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Canestaro WJ, Edwards TC, Patrick DL. Systematic review: patient-reported outcome measures in coeliac disease for regulatory submissions. Aliment Pharmacol Ther 2016; 44:313-31. [PMID: 27349458 DOI: 10.1111/apt.13703] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 02/20/2016] [Accepted: 06/01/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND New therapeutics are moving into phase 3 clinical trials for the treatment of coeliac disease, a condition with no established therapies other than gluten-free diet. These trials will require a meaningful, validated and fit for purpose patient-reported outcome measure (PROM) to quantify the symptomatic improvement of patients. AIM To evaluate existing PROMs for suitability in a Food and Drug Administration (FDA) approval trial for a coeliac disease therapeutic. METHOD We performed a systematic search in five online databases (MedLine, EmBase, Web of Science, CENTRAL, CINAHL) for studies that enrolled patients with coeliac disease and used PROMs. Studies included in this review had to measure some PROM concept, be patient administered and based upon a previously validated instrument with published measurement properties. RESULTS Our literature search identified 2706 unique records of which 199 ultimately qualified for abstraction. The majority of PROMs used in studies of coeliac disease was generic and did not measure numerous symptoms or concerns of interest to patients. Four PROMs were found to contain appropriate content for use in an FDA trial: the coeliac disease-specific modification of the Gastrointestinal Symptoms Rating Scale (CeD-GSRS), Psychological General Well-Being Index (PGWB), the Celiac Disease Symptom Diary (CDSD) and the Celiac Disease Patient Reported Outcome (CeD-PRO). The GSRS and PGWB are most often used together and are two of the most extensively used measures in coeliac disease. The CDSD and CeD-PRO were developed exclusively for trials in coeliac disease but have much less published information on their measurement properties. CONCLUSIONS While we did not find PROMs that currently meet the stated expectations of the FDA for regulatory purposes, four PROMs (CeD-GSRS, PGWB, CDSD and CeD-PRO) appear to contain appropriate content and with modest additional validation work could meet scientific standards for valid and sensitive measures of disease and treatment outcome. Specifically, what is needed for these instruments is an understanding of how sensitive they are to real changes in-patient condition, how stable they are over a period of time when health status should not have changed (test-retest reliability) as well as how they correlate with other measures of patient functioning such as intestinal biopsy. All of these objectives could feasibly be accomplished over a short cohort study of patients with biopsy-defined coeliac disease undergoing gluten challenge.
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Affiliation(s)
- W J Canestaro
- Pharmaceutical Outcomes Research and Policy Program, University of Washington School of Pharmacy, Seattle, WA, USA
| | - T C Edwards
- Department of Health Services, Seattle Quality of Life Group, University of Washington School of Public Health, Seattle, WA, USA
| | - D L Patrick
- Department of Health Services, Seattle Quality of Life Group, University of Washington School of Public Health, Seattle, WA, USA
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Corposanto C, Molinari B, Neuhold S. Celiac Disease Seen with the Eyes of the Principle Component Analysis and Analyse Des Données. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ojs.2015.53023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Mahmoodi A, Jafarihaydarlo A, Yasemi M, Hemati K, Peyman H. Celiac disease prevalence in the patients with irritable bowel syndrome in the ilam province; a cross sectional study from Western iran. J Clin Diagn Res 2014; 8:GC01-3. [PMID: 25653962 DOI: 10.7860/jcdr/2014/10175.5286] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 09/15/2014] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Many studies have shown that the prevalence of celiac disease (CD) is increasing in the patients with irritable bowel syndrome (IBS), but the present evidences are controversy and all of the researches don't suggest evaluation of the patients with IBS for the CD. MATERIALS AND METHODS In the cross-sectional study, 1000 patients that affected by IBS with the predominant feature of diarrhea who referred to the gastroenterology clinic were evaluated during 2009-2012 years. Blood samples were taken from the patients for ELISA of IgA tissue transglutaminase (TTG) Ab. Then biopsy was taken from the second part of duodenum of all of patients by endoscopy and the sample was referred to pathologist for histopathology evaluation in order to confirm diagnosis. RESULTS About half of the patients with IBS were women (50.3%) and the mean age ± Standard deviation of the men and women was 29.59±11.41 and 28.42±11.73, respectively. The mean titer of TTG IgA Ab in the women and men affected by IBS was 5.25±17.77 and 7.22±25.4, respectively. Seventy six cases (7.6%) that affected by IBS had high serum level of Ab titer (TTG IgA.Ab≥10) that including 41 women and 35 men. In the patients with high serum level of Ab titer, 57 cases (75%) were affected by celiac disease (based on histopathology report). Therefore, the prevalence of CD was 5.7% among patients with IBS. CONCLUSION In the current study the incidence of CD was evaluated 5.7 cases per each 100 people with IBS. It's suggested that all of the patients with diarrhea predominant IBS and high serum level of TTG IgA Ab must be examined for evaluation of CD.
