期刊论文详细信息
BMC Gastroenterology
Predictors of persistent symptoms and reduced quality of life in treated coeliac disease patients: a large cross-sectional study
Katri Kaukinen2  Markku Mäki1  Heini Huhtala4  Pekka Collin3  Anniina Ukkola1  Kalle Kurppa1  Pilvi Paarlahti1 
[1]Tampere Centre for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
[2]Seinäjoki Central Hospital, Seinäjoki, Finland
[3]Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland
[4]Tampere School of Health Sciences, University of Tampere, Tampere, Finland
关键词: Adults;    Gluten-free diet;    Quality of life;    Symptoms;    Coeliac disease;   
Others  :  858022
DOI  :  10.1186/1471-230X-13-75
 received in 2012-09-13, accepted in 2013-04-16,  发布年份 2013
PDF
【 摘 要 】

Background

Evidence suggests that many coeliac disease patients suffer from persistent clinical symptoms and reduced health-related quality of life despite a strict gluten-free diet. We aimed to find predictors for these continuous health concerns in long-term treated adult coeliac patients.

Methods

In a nationwide study, 596 patients filled validated Gastrointestinal Symptom Rating Scale and Psychological General Well-Being questionnaires and were interviewed regarding demographic data, clinical presentation and treatment of coeliac disease, time and place of diagnosis and presence of coeliac disease-associated or other co-morbidities. Dietary adherence was assessed by a combination of self-reported adherence and serological tests. Odds ratios and 95% confidence intervals were calculated by binary logistic regression.

Results

Diagnosis at working age, long duration and severity of symptoms before diagnosis and presence of thyroidal disease, non-coeliac food intolerance or gastrointestinal co-morbidity increased the risk of persistent symptoms. Patients with extraintestinal presentation at diagnosis had fewer current symptoms than subjects with gastrointestinal manifestations. Impaired quality of life was seen in patients with long duration of symptoms before diagnosis and in those with psychiatric, neurologic or gastrointestinal co-morbidities. Patients with persistent symptoms were more likely to have reduced quality of life.

Conclusions

There were a variety of factors predisposing to increased symptoms and impaired quality of life in coeliac disease. Based on our results, early diagnosis of the condition and consideration of co-morbidities may help in resolving long-lasting health problems in coeliac disease.

