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Chaves C, Zandonadi RP, Raposo A, Nakano EY, Ramos F, Farage P, Teixeira-Lemos E. Health-related quality of life among celiacs in Portugal: a comparison between general and specific questionnaires. Front Immunol 2024; 15:1372369. [PMID: 38500888 PMCID: PMC10944991 DOI: 10.3389/fimmu.2024.1372369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 02/20/2024] [Indexed: 03/20/2024] Open
Abstract
Objective This study aimed to compare the 36-Item Short Form Survey Instrument version 2 (SF-36-v2) (generic) and Celiac Disease Questionnaire (CDQ) (specific) questionnaires used to evaluate the quality of life (QoL) in celiac Portuguese adult individuals. Methods This cross-sectional study used non-probabilistic sampling based on Portuguese celiac patients who accessed the online survey in 2022. The online data collection used a self-reported instrument composed of three parts: (i) socioeconomic, health, and gluten-free diet (GFD) adherence questions; (ii) SF-36 v2 - Portuguese version (generic questionnaire) and (iii) Celiac Disease Questionnaire (CDQ) (specific questionnaire). Results A total of 234 individuals who accessed the survey completed the questionnaire. Seven of the eight SF-36 domains positively correlated to the specific questionnaire CDQ. The "General Health" domain (domain 4) showed a negative correlation with the CDQ. Differences in content between the two instruments might be able to explain this finding since the CDQ explores issues regarding the specificities of celiac disease (CD) and the lifelong GFD burden. About half of the sample from this study displayed poor diet adherence, it is possible that the SF-36 could not reflect the impact of CD treatment - the complete elimination of gluten from the diet - on patients' health. Therefore, this issue should be carefully evaluated in future research. Conclusion Specific validated questionnaires for CD individuals, such as the CDQ, contemplate social, economic, and clinical variables that permeate the patient's life context. Therefore, these instruments may be more suitable for evaluating QoL in this public. However, using a general questionnaire such as the SF-36 would be indicated for comparing QOL between celiac patients and the general population or even between CD and other disease individuals. In this case, we recommend assessing GFD compliance for control parallelly.
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Affiliation(s)
- Cláudia Chaves
- ESSV, Centre for Studies in Education and Innovation (CI&DEI), Polytechnic University of Viseu, Viseu, Portugal
| | | | - António Raposo
- CBIOS (Research Center for Biosciences and Health Technologies), Universidade Lusófona de Humanidades e Tecnologias, Lisboa, Portugal
| | | | - Fernando Ramos
- Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
- Associated Laboratory for Green Chemistry (LAQV) of the Network of Chemistry and Technology (REQUIMTE), Porto, Portugal
| | - Priscila Farage
- Faculty of Nutrition, Federal University of Goiás, Goiânia, Brazil
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Simón E, Molero-Luis M, Fueyo-Díaz R, Costas-Batlle C, Crespo-Escobar P, Montoro-Huguet MA. The Gluten-Free Diet for Celiac Disease: Critical Insights to Better Understand Clinical Outcomes. Nutrients 2023; 15:4013. [PMID: 37764795 PMCID: PMC10537989 DOI: 10.3390/nu15184013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/10/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
The gluten-free diet (GFD) remains a complex paradigm in managing celiac disease (CeD) in children and adults, and there are many reasons why GFD adherence should be strict to improve outcomes. However, this is a challenging task for patients, since they need to have access to quality healthcare resources that facilitate optimal GFD adherence. Understanding the strengths and weaknesses of the GFD, tackling coexisting nutritional deficiencies, and dealing with complex situations, such as seronegative CeD or non-responsive CeD, all require the involvement of a multidisciplinary team. The short- and long-term follow-up of CeD patients should preferably be performed by a combined Gastroenterology and Nutrition service with well-defined quality standards and the multidisciplinary involvement of physicians, nurses, dietitians, and psychologists. Nutritional advice and counseling by an experienced dietitian can reduce the costs associated with long-term follow-up of CeD patients. Likewise, psychological interventions may be essential in specific scenarios where implementing and sustaining a lifelong GFD can cause a significant psychological burden for patients. This manuscript aims to provide guidelines to improve clinical practice in the follow-up and monitoring of CeD patients and provide information on the nutritional risks of an ill-advised GFD. Clinicians, biochemists, food technologists, dietitians, and psychologists with a global view of the disease have been involved in its writing.