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Affiliation(s)
- Alireza Mahmoodi
- Student Research Committee, Ilam University of Medical Sciences , Ilam, Iran
| | - Ali Jafarihaydarlo
- Assistant Professor of Gastroenterology, Dept of Internal Medicine, Faculty of Medicine, Ilam University of Medical Sciences , Ilam, Iran
| | - Masood Yasemi
- Student Research Committee, Ilam University of Medical Sciences , Ilam, Iran
| | - Karim Hemati
- Assistant Professor of Anesthesia, Department of Anesthesiology, Faculty of Medicine, Ilam University of Medical Sciences , Ilam, Iran
| | - Hadi Peyman
- Student Research Committee, Ilam University of Medical Sciences , Ilam, Iran
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4
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Celiac symptoms in patients with fibromyalgia: a cross-sectional study. Rheumatol Int 2014; 35:561-7. [DOI: 10.1007/s00296-014-3110-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 07/31/2014] [Indexed: 12/28/2022]
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5
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Sharp K, Walker H, Coppell KJ. Coeliac disease and the gluten-free diet in New Zealand: The New Zealand Coeliac Health Survey. Nutr Diet 2014. [DOI: 10.1111/1747-0080.12105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Kiri Sharp
- Department of Medicine; Edgar National Centre for Diabetes and Obesity Research; Dunedin New Zealand
| | - Heather Walker
- Department of Human Nutrition; LINZ Nutrition and Activity Research Unit; Dunedin New Zealand
| | - Kirsten J. Coppell
- Department of Medicine; Edgar National Centre for Diabetes and Obesity Research; Dunedin New Zealand
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6
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Khanna P, Agarwal N, Khanna D, Hays RD, Chang L, Bolus R, Melmed G, Whitman CB, Kaplan RM, Ogawa R, Snyder B, Spiegel BM. Development of an online library of patient-reported outcome measures in gastroenterology: the GI-PRO database. Am J Gastroenterol 2014; 109:234-48. [PMID: 24343547 PMCID: PMC4275098 DOI: 10.1038/ajg.2013.401] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 10/22/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Because gastrointestinal (GI) illnesses can cause physical, emotional, and social distress, patient-reported outcomes (PROs) are used to guide clinical decision making, conduct research, and seek drug approval. It is important to develop a mechanism for identifying, categorizing, and evaluating the over 100 GI PROs that exist. Here we describe a new, National Institutes of Health (NIH)-supported, online PRO clearinghouse-the GI-PRO database. METHODS Using a protocol developed by the NIH Patient-Reported Outcome Measurement Information System (PROMIS(®)), we performed a systematic review to identify English-language GI PROs. We abstracted PRO items and developed an online searchable item database. We categorized symptoms into content "bins" to evaluate a framework for GI symptom reporting. Finally, we assigned a score for the methodological quality of each PRO represented in the published literature (0-20 range; higher indicates better). RESULTS We reviewed 15,697 titles (κ>0.6 for title and abstract selection), from which we identified 126 PROs. Review of the PROs revealed eight GI symptom "bins": (i) abdominal pain, (ii) bloat/gas, (iii) diarrhea, (iv) constipation, (v) bowel incontinence/soilage, (vi) heartburn/reflux, (vii) swallowing, and (viii) nausea/vomiting. In addition to these symptoms, the PROs covered four psychosocial domains: (i) behaviors, (ii) cognitions, (iii) emotions, and (iv) psychosocial impact. The quality scores were generally low (mean 8.88 ± 4.19; 0 (min)-20 (max). In addition, 51% did not include patient input in developing the PRO, and 41% provided no information on score interpretation. CONCLUSIONS GI PROs cover a wide range of biopsychosocial symptoms. Although plentiful, GI PROs are limited by low methodological quality. Our online PRO library (www.researchcore.org/gipro/) can help in selecting PROs for clinical and research purposes.