【 授权许可】

   
2013 Paarlahti et al.; licensee BioMed Central Ltd.

【 预 览 】
附件列表
Files Size Format View
20140723091840847.pdf 157KB PDF download
【 参考文献 】
  • [1]Green PH, Cellier C: Celiac disease. N Engl J Med 2007, 357:1731-1743.
  • [2]Catassi C, Bearzi I, Holmes GK: Association of celiac disease and intestinal lymphomas and other cancers. Gastroenterology 2005, 128:S79-86.
  • [3]Hallert C, Grännö C, Hulten S, Midhagen G, Ström M, Svensson H, Valdimarsson T: Living with coeliac disease: controlled study of the burden of illness. Scand J Gastroenterol 2002, 37:39-42.
  • [4]Lee AR, Ng DL, Zivin J, Green PH: Economic burden of a gluten-free diet. J Hum Nutr Diet 2007, 20:423-430.
  • [5]Abdulkarim AS, Burgart LJ, See J, Murray JA: Etiology of nonresponsive celiac disease: results of a systematic approach. Am J Gastroenterol 2002, 97:2016-2021.
  • [6]Murray JA, 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.
  • [7]Hallert C, Grännö C, Grant C, Hulten S, Midhagen G, Ström M, Svensson H, Valdimarsson T, Wickström T: Quality of life of adult coeliac patients treated for 10 years. Scand J Gastroenterol 1998, 33:933-938.
  • [8]Usai P, Minerba L, Marini B, Cossu R, Spada S, Carpiniello B, Cuomo R, Boy MF: Case control study on health-related quality of life in adult coeliac disease. Dig Liver Dis 2002, 34:547-552.
  • [9]Nachman F, Maurino E, Vazquez H, Sfoggia C, Gonzalez A, Gonzalez V, Plancer del Campo M, Smecuol E, Niveloni S, Sugai E, Mazure R, Cabanne A, Bai JC: Quality of life in celiac disease patients: prospective analysis on the importance of clinical severity at diagnosis and the impact of treatment. Dig Liver Dis 2009, 41:15-25.
  • [10]Norström F, Lindholm L, Sandström O, Nordyke K, Ivarsson A: Delay to celiac disease diagnosis and its implications for health-related quality of life. BMC Gastroenterol 2011, 11:118. BioMed Central Full Text
  • [11]Kurppa K, Collin P, Mäki M, Kaukinen K: Celiac disease and health-related quality of life. Expert Rev Gastroenterol Hepatol 2011, 5:83-90.
  • [12]Viljamaa M, Collin P, Huhtala H, Sievänen H, Mäki M, Kaukinen K: Is coeliac disease screening in risk groups justified? A fourteen-year follow-up with special focus on compliance and quality of life. Aliment Pharmacol Ther 2005, 22:317-324.
  • [13]Mustalahti K, Lohiniemi S, Collin P, Vuolteenaho N, Laippala P, Mäki M: Gluten-free diet and quality of life in patients with screen-detected celiac disease. Eff Clin Pract 2002, 5:105-113.
  • [14]Hopman EG, Koopman HM, Wit JM, Mearin ML: Dietary compliance and health-related quality of life in patients with coeliac disease. Eur J Gastroenterol Hepatol 2009, 21:1056-1061.
  • [15]Roos S, Karner A, Hallert C: Psychological well-being of adult coeliac patients treated for 10 years. Dig Liver Dis 2006, 38:177-180.
  • [16]Svedlund J, Sjödin I, Dotevall G: GSRS–a clinical rating scale for gastrointestinal symptoms in patients with irritable bowel syndrome and peptic ulcer disease. Dig Dis Sci 1988, 33:129-134.
  • [17]Revicki DA, Wood M, Wiklund I, Crawley J: Reliability and validity of the Gastrointestinal Symptom Rating Scale in patients with gastroesophageal reflux disease. Qual Life Res 1998, 7:75-83.
  • [18]Häuser W, Stallmach A, Caspary WF, Stein J: Predictors of reduced health-related quality of life in adults with coeliac disease. Aliment Pharmacol Ther 2007, 25:569-578.
  • [19]Zeltzer LK, Lu Q, Leisenring W, Tsao JC, Recklitis C, Armstrong G, Mertens AC, Robison LL, Ness KK: Psychosocial outcomes and health-related quality of life in adult childhood cancer survivors: a report from the childhood cancer survivor study. Cancer Epidemiol Biomarkers Prev 2008, 17:435-446.
  • [20]Wilt TJ, Rubins HB, Collins D, O'Connor TZ, Rutan GH, Robins SJ: Correlates and consequences of diffuse atherosclerosis in men with coronary heart disease. Veterans Affairs High-Density Lipoprotein Intervention Trial Study Group. Arch Intern Med 1996, 156:1181-1188.
  • [21]Dupuy H: The Psychological General Well-Being (PGWB) Index. In Assessment of quality of life in clinical trial of cardiovascular therapies.. New York: Le Jacq Publishing: Edited by Wenger N, Mattson M, Furberg C, Elinson J; 984:184-188.
  • [22]Sulkanen S, Collin P, Laurila K, Mäki M: IgA- and IgG-class antihuman umbilical cord antibody tests in adult coeliac disease. Scand J Gastroenterol 1998, 33:251-254.