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Affiliation(s)
- Edurne Simón
- GLUTEN3S Research Group, Department of Nutrition and Food Science, University of the Basque Country, 01006 Vitoria-Gasteiz, Spain
| | - Marta Molero-Luis
- Laboratory of Gastroenterology and Trace Elements, Department of Laboratory Medicine, Hospital Universitario La Paz, 28046 Madrid, Spain;
| | - Ricardo Fueyo-Díaz
- PROSAM Research Group (S69-23R), Department of Psychology and Sociology, Universidad de Zaragoza, 50009 Zaragoza, Spain;
| | - Cristian Costas-Batlle
- Department of Nutrition and Dietetics, Bradford Teaching Hospitals NHS Foundation Trust, Bradford BD9 6DA, UK;
| | - Paula Crespo-Escobar
- ADViSE Research Group, Department of Health Science, European University Miguel de Cervantes, 47012 Valladolid, Spain;
- Department of Nutrition and Obesity, Hospital Recoletas Campo Grande, 47007 Valladolid, Spain
| | - Miguel A. Montoro-Huguet
- Gastroenterology, Hepatology and Nutrition Unit, University Hospital San Jorge, 22004 Huesca, Spain
- Department of Medicine, Faculty of Health and Sport Sciences, University of Zaragoza, 22002 Huesca, Spain
- Aragon Health Research Institute (IIS Aragon), 50009 Zaragoza, Spain
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Meyer S, Monachesi C, Barchetti M, Lionetti E, Catassi C. Cross-Cultural Participation in Food-Related Activities and Quality of Life among Children with Celiac Disease. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1300. [PMID: 37628299 PMCID: PMC10453502 DOI: 10.3390/children10081300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/22/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023]
Abstract
Children with celiac disease may face challenges in managing a gluten-free diet during their daily interactions and activities. The objective of this study was to compare how children with celiac disease manage their gluten-free diet and participate in food-related activities in Italy and Israel and to assess their quality of life. The previously validated Children's Activities Report (CD-Chart) and the Disease-specific Health-Related Quality of Life Questionnaire for Children with Celiac Disease (CDDUX) were administered in Italy to children aged 8-16 diagnosed with CD (n = 39). The results were compared to data that had been previously gathered from Israeli children with CD (n = 106). The CD-Chart demonstrated satisfactory internal reliability within each cultural group (Italy: α = 0.82; Israel: α = 0.76). Mann-Whitney U-tests indicated significant differences between the two groups. The Italian children exhibited a significantly higher preference for participating in the activities compared to the Israelis (U = 3283.50, p < 0.001). Nonetheless, the Italian children displayed a notable decrease in their level of involvement in the preparation required before engaging in different activities (U = 760.50, p < 0.001). Moreover, they exhibited significantly lower self-determination in this preparatory process compared to the Israeli children (U = 726.00, p < 0.001). Significant group differences were found between the CDDUX children's self-reports and parents' proxy reports in the Israeli group but not in the Italian group. The CD-Chart revealed both shared and distinct participation characteristics in daily food-related activities across different cultural contexts. By incorporating the CD-Chart and the CDDUX, healthcare professionals can emphasize crucial aspects of day-to-day health management and guide them in establishing suitable intervention objectives to enhance effective health self-management.
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Affiliation(s)
- Sonya Meyer
- Department of Occupational Therapy, Ariel University, Ariel 40700, Israel
| | - Chiara Monachesi
- Celiac Disease Research Laboratory, Polytechnic University of Marche, 60123 Ancona, Italy;
| | - Mara Barchetti
- Division of Pediatrics, DISCO Department, Polytechnic University of Marche, 60123 Ancona, Italy; (M.B.); (E.L.)
| | - Elena Lionetti
- Division of Pediatrics, DISCO Department, Polytechnic University of Marche, 60123 Ancona, Italy; (M.B.); (E.L.)
| | - Carlo Catassi
- Division of Pediatrics, DISCO Department, Polytechnic University of Marche, 60123 Ancona, Italy; (M.B.); (E.L.)
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Chaves C, Raposo A, Zandonadi RP, Nakano EY, Ramos F, Teixeira-Lemos E. Quality of Life Perception among Portuguese Celiac Patients: A Cross-Sectional Study Using the Celiac Disease Questionnaire (CDQ). Nutrients 2023; 15:2051. [PMID: 37432200 DOI: 10.3390/nu15092051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/21/2023] [Accepted: 04/22/2023] [Indexed: 07/12/2023] Open
Abstract
The aim of this study is to assess Portuguese celiac patients' quality of life (QoL) perception. A cross-sectional study was performed with a non-probability convenience sample of Portuguese celiac patients using an online self-administered celiac disease quality of life questionnaire (CDQ), previously validated for the Portuguese population. The final sample comprised 234 celiac patients, which included the following: primarily women (69.2%); aged between 18 and 49 years old (56.4%); with a partner (60.6%); with a high educational level (58.9%-graduated or post-graduated); following a gluten-free diet (GFD) (55.1%); and not using antidepressants (93.1%). The Portuguese CDQ presented good reliability and responsiveness in this sample of Portuguese celiac patients. In general, the CDQ in Portugal was affected by age at diagnosis (p = 0.017), educational level (p = 0.005), and compliance with GFD (p = 0.034). The emotion domain was affected only by using antidepressants (p = 0.036). The social domain was affected by gender (females had lower rates, p = 0.016), age at diagnosis (p = 0.009), educational level (p = 0.000), and compliance with a GFD (p = 0.002). The worries domain did not differ according to socioeconomic data. The symptoms domain was affected by compliance with GFD (p = 0.000), age at diagnosis (p = 0.000), and educational level (p = 0.014). Data on celiac QoL is essential to support the formulation and implementation of strategies to minimize the issues suffered by celiac patients, lowering their physical, emotional, and social burden. Additionally, data on Portuguese celiac disease patients using the CDQ will allow future comparative research among celiac populations from different countries.