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Affiliation(s)
- Puja Khanna
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Nikhil Agarwal
- Department of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA,Department of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Dinesh Khanna
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ron D. Hays
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, and Department of Health Services, UCLA School of Public Health, Los Angeles, California, USA
| | - Lin Chang
- Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA,Center for Neurobiology of Stress, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Roger Bolus
- Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA,UCLA/VA Center for Outcomes Research and Education, Los Angeles, California, USA
| | - Gil Melmed
- Department of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Cynthia B. Whitman
- UCLA/VA Center for Outcomes Research and Education, Los Angeles, California, USA
| | - Robert M. Kaplan
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, and Department of Health Services, UCLA School of Public Health, Los Angeles, California, USA
| | - Rikke Ogawa
- Biomedical Library of the Health Sciences, University of California at Los Angeles, Los Angeles, California, USA
| | - Bradley Snyder
- UCLA/VA Center for Outcomes Research and Education, Los Angeles, California, USA
| | - Brennan M.R. Spiegel
- Department of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA,Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, and Department of Health Services, UCLA School of Public Health, Los Angeles, California, USA,Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA,UCLA/VA Center for Outcomes Research and Education, Los Angeles, California, USA
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Sainsbury K, Mullan B, Sharpe L. Reduced quality of life in coeliac disease is more strongly associated with depression than gastrointestinal symptoms. J Psychosom Res 2013; 75:135-41. [PMID: 23915769 DOI: 10.1016/j.jpsychores.2013.05.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 05/29/2013] [Accepted: 05/31/2013] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Despite evidence indicating a heightened incidence of psychological symptoms in coeliac disease (CD), the direct link between psychological factors and quality of life (QOL) has received little attention. The purpose of this paper was to compare the relative impacts of psychological symptoms and coping to the known negative impacts of gastrointestinal symptoms and adherence to the gluten free diet (GFD) on QOL. METHODS In study 1 (N=390), participants completed measures of QOL, psychological symptoms, coping, several indices of symptom severity, and adherence. Correlations and regression analyses were used to determine the relationships between QOL and the measured variables. Study 2 (N=189) replicated the findings using a validated measure of current gastrointestinal symptom severity and a more comprehensive measure of coping. RESULTS Across both studies, poorer QOL was correlated with a higher incidence of psychological and gastrointestinal symptoms, greater reliance on maladaptive coping strategies, and poorer GFD adherence. The relationship between psychological symptoms (particularly depression) and QOL persisted when controlling for past (study 1) and current (study 2) gastrointestinal symptom severity. Psychological symptoms and GFD adherence were more strongly related to reduced QOL than gastrointestinal symptoms. CONCLUSION The negative impact of psychological symptoms on QOL and adherence suggests that management in CD should include the provision of psychological coping skills, as well as purely dietetic-based strategies to minimise gastrointestinal symptoms.
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Affiliation(s)
- Kirby Sainsbury
- Clinical Psychology Unit, The University of Sydney, Australia
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Spiegel BMR. Patient-reported outcomes in gastroenterology: clinical and research applications. J Neurogastroenterol Motil 2013; 19:137-48. [PMID: 23667745 PMCID: PMC3644650 DOI: 10.5056/jnm.2013.19.2.137] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 02/25/2013] [Accepted: 02/26/2013] [Indexed: 12/11/2022] Open
Abstract
Patient-generated reports, also known as Patient-Reported Outcomes (PROs), capture the patients' illness experience in a structured format and may help bridge the gap between patients and providers. PROs measure any aspect of patient-reported health (e.g., physical, emotional or social symptoms) and can help to direct care and improve clinical outcomes. When clinicians systematically collect patient-reported data in the right place at the right time, PRO measurement can effectively aid in detection and management of conditions, improve satisfaction with care and enhance the patient-provider relationship. This review article summarizes the latest approaches to PRO measuring for clinical trials and clinical practice, with a focus on use of PROs in gastroenterology.
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Affiliation(s)
- Brennan M R Spiegel
- Department of Gastroenterology, VA Greater Los Angeles Healthcare System; Division of Digestive Diseases, David Geffen School of Medicine at UCLA; Department of Health Services, UCLA School of Public Health; and UCLA/VA Center for Outcomes Research and Education, Los Angeles, California, USA
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Al-Raee MB, El-Sakka MA, Al-Wahaidi AA. In depth analysis of risk factors for coeliac disease amongst children under 18 years old in the Gaza strip. A cross sectional study. Nutr J 2012; 11:97. [PMID: 23164160 PMCID: PMC3511227 DOI: 10.1186/1475-2891-11-97] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 10/16/2012] [Indexed: 11/26/2022] Open
Abstract
UNLABELLED Coeliac disease is an important clinical disorder affecting the human gastrointestinal tract leading to multiple signs and symptoms in different body organs. This disease was the subject of a cross sectional descriptive-analytic study conducted in the Gaza Strip during 2010. Objectives were oriented to identify and verify several variables and attributes affecting the prognosis of coeliac disease in the patients. Ninety five children out of 113 patients were arranged into two groups according to age from 2 to 11 years and from 12 to 18 years old. Results showed the poor interest of health professionals regarding coeliac disease in the Gaza Strip. The mean age of study population was 5.47 years for males and 8.93 years for females. The lifestyle of coeliac patients was directly proportional with better nutritional indictors. Poor recognition of the emblem illustrating gluten in foods implicates effective health awareness or promotion. The more knowledgeable patients or mothers (P = 0.036) were the more compliant. The compliance to giving gluten free foods outside home was statistically significant (P = 0.037). Similarly, cautious approach when buying foods or detergents (P = 0.011). According to BMI 74.4%, 23.4% and 3.2% of all patients were normal, underweight and overweight respectively. Albumin blood level was normal in 32.6% and low in 67.4%. Meanwhile, blood calcium level was normal in 76.8%, low in 21.1% and high in 2.1% of all patients. CONCLUSION The study showed that recreation and social activities for coeliac patients are substantially missing in the Gaza Strip. Moreover, the study proved that AEI is a reliable centre for care of coeliac disease patients and conducting relevant studies. RECOMMENDATION There is a need for thorough and continuous community and institutional mobilization regarding coeliac disease in the Gaza Strip and in Palestine.