  • [23]Cranney A, Zarkadas M, Graham ID, Butzner JD, Rashid M, Warren R, Molloy M, Case S, Burrows V, Switzer C: The Canadian Celiac Health Survey. Dig Dis Sci 2007, 52:1087-1095.
  • [24]Midhagen G, Hallert C: High rate of gastrointestinal symptoms in celiac patients living on a gluten-free diet: controlled study. Am J Gastroenterol 2003, 98:2023-2026.
  • [25]Leffler DA, Dennis M, Hyett B, Kelly E, Schuppan D, Kelly CP: Etiologies and predictors of diagnosis in nonresponsive celiac disease. Clin Gastroenterol Hepatol 2007, 5:445-450.
  • [26]Fine KD, Meyer RL, Lee EL: The prevalence and causes of chronic diarrhea in patients with celiac sprue treated with a gluten-free diet. Gastroenterology 1997, 112:1830-1838.
  • [27]Saito YA, Locke GR, Talley NJ, Zinsmeister AR, Fett SL, Melton LJ 3rd: A comparison of the Rome and Manning criteria for case identification in epidemiological investigations of irritable bowel syndrome. Am J Gastroenterol 2000, 95:2816-2824.
  • [28]Knowles CH, Aziz Q: Basic and clinical aspects of gastrointestinal pain. Pain 2009, 141:191-209.
  • [29]Sharma A, Lelic D, Brock C, Paine P, Aziz Q: New technologies to investigate the brain-gut axis. World J Gastroenterol 2009, 15:182-191.
  • [30]O'Leary C, Wieneke P, Buckley S, O'Regan P, Cronin CC, Quigley EM, Shanahan F: Celiac disease and irritable bowel-type symptoms. Am J Gastroenterol 2002, 97:1463-1467.
  • [31]Verdu EF, Armstrong D, Murray JA: Between celiac disease and irritable bowel syndrome: the "no man's land" of gluten sensitivity. Am J Gastroenterol 2009, 104:1587-1594.
  • [32]Barratt SM, Leeds JS, Robinson K, Shah PJ, Lobo AJ, McAlindon ME, Sanders DS: Reflux and irritable bowel syndrome are negative predictors of quality of life in coeliac disease and inflammatory bowel disease. Eur J Gastroenterol Hepatol 2011, 23:159-165.
  • [33]Spiller R, Garsed K: Postinfectious irritable bowel syndrome. Gastroenterology 2009, 136:1979-1988.
  • [34]Kakar S, Nehra V, Murray JA, Dayharsh GA, Burgart LJ: Significance of intraepithelial lymphocytosis in small bowel biopsy samples with normal mucosal architecture. Am J Gastroenterol 2003, 98:2027-2033.
  • [35]Rubio-Tapia A, Rahim MW, See JA, Lahr BD, Wu TT, Murray JA: Mucosal recovery and mortality in adults with celiac disease after treatment with a gluten-free diet. Am J Gastroenterol 2010, 105:1412-1420.
  • [36]Chang MS, Green PH: A review of rifaximin and bacterial overgrowth in poorly responsive celiac disease. Therap Adv in Gastroenterol 2012, 5:31-36.
  • [37]Rubio-Tapia A, Barton SH, Rosenblatt JE, Murray JA: Prevalence of small intestine bacterial overgrowth diagnosed by quantitative culture of intestinal aspirate in celiac disease. J Clin Gastroenterol 2009, 43:157-161.
  • [38]Ebert EC: The thyroid and the gut. J Clin Gastroenterol 2010, 44:402-406.
  • [39]Watt T, Groenvold M, Rasmussen AK, Bonnema SJ, Hegedus L, Bjorner JB, Feldt-Rasmussen U: Quality of life in patients with benign thyroid disorders. A review. Eur J Endocrinol 2006, 154:501-510.
  • [40]Smith DF, Gerdes LU: Meta-analysis on anxiety and depression in adult celiac disease. Acta Psychiatr Scand 2012, 125:189-193.
  • [41]Addolorato G, Leggio L, D'Angelo C, Mirijello A, Ferrulli A, Cardone S, Vonghia L, Abenavoli L, Leso V, Nesci A, Piano S, Capristo E, Gasbarrini G: Affective and psychiatric disorders in celiac disease. Dig Dis 2008, 26:140-148.
  • [42]Addolorato G, De Lorenzi G, Abenavoli L, Leggio L, Capristo E, Gasbarrini G: Psychological support counselling improves gluten-free diet compliance in coeliac patients with affective disorders. Aliment Pharmacol Ther 2004, 20:777-782.
  • [43]Lundin KE, Nilsen EM, Scott HG, Loberg EM, Gjoen A, Bratlie J, Skar V, Mendez E, Lovik A, Kett K: Oats induced villous atrophy in coeliac disease. Gut 2003, 52:1649-1652.
  • [44]Peräaho M, Kaukinen K, Mustalahti K, Vuolteenaho N, Mäki M, Laippala P, Collin P: Effect of an oats-containing gluten-free diet on symptoms and quality of life in coeliac disease. A randomized study. Scand J Gastroenterol 2004, 39:27-31.
  • [45]Hopman E, Dekking L, Blokland ML, Wuisman M, Zuijderduin W, Koning F, Schweizer J: Tef in the diet of celiac patients in The Netherlands. Scand J Gastroenterol 2008, 43:277-282.
  文献评价指标  
  下载次数:2次 浏览次数:6次