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Affiliation(s)
- Cláudia Chaves
- ESSV, Centre for Studies in Education and Innovation (CI&DEI), Polytechnic University of Viseu, 3504-510 Viseu, Portugal
| | - António Raposo
- CBIOS (Research Center for Biosciences and Health Technologies), Universidade Lusófona de Humanidades e Tecnologias, Campo Grande 376, 1749-024 Lisboa, Portugal
| | - Renata Puppin Zandonadi
- University of Brasília, Faculty of Health Sciences, Nutrition Department, Campus Universitário Darcy Ribeiro, Brasília 70910-900, Brazil
| | | | - Fernando Ramos
- Faculty of Pharmacy, University of Coimbra, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal
- Associated Laboratory for Green Chemistry (LAQV) of the Network of Chemistry and Technology (REQUIMTE), Rua D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal
| | - Edite Teixeira-Lemos
- CERNAS-IPV, Research Centre, Polytechnic University of Viseu, 3504-510 Viseu, Portugal
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Angyal MM, Lakatos PL, Jenei B, Brodszky V, Rencz F. Health utilities and willingness to pay in adult patients with coeliac disease in Hungary. Qual Life Res 2023:10.1007/s11136-023-03418-w. [PMID: 37067657 PMCID: PMC10393904 DOI: 10.1007/s11136-023-03418-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Coeliac disease (CD) is a life-long food-related disorder with a global prevalence of approximately 1%. Patients with CD often experience reduced health-related quality of life that could improve with a strict adherence to a gluten-free diet (GFD). OBJECTIVES To obtain visual analogue scale (VAS), time trade-off (TTO) and willingness-to-pay (WTP) values amongst patients with CD. METHODS In 2020-2021, a cross-sectional online survey was conducted amongst 312 adult CD patients in Hungary. Patients completed the Gastrointestinal Symptom Rating Scale (GSRS) and evaluated their current health and three hypothetical health state vignettes defined based on dietary adherence using VAS, conventional 10-year TTO and WTP. Multivariate regressions were used to explore the effect of patients' demographic and clinical characteristics on utility and WTP values. RESULTS Mean VAS values for current health and 'CD with strict adherence to GFD', 'CD with loose adherence to GFD' and 'CD without GFD' hypothetical health states were 79.69 ± 18.52, 85.36 ± 16.18, 62.44 ± 19.91 and 36.69 ± 25.83, respectively. Corresponding mean TTO utilities were: 0.90 ± 0.19, 0.91 ± 0.20, 0.87 ± 0.23 and 0.76 ± 0.29. Mean annual WTP values for returning to full health were: €845 ± 1077, €648 ± 1002, €862 ± 1135 and €1251 ± 1496. Older age at diagnosis, male sex, more severe gastrointestinal symptoms (GSRS) and having comorbidities were associated with lower VAS and TTO or higher WTP values for current own health (p < 0.05). CONCLUSION This is the first study to report TTO utilities for CD health states. Strict adherence to the GFD may result in substantial health gains in symptomatic patients. Utilities and WTP results can be used to estimate benefits of GFD in cost-utility and cost-benefit analyses.
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Affiliation(s)
- M Mercédesz Angyal
- Károly Rácz Doctoral School of Clinical Medicine, Semmelweis University, 26 Üllői út, Budapest, 1085, Hungary
- Department of Health Policy, Corvinus University of Budapest, 8 Fővám tér, Budapest, 1093, Hungary
| | - Peter L Lakatos
- McGill University Health Centre, Montreal General Hospital, 1650 Ave. Cedar, D16.173.1, Montreal, QC, H3G 1A4, Canada
- Department of Internal Medicine and Oncology, Semmelweis University, Korányi Sándor u. 2/a, Budapest, 1083, Hungary
| | - Balázs Jenei
- Department of Health Policy, Corvinus University of Budapest, 8 Fővám tér, Budapest, 1093, Hungary
| | - Valentin Brodszky
- Department of Health Policy, Corvinus University of Budapest, 8 Fővám tér, Budapest, 1093, Hungary
| | - Fanni Rencz
- Department of Health Policy, Corvinus University of Budapest, 8 Fővám tér, Budapest, 1093, Hungary.
