Alimentary TractGastrointestinal symptoms and quality of life in screen-detected celiac disease☆
Introduction
The majority of celiac disease patients do not suffer from classical gastrointestinal symptoms, but instead have subtle or atypical presentation or even no symptoms at all. Because of this heterogeneous clinical picture, most patients remain unrecognized [1], [2]. Active serological screening in at-risk groups such as first-degree relatives has proved an effective means of increasing the diagnostic rate [3], [4]. Nevertheless, diagnosing apparently asymptomatic individuals by screening is not completely unproblematic. Currently the only treatment for celiac disease is a strict life-long gluten-free diet, and although this approach has been shown to be beneficial in classical gastrointestinal celiac disease [5], [6], data on subjects with atypical or asymptomatic presentation are scant [7], [8], [9], [10]. The diet is troublesome, expensive and socially restrictive, which makes for difficulties in adherence, particularly in patients who consider themselves healthy [9], [11], [12], [13]. Moreover, a gluten-free diet is not nutritionally optimal, potentially exposing individuals to high sugar and low fibre and mineral intake [14], [15], which again may predispose to constipation and other health problems. Even though in symptomatic celiac disease the diet at first results in rapid recovery from symptoms and improvement in quality of life [6], [8], [10], evidence shows that patients, especially women, tend to do less well in the course of treatment [16], [17], [18], [19]. In line with this, studies conducted among screen-detected asymptomatic patients also imply that a gluten-free diet has a positive impact in health and quality of life within one year's follow-up [8], [10], but data on the long-term outcome in these subjects are scarce [20], [21]. These issues call for comprehensive study before implementation of large-scale celiac disease screening programmes.
We here investigated the effect of long-term gluten-free dietary treatment on gastrointestinal symptoms and psychological well-being in a large cohort of screen-detected celiac disease patients. The participants were evaluated by validated questionnaires, to establish whether screen-detected patients reach the same level of health and well-being as the general population after long-term dietary treatment.
Section snippets
Patients and study design
The study was conducted at the University of Tampere and Tampere University Hospital during 2006–2010. Voluntary subjects having biopsy-proven celiac disease were recruited by a nationwide search using newspaper advertisements and the Finnish Celiac Society newsletter. All celiac disease diagnoses were verified from the medical records. Thereafter participants attended structured interviews including questions on the diagnosis of celiac disease, current and prior symptoms, associated medical
Results
Clinical characteristics of the 96 screen-detected patients and 370 symptom-detected celiac controls are summarized in Table 1. In both groups patients had been on a gluten-free diet for a long time (median seven and nine years, respectively). Currently, 88% of the patients were strictly adherent, and none reported completely unrestricted gluten consumption. Altogether 87% of patients having family members with celiac disease and 91% without them adhered to a strict gluten-free diet (p = 0.239).
Discussion
The main finding in this study was that screen-detected celiac disease patients, women in particular, may suffer from persistent gastrointestinal symptoms even after a long-term gluten-free diet. This is in line with previous studies carried out among symptom-detected treated celiac disease patients [17], [18], [19], [25], [26], [27]. The findings thus demonstrate that both screen- and symptom-detected celiac disease belong to the same gluten-induced disease spectrum. The reasons behind the
Conflict of interest statement
None declared.
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This study is supported by the Academy of Finland Research Council for Health, the Competitive Research Funding of the Pirkanmaa Hospital District, the Sigrid Juselius Foundation, the Foundation for Paediatric Research, the National Graduate School of Clinical Investigation, the Ehrnrooth Foundation, the Finnish Gastroenterology Society, the Finnish Pediatric Society and the Finnish Celiac Society.