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Affiliation(s)
- Mohammad B Al-Raee
- El Dorra Pediatrics Hospital, Yafast, the Gaza strip, Gaza city, Palestine
| | - Mazen A El-Sakka
- Collage of Pharmacology, Al-Azhar University, Al-Thalathiney St, the Gaza strip, Gaza city, Palestine
| | - Adnan A Al-Wahaidi
- Ard El-Insan Palestinian Benevolent Association, Al-Nussir St, the Gaza strip, Gaza city, Palestine
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Dorn SD, Hernandez L, Minaya MT, Morris CB, Hu Y, Leserman J, Lewis S, Lee A, Bangdiwala SI, Green PHR, Drossman DA. The development and validation of a new coeliac disease quality of life survey (CD-QOL). Aliment Pharmacol Ther 2010; 31:666-75. [PMID: 20015103 DOI: 10.1111/j.1365-2036.2009.04220.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Previous studies on coeliac disease (CD)-related quality of life (QOL) have been limited by their use of a 'generic' rather than coeliac disease-specific assessment instruments. AIM To develop and psychometrically validate a new coeliac disease-specific instrument, the CD-QOL. METHODS Through a series of focus groups, we elicited items from patients that related to the specific nature of their disease and its impact on their basic needs. Through expert review, cognitive debriefing with patients and pilot testing, a scale was developed, refined and administered to 387 patients on a gluten-free diet from both community-based support groups and a tertiary care referral centre. Finally, a formal validation study was conducted to assess the psychometric properties of the CD-QOL. RESULTS The final CD-QOL has 20 items across four clinically relevant subscales (Limitations, Dysphoria, Health Concerns, and Inadequate Treatment). The CD-QOL has high internal consistency, reliability, and psychometric validation indicates both convergent and discriminate validity. CONCLUSIONS The CD-QOL is a reliable and valid measure of coeliac disease related QOL. As a new disease-specific instrument, it is likely to be a useful tool for evaluating patients with this disorder.
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Affiliation(s)
- S D Dorn
- Center for Functional GI and Motility Disorders, University of North Carolina, USA
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Galván JA, Lemos G, Fernández de Cossio ME, Ruenes C, Martínez Y, Tejeda Y, Roca J, Palenzuela DO, Novoa LI, Nazabal M. Silent celiac disease in a cohort of healthy adults. Autoimmunity 2009; 42:705-8. [DOI: 10.3109/08916930903214009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hall NJ, Rubin G, Charnock A. Systematic review: adherence to a gluten-free diet in adult patients with coeliac disease. Aliment Pharmacol Ther 2009; 30:315-30. [PMID: 19485977 DOI: 10.1111/j.1365-2036.2009.04053.x] [Citation(s) in RCA: 271] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Coeliac disease is increasingly diagnosed in adult patients who present with atypical symptoms or who are asymptomatic and detected by case screening. Its treatment, a gluten-free diet, can have a considerable impact on daily living. Understanding the factors associated with non-adherence is important in terms of supporting patients with their condition. AIM To investigate factors associated with adherence to a gluten-free diet in adults with coeliac disease. METHODS A literature search of multiple electronic databases using a pre-determined search string for literature between 1980 and November 2007 identified a possible 611 hits. After checking for relevance, 38 studies were included in this review. RESULTS Rates for strict adherence range from 42% to 91% depending on definition and method of assessment and are the lowest among ethnic minorities and those diagnosed in childhood. Adherence is most strongly associated with cognitive, emotional and socio-cultural influences, membership of an advocacy group and regular dietetic follow-up. Screen and symptom-detected coeliac patients do not differ in their adherence to a gluten-free diet. CONCLUSIONS The existing evidence for factors associated with non-adherence to a gluten-free diet is of variable quality. Further and more rigorous research is needed to characterize those individuals most likely to be non-adherent to assist them better with their treatment.