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Zingone F, Maimaris S, Auricchio R, Caio GPI, Carroccio A, Elli L, Galliani E, Montagnani M, Valiante F, Biagi F. Guidelines of the Italian societies of gastroenterology on the diagnosis and management of coeliac disease and dermatitis herpetiformis. Dig Liver Dis 2022; 54:1304-1319. [PMID: 35858884 DOI: 10.1016/j.dld.2022.06.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/11/2022] [Accepted: 06/19/2022] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Coeliac disease and dermatitis herpetiformis are immune-mediated diseases triggered by the consumption of gluten in genetically predisposed individuals. These guidelines were developed to provide general practitioners, paediatricians, gastroenterologists, and other clinicians with an overview on the diagnosis, management and follow-up of coeliac patients and those with dermatitis herpetiformis. METHODS Guidelines were developed by the Italian Societies of Gastroenterology. Following a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation methodology was used to assess the certainty of the evidence. Statements and recommendations were developed by working groups consisting of gastroenterologists and a paediatrician with expertise in this field. RESULTS These guidelines provide a practical guidance for the diagnosis, management and follow-up of coeliac patients and dermatitis herpetiformis in children and adults, both in primary care and in specialist settings. We developed four sections on diagnosis, gluten-free diet, follow-up and risk of complications in adults, one section focused on diagnosis and follow-up in children and one on the diagnosis and management of dermatitis herpetiformis. CONCLUSIONS These guidelines may support clinicians to improve the diagnosis and management of patients with coeliac disease.
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Affiliation(s)
- Fabiana Zingone
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Italy; Gastroenterology Unit, Azienda Ospedale Università, Padova, Italy.
| | - Stiliano Maimaris
- Dipartimento di Medicina Interna e Terapia Medica, Università di Pavia, Italia
| | - Renata Auricchio
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Giacomo Pietro Ismaele Caio
- Department of Morphology, Surgery and Experimental Medicine, St. Anna Hospital, University of Ferrara, Ferrara, Italy
| | - Antonio Carroccio
- Unit of Internal Medicine, "V. Cervello" Hospital, Ospedali Riuniti "Villa Sofia-Cervello", 90146 Palermo, University of Palermo, Italy
| | - Luca Elli
- Gastroenterology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Ermenegildo Galliani
- UOC Gastroenterologia ed Endoscopia Digestiva, AULSS1 Dolomiti Veneto, Ospedale San Martino, Belluno, Italy
| | - Marco Montagnani
- Department of Medical and Surgical Sciences, University of Bologna, Italy; Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Flavio Valiante
- UOC Gastroenterologia ed Endoscopia Digestiva, AULSS1 Dolomiti Veneto, Feltre (BL), Italy
| | - Federico Biagi
- Istituti Clinici Maugeri, IRCCS, Unità di Gastroenterologia dell'Istituto di Pavia, Italy
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Kvamme JM, Sørbye S, Florholmen J, Halstensen TS. Population-based screening for celiac disease reveals that the majority of patients are undiagnosed and improve on a gluten-free diet. Sci Rep 2022; 12:12647. [PMID: 35879335 PMCID: PMC9314380 DOI: 10.1038/s41598-022-16705-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/14/2022] [Indexed: 12/30/2022] Open
Abstract
The impact of a gluten-free diet (GFD) on screen-detected celiac disease (CD) is currently ambiguous. We aimed to identify the population-based prevalence of undiagnosed adult CD and examine the impact of a GFD on screen-detected CD. In total, 12,981 adults participated in a population-based health study in Tromsø, Norway. Participants with increased levels of anti-tissue transglutaminase-2 IgA or anti-deamidated gliadin peptide IgG were invited to undergo gastroduodenoscopy with both histological and immunohistochemical examination of small-bowel biopsies. The prevalence of previously diagnosed CD was 0.37%. Additionally, the prevalence of previously undiagnosed CD was 1.10%. Thus, 1.47% of the population had CD, of whom 75% were previously undiagnosed. A GFD resulted in significant improvements in overall gastrointestinal symptoms, diarrhea, and health-related quality of life, with reduced abdominal discomfort (76%) and improved levels of energy (58%). The large majority of patients with adult CD were undiagnosed and benefited from a GFD with reduced gastrointestinal symptoms and improved health-related quality of life. In clinical practice, there should be a low threshold for CD testing even in the absence of abdominal complaints because most adult patients appear to consider their symptoms a part of their normal state and therefore remain untested and undiagnosed.Trial registration: Clinical Trials. Gov Identifier: NCT01695681.
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Affiliation(s)
- Jan-Magnus Kvamme
- Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, 9037, Tromsø, Norway. .,Department of Gastroenterology, University Hospital of North Norway, 9037, Tromsø, Norway.
