Children with celiac disease (CeD) benefit from a gluten–free diet more than adults with the disease, according to researchers.

Such a diet is the only treatment for celiac, an autoimmune disease linked with gluten ingestion, but the authors said there has been little research on its effectiveness on symptoms.

They reviewed the charts of more than 500 children and adults with celiac from 2002–2015.

Children most commonly experienced gastrointestinal (GI) symptoms of abdominal pain, diarrhea and failure to thrive and extra–intestinal (EI) symptoms of short stature, fatigue and headache. Adults’ most frequent GI symptoms included diarrhea, bloating and abdominal pain, and EI symptoms were iron deficiency anemia, fatigue and headache/psychiatric disorders.

Two years after being instructed to follow a strict gluten–free diet, children and adults experienced the greatest improvement in GI symptoms of bloating, diarrhea, weight loss and abdominal pain while there was the least improvement in constipation.

Children also improved significantly in EI symptoms of dermatitis herpetiformis, myalgia, stomatitis, delayed puberty, seizures, iron deficiency anemia and poor mood. They had the least improvement in short stature and psychiatric disorders. Adults saw the most EI symptom improvement for dermatitis herpetiformis, abnormal liver enzymes, seizures and iron deficiency anemia and the least improvement for myalgia and poor mood.

Children’s GI and EI symptoms improved at greater rates than adults. The team also found females, people with a longer duration of symptoms and those who didn’t strictly adhere to the gluten–free diet had lower rates of improvement.

“These findings emphasize the need for early recognition of CeD as well as close attention to diet adherence as these will aid in the most positive outcomes for the patient,” authors wrote.

The study was published in the Journal of Pediatric Gastroenterology and Nutrition.