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Affiliation(s)
- N J Hall
- School of Applied Sciences, University of Sunderland, Sunderland, UK
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Ozdil K, Sokmen M, Ersoy O, Demirsoy H, Kesici B, Karaca C, Akbayir N, Erdem L, Alkim C, Sakiz D. Association of gluten enteropathy and irritable bowel syndrome in adult Turkish population. Dig Dis Sci 2008; 53:1852-5. [PMID: 18270831 DOI: 10.1007/s10620-007-0082-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2006] [Accepted: 10/27/2007] [Indexed: 12/11/2022]
Abstract
PURPOSE Irritable bowel syndrome is generally diagnosed according to the symptoms of the patient, and gluten enteropathy can also be presented with similar symptoms (diarrhea and/or constipation) of irritable bowel syndrome. Aimed to assess the association and the frequency of gluten enteropathy in a group of Turkish patients diagnosed as irritable bowel syndrome. RESULTS Found anti-gliadin IgA positivity only in four patients among patients with irritable bowel syndrome. However, none of these four patients had anti-endomycium positivity or any histopathological findings specific for gluten enteropathy. All these four patients had normal histology in their small bowel biopsies. CONCLUSION Irritable bowel syndrome is a common problem in the population, but gluten enteropathy is not associated with the vast majority of subjects with irritable bowel syndrome as expected. The need for screening gluten enteropathy among these patients is still unclear, and screening with serology only without small bowel biopsy may lead to false positive results.
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Affiliation(s)
- Kamil Ozdil
- Gastroenterology, Sisli etfal education and research hospital, Istanbul 80260, Turkey
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Troncone R, Ivarsson A, Szajewska H, Mearin ML. Review article: future research on coeliac disease - a position report from the European multistakeholder platform on coeliac disease (CDEUSSA). Aliment Pharmacol Ther 2008; 27:1030-43. [PMID: 18315588 DOI: 10.1111/j.1365-2036.2008.03668.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND CDEUSSA is a Specific Support Action project from the Sixth Framework Programme Priority of the European Union (EU). Its aim is to bring together basic and applied research in the area of coeliac disease (CD). This paper reviews the main issues that are a result of the CDEUSSA initiative. AIM To identify the major issues in need of investigation in the areas of clinical aspects, treatment, prevention and public health. METHODS Key stakeholders, representing a wide range of knowledge with crucial importance for CD research and practice, have participated in two workshops aimed at identifying and proposing to the EU, as high priority research, topics in the areas of clinical aspects, treatment, prevention and public health. RESULTS In public health, the overall goal should be to improve quality of life of the European population by implementing primary prevention strategies, early diagnosis and improved treatments for CD. New treatment strategies need to be developed. The option of primary prevention should be fully explored, which requires combined epidemiological, clinical and basic scientific research efforts. Such studies should also consider the importance of gene-environment interactions in the development of CD. Increased knowledge is needed on the natural history of CD. Diagnostic criteria need to be revised. CONCLUSIONS To achieve these goals, a collaboration of the stakeholders is fundamental, including research and patient organizations, as well as industries within both diagnostics and food production.
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Affiliation(s)
- R Troncone
- Department of Paediatrics and European Laboratory for Investigation of Food Induced Diseases, University Federico II, Naples, Italy.
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Leffler DA, Edwards-George J, Dennis M, Schuppan D, Cook F, Franko DL, Blom-Hoffman J, Kelly CP. Factors that influence adherence to a gluten-free diet in adults with celiac disease. Dig Dis Sci 2008; 53:1573-81. [PMID: 17990115 PMCID: PMC3756800 DOI: 10.1007/s10620-007-0055-3] [Citation(s) in RCA: 166] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Accepted: 09/26/2007] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The only treatment for celiac disease is lifelong adherence to a gluten-free diet, yet adherence is limited and factors influencing adherence are poorly understood. The purpose of this study was to determine factors influencing gluten-free diet adherence in adults with celiac disease. METHODS A questionnaire was developed and administered to 154 adults with celiac disease who then underwent a standardized gluten-free diet evaluation by an experienced nutritionist. Multivariate analysis was conducted to determine factors associated with adherence level. RESULTS Thirteen factors hypothesized to contribute to gluten-free diet adherence were found to be significantly associated with improved adherence including: understanding of the gluten-free diet, membership of a celiac disease advocacy group, and perceived ability to maintain adherence despite travel or changes in mood or stress (P < 0.001). CONCLUSIONS This study identified specific factors correlated with gluten-free diet adherence. These results provide a foundation for the design of educational interventions to improve adherence.
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Affiliation(s)
- Daniel A. Leffler
- Department of Gastroenterology, The Celiac Center, Dana 501, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA
| | - Jessica Edwards-George
- Department of Gastroenterology, The Celiac Center, Dana 501, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA; Department of Psychology, Northeastern University, Boston, MA, USA
| | - Melinda Dennis
- Department of Gastroenterology, The Celiac Center, Dana 501, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA
| | - Detlef Schuppan
- Department of Gastroenterology, The Celiac Center, Dana 501, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA
| | - Francis Cook
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Debra L. Franko
- Department of Psychology, Northeastern University, Boston, MA, USA
| | | | - Ciaran P. Kelly
- Department of Gastroenterology, The Celiac Center, Dana 501, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA
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Casellas F, Rodrigo L, Vivancos JL, Riestra S, Pantiga C, Baudet JS, Junquera F, Diví VP, Abadia C, Papo M, Gelabert J, Malagelada JR. Factors that impact health-related quality of life in adults with celiac disease: A multicenter study. World J Gastroenterol 2008; 14:46-52. [PMID: 18176960 PMCID: PMC2673390 DOI: 10.3748/wjg.14.46] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the factors involved in the impairment of health-related quality of life (HRQOL) in patients with celiac disease.