| | - Sveinung Sørbye
- Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, 9037, Tromsø, Norway.,Department of Pathology, University Hospital of North Norway, 9037, Tromsø, Norway
| | - Jon Florholmen
- Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, 9037, Tromsø, Norway
| | - Trond S Halstensen
- Institute of Oral Biology, University of Oslo, P.O. Box 1052, 0316, OsloBlindern, Norway.,Medical Department, Lovisenberg Diaconal Hospital, Oslo, Norway
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Enaud R, Tetard C, Dupuis R, Laharie D, Lamireau T, Zerbib F, Rivière P, Shili-Mismoudi S, Poullenot F. Compliance with Gluten Free Diet Is Associated with Better Quality of Life in Celiac Disease. Nutrients 2022; 14:nu14061210. [PMID: 35334866 PMCID: PMC8951042 DOI: 10.3390/nu14061210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 02/06/2023] Open
Abstract
The quality of life (QOL) of patients with celiac disease (CD) can be altered by both symptoms of the disease and by the restrictions of the gluten-free diet (GFD). The objective was to determine the factors associated with better QOL in a large cohort of CD patients. A link to an online survey was sent to the members of the French Association of Gluten Intolerant People (AFDIAG). The French-Celiac Disease Questionnaire (F-CDQ), scoring from 0 to 100, was used to measure the QOL. Other data collected were sociodemographic characteristics, information on CD, purchasing and consumption habits of gluten-free products, and a self-assessment scale (ranging from 0 to 10) to determine the compliance with the GFD. Among the 907 CD patients who returned the questionnaire, 787 were analyzed (638 women (81%); median age: 49 years; 71% with self-assessed GFD compliance > 8). Their median F-CDQ was 73 (range: 59−82). In multivariate analysis, the main factors associated with a better quality of life were the long duration of the GFD, good compliance with the GFD, and the number of follow-up visits. Compliance with and duration of the GFD are associated with a better quality of life in patients with CD. Taking this into consideration would offset its restrictive aspect and improve its adherence.
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Affiliation(s)
- Raphaël Enaud
- CHU de Bordeaux, Hôpital des Enfants, Service d’Hépato-Gastroentérologie Pédiatriques, 33000 Bordeaux, France; (R.E.); (C.T.); (T.L.)
| | - Candice Tetard
- CHU de Bordeaux, Hôpital des Enfants, Service d’Hépato-Gastroentérologie Pédiatriques, 33000 Bordeaux, France; (R.E.); (C.T.); (T.L.)
- CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, Université de Bordeaux, INSERM CIC 1401, 33000 Bordeaux, France; (R.D.); (D.L.); (F.Z.); (P.R.); (S.S.-M.)
| | - Raphaël Dupuis
- CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, Université de Bordeaux, INSERM CIC 1401, 33000 Bordeaux, France; (R.D.); (D.L.); (F.Z.); (P.R.); (S.S.-M.)
| | - David Laharie
- CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, Université de Bordeaux, INSERM CIC 1401, 33000 Bordeaux, France; (R.D.); (D.L.); (F.Z.); (P.R.); (S.S.-M.)
| | - Thierry Lamireau
- CHU de Bordeaux, Hôpital des Enfants, Service d’Hépato-Gastroentérologie Pédiatriques, 33000 Bordeaux, France; (R.E.); (C.T.); (T.L.)
| | - Frank Zerbib
- CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, Université de Bordeaux, INSERM CIC 1401, 33000 Bordeaux, France; (R.D.); (D.L.); (F.Z.); (P.R.); (S.S.-M.)
| | - Pauline Rivière
- CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, Université de Bordeaux, INSERM CIC 1401, 33000 Bordeaux, France; (R.D.); (D.L.); (F.Z.); (P.R.); (S.S.-M.)
| | - Sarah Shili-Mismoudi
- CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, Université de Bordeaux, INSERM CIC 1401, 33000 Bordeaux, France; (R.D.); (D.L.); (F.Z.); (P.R.); (S.S.-M.)
| | - Florian Poullenot
- CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, Université de Bordeaux, INSERM CIC 1401, 33000 Bordeaux, France; (R.D.); (D.L.); (F.Z.); (P.R.); (S.S.-M.)
- Correspondence:
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Zingone F, Secchettin E, Marsilio I, Valiante F, Zorzetto V, Cataudella G, D'Odorico A, Canova C. Clinical features and psychological impact of celiac disease at diagnosis. Dig Liver Dis 2021; 53:1565-1570. [PMID: 34108093 DOI: 10.1016/j.dld.2021.05.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/26/2021] [Accepted: 05/15/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIM We aimed to describe the socio-demographic, behavioral and clinical profiles of adult patients with newly diagnosed celiac disease (CeD) and their possible association with QoL and psychological symptoms. METHODS Adults newly diagnosed with CeD and residents in the Veneto region were included. Their sociodemographic characteristics, clinical presentation, mode of diagnosis, duration of symptoms before diagnosis and comorbidities were recorded. All patients completed the Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI) and Short Form Health Survey (SF-36) questionnaires. RESULTS Between 2016 and 2019, 110 CeD patients (81% females, mean age 37.5) were recruited. At diagnosis, patients were categorized into classical (n = 56), nonclassical CeD (n = 49) and asymptomatic (n = 5) groups. Patients with classical presentation had a lower QoL than nonclassical patients, who were found to be more depressed. We observed a diagnosis delay of more than 7 months in more than 60% of patients with both classical and nonclassical presentations and we found that a longer duration of GI symptoms decreased the self-reported SF36 scores in the physical health (p = 0.002), social functioning (p = 0.03) and general health (p = 0.009) domains. Women had an overall lower self-perceived QoL. CONCLUSIONS Symptomatic presentation at CeD diagnosis, diagnostic delay and sex may affect QoL and psychological disorders.
