Dr. Zahoor Hussain Daraz, Consultant Pediatrician & NICU Specialist, Medicare Superspeciality Hospital, Karan Nagar, Srinagar
I get some version of this question a lot in clinic. A child is put on a gluten-free diet, the parents are doing everything right, and weeks turn into months without much change. The stools are still loose and oily. The weight isn't coming up. Everyone starts wondering if they're missing something in the diet, or not being strict enough.
Sometimes that's exactly what's happening. But sometimes there's a second condition sitting underneath the first one, and it doesn't show up until you go looking for it.
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We recently wrote up a case like this — a 2½-year-old boy — and it was published this August in the Asian Journal of Pediatric Research.
What actually happened
He came in with the kind of history I've seen many times: loose, bulky, foul-smelling stools, a swollen belly, irritability, frequent infections, and growth that just wasn't keeping pace. His blood work fit coeliac disease, and he was started on a gluten-free diet.
But he didn't turn the corner the way most kids do. The stools stayed oily. His weight wasn't moving. At that point, rather than assuming the diet needed to be stricter, we pushed further — a sweat chloride test and genetic testing, which confirmed cystic fibrosis alongside the coeliac disease.
Once we treated both conditions together — the gluten-free diet, plus pancreatic enzymes and nutritional support for the CF side — he started improving. Over about four months, his appetite came back, the bloating settled, and his weight started climbing.
Why I think this is worth knowing about
Cystic fibrosis and coeliac disease can look almost identical in a small child. Poor weight gain, greasy stools, a distended belly — either condition can cause all of it on its own. So when one is confirmed and treated, it's easy to assume that explains everything.
Most of the time it does. This case is a reminder that it doesn't always.
When it's worth asking more questions
If your child is genuinely following a strict gluten-free diet and you're still seeing:
- Oily or bad-smelling stools that haven't improved after a few months
- Weight or height that isn't catching up
- A belly that's still swollen
- Repeated chest infections or a cough that won't quit, alongside the digestive symptoms
...it's worth bringing that up at your next visit and asking whether anything else should be checked.
A note on why we publish these
Cases like this don't come along often, and honestly, most of what I learn about handling the unusual ones comes from other doctors who took the time to write theirs up. This is our way of adding to that.
Reference: Daraz ZH, Shabir B, Ismail A. "Unusual Association of Cystic Fibrosis and Coeliac Disease: A Rare Case Report." Asian Journal of Pediatric Research. 2026;16(9):114-118. DOI: 10.9734/ajpr/2026/v16i9571
If your child's symptoms sound familiar, book a consultation at Medicare Superspeciality Hospital, Karan Nagar, Srinagar.