METHODS: A multicenter, cross-sectional prospective study was performed in patients with celiac disease who completed two HRQOL questionnaires: the gastrointestinal quality of life index (GIQLI) and the EuroQol-5D (EQ).
RESULTS: Three hundred and forty patients (163 controlled with a gluten-free diet, and 177 newly diagnosed with a normal diet) were included. The GIQLI score was significantly better in patients on a gluten-free diet (GFD) than in non-treated patients on their usual diet, both in terms of the overall score (3.3 vs 2.7, respectively; P < 0.001), as well as on the individual questionnaire dimensions. Both the preference value of the EQ as the visual analogue scale were significantly better in treated than in non-treated patients (0.93 vs 0.72, P < 0.001 and 80 vs 70, P < 0.001, respectively). Variables significantly associated with a worse HRQOL score were female gender, failure to adhere to a GFD, and symptomatic status.
CONCLUSION: In untreated celiac disease, the most important factors that influence patient perception of health are the presence of symptoms and a normal diet. HRQOL improves to levels similar to those described in the general population in celiac disease patients well controlled with a GFD.
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Silvester JA, Rashid M. Long-term follow-up of individuals with celiac disease: an evaluation of current practice guidelines. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2007; 21:557-64. [PMID: 17853949 PMCID: PMC2657984 DOI: 10.1155/2007/342685] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Celiac disease can be treated by following a strict gluten-free diet for life. If properly followed, the diet resolves symptoms and nutritional deficiencies. It is generally recommended that individuals with celiac disease have careful long-term follow-up. However, it is not clear which elements of disease status evaluation, laboratory investigations and self-management support should be included in follow-up. OBJECTIVES To examine the current practice guidelines and recommendations regarding follow-up of individuals with celiac disease. METHODS Guidelines issued by gastroenterological societies and associations, and recommendations by experts were retrieved using Medline and other Internet search engines. RESULTS Practice guidelines were available from the American Gastroenterological Association; the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition; the National Institutes of Health Consensus Development Conference 2004; the World Gastroenterology Organization; the British Society for Gastroenterology and the United Kingdom-based Primary Care Society for Gastroenterology. Most guidelines recommended a scheduled annual review and regular measurements of body mass index. The British Society for Gastroenterology recommended dietary review only at times of stress, while others recommended dietary review with a nutritionist. All associations recommended serial tissue transglutaminase antibody testing. The American Gastroenterological Association and the Primary Care Society for Gastroenterology recommended annual hemoglobin, ferritin and folate checks. One guideline recommended annual hemoglobin, electrolyte, calcium, albumin, ferritin, folate, fat-soluble vitamin, liver function test, parathyroid hormone and bone density measurements (approximately $400 per patient). CONCLUSIONS The current practice guidelines regarding the follow-up of patients with celiac disease varied greatly in their recommendations and many were not evidence-based. Prospective studies are required to develop rational, cost-effective and risk-stratified guidelines for long-term follow-up of these patients.
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Affiliation(s)
| | - Mohsin Rashid
- Division of Gastroenterology and Nutrition, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia
- Correspondence: Dr Mohsin Rashid, Division of Gastroenterology, IWK Health Centre, Dalhousie University, 5850 University Avenue, Halifax, Nova Scotia B3K 6R8. Telephone 902-470-8746, fax 902-470-7249, e-mail
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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; 52:1087-95. [PMID: 17318390 DOI: 10.1007/s10620-006-9258-2] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2005] [Accepted: 02/13/2006] [Indexed: 12/12/2022]
Abstract
The purpose of this study was to characterize the diagnostic process, frequency of associated disorders, family history, and impact of a gluten-free diet in individuals with celiac disease. All members of the Canadian Celiac Association (n=5240) were surveyed with a questionnaire. Respondents included 2681 adults with biopsy-proven celiac disease. The mean age was 56 years. Most common presenting symptoms included abdominal pain (83%), diarrhea (76%), and weight loss (69%). The mean delay in diagnosis was 11.7 years. Diagnoses made prior to celiac disease included anemia (40%), stress (31%), and irritable bowel syndrome (29%). Osteoporosis was common. Prior to diagnosis, 27% of respondents consulted three or more doctors about their symptoms. Delays in diagnosis of celiac disease remain a problem. Associated medical conditions occur frequently. More accurate food labeling is needed. Improved awareness of celiac disease and greater use of serological screening tests may result in earlier diagnosis and reduced risk of associated conditions.