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Affiliation(s)
- Fabiana Zingone
- Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Italy
| | - Erica Secchettin
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Italy
| | - Ilaria Marsilio
- Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Italy
| | - Flavio Valiante
- Santa Maria del Prato Hospital, ULSS 1 Dolomiti, Gastroenterology and Digestive Endoscopy Unit, Feltre, BL, Italy
| | | | | | - Anna D'Odorico
- Department of Surgery, Oncology and Gastroenterology, University Hospital of Padua, Italy
| | - Cristina Canova
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Italy.
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10
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Leonard MM, Silvester JA, Leffler D, Fasano A, Kelly CP, Lewis SK, Goldsmith JD, Greenblatt E, Kwok WW, McAuliffe WJ, Galinsky K, Siegelman J, Chow IT, Wagner JA, Sapone A, Smithson G. Evaluating Responses to Gluten Challenge: A Randomized, Double-Blind, 2-Dose Gluten Challenge Trial. Gastroenterology 2021; 160:720-733.e8. [PMID: 33130104 PMCID: PMC7878429 DOI: 10.1053/j.gastro.2020.10.040] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/15/2020] [Accepted: 10/25/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS Gluten challenge is used to diagnose celiac disease (CeD) and for clinical research. Sustained gluten exposure reliably induces histologic changes but is burdensome. We investigated the relative abilities of multiple biomarkers to assess disease activity induced by 2 gluten doses, and aimed to identify biomarkers to supplement or replace histology. METHODS In this randomized, double-blind, 2-dose gluten-challenge trial conducted in 2 US centers (Boston, MA), 14 adults with biopsy-proven CeD were randomized to 3 g or 10 g gluten/d for 14 days. The study was powered to detect changes in villous height to crypt depth, and stopped at planned interim analysis on reaching this end point. Additional end points included gluten-specific cluster of differentiation (CD)4 T-cell analysis with HLA-DQ2-gluten tetramers and enzyme-linked immune absorbent spot, gut-homing CD8 T cells, interleukin-2, symptoms, video capsule endoscopy, intraepithelial leukocytes, and tissue multiplex immunofluorescence. RESULTS All assessments showed changes with gluten challenge. However, time to maximal change, change magnitude, and gluten dose-response relationship varied. Villous height to crypt depth, video capsule endoscopy enteropathy score, enzyme-linked immune absorbent spot, gut-homing CD8 T cells, intraepithelial leukocyte counts, and HLA-DQ2-restricted gluten-specific CD4 T cells showed significant changes from baseline at 10 g gluten only; symptoms were significant at 3 g. Symptoms and plasma interleukin-2 levels increased significantly or near significantly at both doses. Interleukin-2 appeared to be the earliest, most sensitive marker of acute gluten exposure. CONCLUSIONS Modern biomarkers are sensitive and responsive to gluten exposure, potentially allowing less invasive, lower-dose, shorter-duration gluten ingestion. This work provides a preliminary framework for rational design of gluten challenge for CeD research. ClinicalTrials.gov number, NCT03409796.
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Affiliation(s)
- Maureen M Leonard
- Center for Celiac Research and Treatment, Massachusetts General Hospital, Boston, Massachusetts; Celiac Disease Research Program, Harvard Medical School, Boston, Massachusetts
| | - Jocelyn A Silvester
- Celiac Disease Research Program, Harvard Medical School, Boston, Massachusetts; Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts; Celiac Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Daniel Leffler
- Celiac Disease Research Program, Harvard Medical School, Boston, Massachusetts; Takeda Pharmaceuticals Inc Co, Cambridge, Massachusetts
| | - Alessio Fasano
- Center for Celiac Research and Treatment, Massachusetts General Hospital, Boston, Massachusetts; Celiac Disease Research Program, Harvard Medical School, Boston, Massachusetts
| | - Ciarán P Kelly
- Celiac Disease Research Program, Harvard Medical School, Boston, Massachusetts; Celiac Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Suzanne K Lewis
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - Jeffrey D Goldsmith
- Celiac Disease Research Program, Harvard Medical School, Boston, Massachusetts; Department of Pathology, Boston Children's Hospital, Boston, Massachusetts
| | | | - William W Kwok
- Benaroya Research Institute at Virginia Mason, Seattle, Washington
| | | | | | | | - I-Ting Chow
- Benaroya Research Institute at Virginia Mason, Seattle, Washington
| | - John A Wagner
- Takeda Pharmaceuticals Inc Co, Cambridge, Massachusetts
| | - Anna Sapone
- Takeda Pharmaceuticals Inc Co, Cambridge, Massachusetts
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11
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Evaluation of Daily Lives of Children and Adolescents with Celiac Disease and Nursing Approaches. Gastroenterol Nurs 2020; 43:E202-E213. [PMID: 33259438 DOI: 10.1097/sga.0000000000000509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The incidence of celiac disease has been increasing in recent years. Celiac disease is an autoimmune enteropathy that emerges mostly in the childhood period. This disorder is a chronic condition of the small intestine due to gluten intake in individuals with genetic predisposition. In the treatment of celiac disease, gluten-free diet therapy is applied. However, the adaptation process to the diet may create difficulties for patients. Compliance with diet is much more difficult among patients with celiac disease in childhood and adolescence than in adult patients. Children and adolescents face distinct difficulties in their homes, at school, and in their social lives. Besides following dietary treatment, children and adolescents living with celiac disease need peer support to manage their daily routines. In this article, we aimed to discuss the problems experienced by children and adolescents living with celiac disease and nursing approaches to these problems.
