Celiac disease, gluten-free diet and health-related quality of life Translated title: Enfermedad celiaca, dieta sin gluten y calidad de vida relacionada con la salud

OBJECTIVE We sought to evaluate the impact of the gluten-free diet on the 5,240 members of the Canadian Celiac Association (CCA). Data are presented on 2,681 adults (>or=16 years) with biopsy-proven celiac disease (CD). A mail-out survey was used. Quality of life was evaluated using the 'SF12', and celiac-specific questions. Mean age was 56 years, mean age at diagnosis was 45 years, and 75% were female. The 'SF12' summary scores were similar to normative Canadian data, but were significantly lower for females and newly diagnosed patients. Respondents reported: following a gluten-free (GF) diet (90%), improvement on the diet (83%), and difficulties following the diet (44%), which included: determining if foods were GF (85%), finding GF foods in stores (83%), avoiding restaurants (79%), and avoiding travel (38%). Most common reactions to consumed gluten (among 73%) included pain, diarrhea, bloating, fatigue, nausea, and headache. Excellent information on CD and its treatment was provided by the CCA (64%), gastroenterologists (28%), dietitians (26%) and family doctor (12%). Quality of life in those with CD could be increased with early diagnosis, increased availability of gluten-free foods, improved food labelling, and better dietary instruction. Education of physicians and dietitians about CD and its treatment is essential.

Coeliac Disease (CD) is an increasingly common autoimmune condition, the treatment of which is a gluten-free diet (GFD). Previous studies fail to reach consensus of the impact this restrictive diet has on an individual's quality of life (QoL). Furthermore, how patient characteristics, such as demographic and educational background, may predict GFD adherence is poorly understood. We aimed to assess which factors had an impact on Qol in patients with CD. Case-control postal survey (n=573). Biopsy-proven CD patients (n=225; mean disease duration 8yrs; range 0.5-52yrs; male 26%) and age and sex matched controls (n=348; male 36%) completed The Short-Form 36-Item (SF-36) QoL measure, The Hospital Anxiety & Depression Scale (HADS), GFD assessment, and demographic questionnaire. We found a high proportion of GFD adherence: 'Full Adherence' 65%, 'Partial Adherence' 31%, 'None Adherence' 4%, accompanied however, by 80% of patients reporting difficulty adhering to the GFD: 'Impossible' 5%, 'Mostly difficult' 14%, 'Sometimes difficult' 61%, 'No difficulty' 20%. Negligible differences in QoL scores were observed when comparing full versus partial/none GFD patients (P=>0.05), however, stepwise reductions in QoL and increasing likelihood of anxiety/depression were found in association with increasing degree of difficulty adhering to the GFD (P=<0.0001). Demographic assessment suggests that an affluent background and a university education promote greater GFD adherence. Most coeliac patients adhere to a GFD but encounter difficulty doing so (potentially influenced by social and educational background). The degree of GFD difficulty is associated with reductions in patient wellbeing and psychological distress that the dietician is critically placed to address.

The benefits of serologic screening and early diagnosis of celiac disease in asymptomatic patients are not known. We investigated the impact of a gluten-free diet on self-perceived health and well-being in symptomatic and asymptomatic patients with celiac disease. We performed a prospective study of 698 consecutive adults newly diagnosed with celiac disease because of classic (n = 490) or extraintestinal (n = 62) symptoms or through screening of at-risk groups (n = 146; 23 were asymptomatic and analyzed separately). The survey included questions on health and well-being; quality of life was evaluated by the psychological general well-being (PGWB) questionnaire. Patients were followed for 1 year of treatment; 110 healthy subjects served as controls. On a gluten-free diet, self-perceived health improved significantly among patients with classic symptoms and those detected by screening. Patients in all groups were equally concerned about their health before the diagnosis, but anxiety was alleviated by the gluten-free diet. At diagnosis, the quality of life reduced among all 3 groups but improved significantly among patients on the diet. Among the 23 asymptomatic patients, perception of health worsened and concern about health increased while they were on the diet. Self-perceived health and well-being were low among patients at the time they were diagnosed with celiac disease. Most patients benefited from a gluten-free diet, so it is important to identify patients with celiac disease. Perception of health decreased among asymptomatic cases, which discourages population-based screening. Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.