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Affiliation(s)
- Ann Cranney
- Department of Medicine, Ottawa Health Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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Rashid M, Cranney A, Zarkadas M, Graham ID, Switzer C, Case S, Molloy M, Warren RE, Burrows V, Butzner JD. Celiac disease: evaluation of the diagnosis and dietary compliance in Canadian children. Pediatrics 2005; 116:e754-9. [PMID: 16322131 DOI: 10.1542/peds.2005-0904] [Citation(s) in RCA: 142] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We sought to characterize the clinical features at presentation as well as the associated disorders, family history, and evaluation of compliance with a gluten-free diet in children with celiac disease from across Canada. STUDY DESIGN All members (n = 5240) of the Canadian Celiac Association were surveyed with a questionnaire. Of the 2849 respondents with biopsy-confirmed celiac disease, 168 who were < 16 years old provided the data reported here. RESULTS The mean age when surveyed was 9.1 +/- 4.1 years, and 58% were female. Median age at diagnosis was 3.0 years with a range of 1 to 15 years. Presenting symptoms included abdominal pain (90%), weight loss (71%), diarrhea (65%), weakness (64%), nausea/vomiting (53%), anemia (40%), mood swings (37%), and constipation (30%). Almost one third of families consulted > or = 2 pediatricians before confirmation of the diagnosis. Before the recognition of celiac disease, other diagnoses received by these children included anemia (15%), irritable bowel syndrome (11%), gastroesophageal reflux (8%), stress (8%), and peptic ulcer disease (4%). A serological test was performed to screen for celiac disease in 70% of those in this population. Eight percent had either type 1 diabetes mellitus or a first-degree relative with celiac disease. Almost all respondents (95%) reported strict adherence to a gluten-free diet, and 89% noted improved health. Reactions after accidental gluten ingestion developed in 54% of the children between 0.5 and 60 hours after ingestion with a median of 2.0 hours. Reactions included abdominal discomfort (87%), diarrhea (64%), bloating (57%), fatigue (37%), headache (24%), and constipation (8%), and most displayed > 1 symptom. Although most adjusted well to their disease and diet, 10% to 20% reported major disruptions in lifestyle. Twenty-three percent felt angry all or most of the time about following a gluten-free diet. Only 15% avoided traveling all or most of the time, and during travel, 83% brought gluten-free food with them all of the time. More than half of the families avoided restaurants all or most of the time. Twenty-eight percent of the respondents found it extremely difficult to locate stores with gluten-free foods, and 27% reported extreme difficulty in finding gluten-free foods or determining if foods were free of gluten. Sixty-three percent of the respondents felt that the information supplied by the Canadian Celiac Association was excellent. Gastroenterologists provided excellent information to 44%, dietitians to 36%, and the family physician to 11.5%. When asked to select 2 items that would improve their quality of life, better labeling of gluten-containing ingredients was selected by 63%, more gluten-free foods in the supermarket by 49%, gluten-free choices on restaurant menus by 49%, earlier diagnosis of celiac disease by 34%, and better dietary counseling by 7%. CONCLUSIONS In Canada, children with celiac disease present at all ages with a variety of symptoms and associated conditions. Delays in diagnosis are common. Most children are compliant with a gluten-free diet. A minority of these children experience difficulties in modifying their lifestyles, and gluten-free foods remain difficult to obtain.
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Affiliation(s)
- Mohsin Rashid
- Division of Gastroenterology and Nutrition, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.
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Zipser RD, Farid M, Baisch D, Patel B, Patel D. Physician awareness of celiac disease: a need for further education. J Gen Intern Med 2005; 20:644-6. [PMID: 16050861 PMCID: PMC1490146 DOI: 10.1111/j.1525-1497.2005.0107.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Celiac disease is a common disorder (up to 0.7%); however, it is uncommonly diagnosed in the United States. OBJECTIVE We sought to determine physician awareness of celiac disease. DESIGN Surveys completed by 2,440 (47%) of 5,191 patients in a support group were analyzed for frequency of diagnosis by physician specialties. Questionnaires were then sent to primary care physicians (PCPs) (n=132) in a southern California county to assess knowledge of celiac disease. RESULTS In patient surveys, only 11% were diagnosed by PCPs (internists and family physicians) versus 65% by gastroenterologists. Physician surveys (70% response) showed that only 35% of PCPs had ever diagnosed celiac disease. Almost all physicians (95%) knew of wheat intolerance, but few (32%) knew that onset of symptoms in adulthood is common. Physicians were well aware (90%) of diarrhea as a symptom, but fewer knew of common symptoms of irritable bowel syndrome (71%), chronic abdominal pain (67%), fatigue (54%), depression and irritability (24%) or of associations with diabetes (13%), anemia (45%) or osteoporosis (45%), or of diagnosis by endomysial antibody tests (44%). CONCLUSIONS Lack of physician awareness of adult onset of symptoms, associated disorders, and use of serology testing may contribute to the underdiagnosis of celiac disease.