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12
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Turk E, Mičetić-Turk D, Šikić-Pogačar M, Tapajner A, Vlaisavljević V, Prevolnik Rupel V. Health related QoL in celiac disease patients in Slovenia. Health Qual Life Outcomes 2020; 18:356. [PMID: 33148252 PMCID: PMC7641854 DOI: 10.1186/s12955-020-01612-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 10/27/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Measurements of health-related quality of life (HRQoL) among celiac disease patients using a validated questionnaire have been lacking in Slovenia. This study aims to measure HRQoL in celiac disease (CD) patients using EQ-5D internationally validated questionnaire and comparing it to the HRQoL of the general population. METHODS In this cross sectional analysis all of the approximately 2000 members of the Slovenian Celiac Society were invited to take part. We used a 3 step approach for recruitment and data collection. HRQoL was evaluated through the EuroQoL EQ-5D-5L instrument (Slovenian version) and analysed using the ordinal logistic regression. RESULTS Out of 321 patients who gave their consent, 247 celiac patients were included in the study (77%). 68% of the participants were female and 53% of them lived in an urban setting. Most patients originated from North-East Slovenia, whereas approximately 30% of patients came from other Slovenian regions. The EQ-5D respondents' self-reported health status at the time of the study show that most patients have slight or no problems when living with CD. The duration of the gluten-free diet, academic education and rare (< 1 × year) doctor visits affect EQ-5D in a positive way. On the other hand, higher age and chronic rheumatic disease were negatively associated with EQ-5D also when compared to the general population. CONCLUSION This is the first Slovenian study to measure the HRQoL of Slovenian CD patients, using an internationally validated questionnaire. The results of our study show that HRQoL is slightly impaired among Slovenian patients with CD. Clinical characteristics are better determinants of their HRQoL than socio-demographic factors. Greater awareness of the impact of CD on patients' HRQoL would improve the holistic management of CD patients.
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Affiliation(s)
- Eva Turk
- Science Centre Health and Technology, University of South-Eastern Norway, Grønland 53, 3045, Drammen, Norway. .,Faculty of Medicine, Department of Pediatrics, University of Maribor, Taborska ulica 8, 2000, Maribor, Slovenia.
| | - Dušanka Mičetić-Turk
- Faculty of Medicine, Department of Pediatrics, University of Maribor, Taborska ulica 8, 2000, Maribor, Slovenia
| | - Maja Šikić-Pogačar
- Faculty of Medicine, Department of Pediatrics, University of Maribor, Taborska ulica 8, 2000, Maribor, Slovenia
| | - Alojz Tapajner
- Faculty of Medicine, Department of Pediatrics, University of Maribor, Taborska ulica 8, 2000, Maribor, Slovenia
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13
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Assessment of quality of life in children, adolescents, and adults with celiac disease through specific questionnaires: Review. NUTR CLIN METAB 2020. [DOI: 10.1016/j.nupar.2020.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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14
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Influence of Compliance to Diet and Self-Efficacy Expectation on Quality of Life in Patients with Celiac Disease in Spain. Nutrients 2020; 12:nu12092672. [PMID: 32887250 PMCID: PMC7551960 DOI: 10.3390/nu12092672] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/28/2020] [Accepted: 08/29/2020] [Indexed: 01/09/2023] Open
Abstract
The purpose of this study is to understand the health-related quality of life (HRQoL) in patients with celiac disease (CD) and analyze its main determinants. A transversal descriptive study of 738 patients with celiac disease was carried out. A series of questionnaires were answered related to their HRQoL, adherence to a gluten-free diet (GFD), and self-efficacy beliefs among other relevant variables. Regression analyses were carried out in order to explore the predictive variables in adherence to the GFD and HRQoL. A total of 61.2% showed a good HRQoL, and the main predictors of HRQoL were specific self-efficacy, adherence to the diet, risk perception, time since diagnosis, and age. While 68.7% of participants showed good or excellent adherence to the GFD, and the main predictors of adherence were specific self-efficacy, perceived adoption of recommended behaviors, HRQoL and gender. The HRQoL of patients with CD, and adherence to the GFD in Spain, are good. It is the self-efficacy expectation, measured specifically and not generally, which is the best predictor of both adherence and HRQoL. It is necessary to develop programs to improve the HRQoL of patients with CD that focus on improving specific self-efficacy.
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15
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Myléus A, Reilly NR, Green PHR. Rate, Risk Factors, and Outcomes of Nonadherence in Pediatric Patients With Celiac Disease: A Systematic Review. Clin Gastroenterol Hepatol 2020; 18:562-573. [PMID: 31173891 DOI: 10.1016/j.cgh.2019.05.046] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 05/21/2019] [Accepted: 05/24/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The only treatment for celiac disease is strict adherence to a gluten-free diet (GFD). We performed a systematic review to investigate the rate of adherence to a GFD in children with celiac disease, risk factors that affect adherence, and outcomes of non-adherence. METHODS We searched PubMed, Cochrane Library, EBSCO, and Scopus for studies through January 2019. We included observational studies of ≥50 children diagnosed with celiac disease and recommended for placement on a GFD. We collected data on adherence assessment (self-report, serology tests, structured dietary interview, biopsies, or assays for gluten immunogenic peptides), risk factors, and outcomes related to adherence. Findings were presented with medians, range, and a narrative synthesis. RESULTS We identified 703 studies; of these, 167 were eligible for full-text assessment and 49 were included in the final analysis, comprising 7850 children. Rates of adherence to a GFD ranged from 23% to 98%. Comparable rates (median rates of adherence, 75%-87%) were found irrespective of how assessments were performed. Adolescents were at risk of non-adherence and children whose parents had good knowledge about celiac disease adhered more strictly. Non-adherence associated with patient growth, symptoms, and quality of life. CONCLUSION In a systematic review of 49 studies of children with celiac disease, we found substantial variation in adherence to a GFD among patients. Rate of adherence was not associated with method of adherence measurement, so all methods appear to be useful, with lack of consensus on the ideal metric. Studies are needed to determine the best method to ensure adherence and effects on long-term health.
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Affiliation(s)
- Anna Myléus
- Division of Family Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
| | - Norelle R Reilly
- Department of Pediatrics, Celiac Disease Center, Columbia University College of Physicians and Surgeons, Columbia University, New York, New York; Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, Columbia University, New York, New York
| | - Peter H R Green
- Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, Columbia University, New York, New York
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Clifford S, Taylor AJ, Gerber M, Devine J, Cho M, Walker R, Stefani I, Fidel S, Drahos J, Leffler DA. Concepts and Instruments for Patient-Reported Outcome Assessment in Celiac Disease: Literature Review and Experts' Perspectives. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:104-113. [PMID: 31952665 DOI: 10.1016/j.jval.2019.07.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/28/2019] [Accepted: 07/18/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND In diseases where there is a large subjective component, such as celiac disease (CD), patient reported-outcomes (PRO) endpoints are highly relevant. However, there is a gap in knowledge about which PRO endpoints and instruments should be used for clinical trials for treatment of celiac disease. OBJECTIVES To identify patient-centered symptom, impact, and health-related quality of life (HRQoL) concepts in CD and relevant PRO instruments, and to gather expert input on concepts and instruments to inform selection of PRO endpoints for use in clinical trials of new CD treatments. METHODS A targeted literature review was conducted to identify symptom, impact, and HRQoL concepts, including those captured in PROs further reviewed against U.S. Food and Drug Administration standards for development and validation as endpoints. US and European clinicians, payers, and a patient advocate (n = 21) were interviewed to assess the identified concepts' relative importance in measuring treatment benefit and to gauge the value of potential PROs as endpoints for market access/reimbursement. RESULTS Thirty-four published studies were identified: 27 elucidated patient-centered concepts and 7 detailed the development or validation of PRO instruments. The Celiac Disease Symptom Diary and Celiac Disease Patient Reported Outcome instrument were deemed most appropriate for use as endpoints; however, each had limitations related to conceptual coverage, evidence for measurement properties, and feasibility for use in clinical trials. Experts reported gastrointestinal symptoms as most important to treat, with extra-intestinal symptoms burdensome from the patient perspective as well. Payers emphasized measuring both frequency and severity of symptoms and targeting patients nonresponsive to the gluten-free diet for treatment. CONCLUSIONS With emerging treatment options for CD, further work is needed to operationalize PRO symptom endpoints that are meaningful to patients, valued by payers, and acceptable to regulators in demonstrating efficacy.
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Affiliation(s)
- Sarah Clifford
- Patient Centered Outcomes, Commercialisation and Outcomes, ICON Clinical Research, Los Angeles, CA, USA
| | | | - Michele Gerber
- Clinical Science, Takeda Pharmaceuticals International, Cambridge, MA, USA
| | - Jacob Devine
- Patient Centered Outcomes, Commercialisation and Outcomes, ICON Clinical Research, South San Francisco, CA, USA
| | - Margaret Cho
- Patient Centered Outcomes, Commercialisation and Outcomes, ICON Clinical Research, South San Francisco, CA, USA.
| | | | - