelines if tTG-IgA is at least 10 times the upper limit of normal and EMA-IgA is positive in a second sample, and that biopsy is generally required at lower titers. Practice-based findings indicate that the cases raising the greatest suspicion combined inattention or hyperactivity with gastrointestinal symptoms, food selectivity, or signs of malabsorption; that, in patients with confirmed celiac disease following a strict gluten-free diet, observed improvements were most pronounced in abdominal pain, bowel regularity, energy, sleep, irritability, and attention in everyday functioning; but that not all core symptoms resolved and many children continued to require ADHD-specific multimodal intervention. Limitations include the nonrandomized design, the small sample, and the lack of audited aggregate results to date. In conclusion, evaluation for celiac disease is recommended in children with gastrointestinal warning signs, nutritional deficiencies, impaired growth, or an autoimmune history before attributing the entire clinical picture to ADHD; it is emphasized that a gluten-free diet is indicated only in confirmed celiac disease or as part of a supervised gastroenterological and nutritional assessment, and is not indicated for ADHD without a diagnosis of celiac disease.

Tüm WCP 2026 özetleri