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Abstract
AIM The aim of this study was to explore the dilemmas experienced by women and men in their everyday lives in relation to their coeliac disease, and to explore the qualities of these dilemmas in relation to specific situations and living conditions. METHODS We interviewed 43 informants, aged 20-40 years, using 'The Critical Incident Technique'. Interviews focused on situations that gave rise to confusion or discomfort in relation to disease. The interviews were transcribed verbatim and analysed qualitatively. RESULTS We found 195 dilemmas, experienced in five arenas: food situation at work, during purchases, when travelling, in relation to meals at home and meals outside the home. Emotions, relationships and the management of daily life were the three main categories of dilemmas that emerged through the analysis. Specific emotions were experienced in relation to the disease, such as isolation, shame, fear of becoming contaminated by gluten and worries about being a bother. In the relationship with other persons the informants experienced a number of complicating dilemmas such as unwanted visibility, neglect, being forgotten, disclosure avoidance and risk taking. Dilemmas related to the management of daily life were restricted product choice, double work and constantly being on call. CONCLUSIONS The lived experiences of coeliac disease were more varied and profound than expected. It is important to take psychological and social aspects into account in the treatment of patients with coeliac disease.
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Affiliation(s)
- A Sverker
- Department of Social Medicine, Göteborg University, Gothenburg, Sweden.
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Abstract
A strict gluten-free diet (GFD) for life is the only treatment for celiac disease (CD). This article reviews (1) the impact of the GFD on the quality of life of individuals with CD and their families; (2) the causes of poorly controlled CD; (3) the access to and source and quality of information provided by health professionals and other groups; (4) management strategies, including nutritional assessment and education guidelines; (5) a variety of resources available to individuals and health professionals; (6) innovative educational initiatives and partnerships; and (7) specific recommendations to address the increasing numbers of people with CD and the growing need for gluten-free (GF) foods and further education about CD and the GFD. Successful management of CD requires a team approach, including the person with CD and his or her family, physician, dietitian, and celiac support group; an individualized approach; understanding of quality of life issues; use of evidence-based, current information and resources; and regular follow-up to monitor compliance, nutritional status, and additional information and support. The physician must clearly communicate, with a positive attitude, an overview of CD and strongly emphasize the importance of a GFD for life. It is essential that the physician initiate an immediate referral to a dietitian with expertise in CD for nutritional assessment, diet education, meal planning, and assistance with the adaptation to the challenging new gluten-free lifestyle. Good dietary compliance will reduce the risk of further complications and associated health care costs and improve quality of life in patients with CD.
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Affiliation(s)
- Shelley Case
- Celiac Disease Foundation, Studio City, California, USA.
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Mein SM, Ladabaum U. Serological testing for coeliac disease in patients with symptoms of irritable bowel syndrome: a cost-effectiveness analysis. Aliment Pharmacol Ther 2004; 19:1199-210. [PMID: 15153173 DOI: 10.1111/j.1365-2036.2004.01958.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients diagnosed with irritable bowel syndrome may have coeliac disease. AIM To evaluate the cost-effectiveness of coeliac disease testing in suspected irritable bowel syndrome. METHODS We used decision analysis to estimate the number of coeliac disease cases detected, quality-adjusted life-years gained, and costs resulting from testing suspected irritable bowel syndrome patients for tissue transglutaminase antibody or an antibody panel (tissue transglutaminase, gliadin, total immunoglobulin A). Positive tests prompted endoscopic biopsy. A gluten-free diet improved quality of life in coeliac disease. RESULTS Assuming a coeliac disease prevalence of 3%, tissue transglutaminase detected 28 and the panel detected 29 of 30 coeliac disease cases among 1000 suspected irritable bowel syndrome patients. The cost/case detected was $4600 with tissue transglutaminase and $8800 with the panel. The cost/quality-adjusted life-year gained with tissue transglutaminase was $7400, and the incremental cost/quality-adjusted life-year gained for the panel vs. tissue transglutaminase was $287 000. Tissue transglutaminase cost under $100 000/quality-adjusted life-year gained at a coeliac disease prevalence >/=1.1%, assuming a modest utility gain of 0.005 with coeliac disease diagnosis. CONCLUSIONS Testing for coeliac disease in patients with suspected irritable bowel syndrome is likely to be cost-effective even at a relatively low coeliac disease prevalence and with small improvements in quality of life with a gluten-free diet.
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Affiliation(s)
- S M Mein
- Division of Gastroenterology, Department of Medicine, University of California, San Francisco, CA, USA
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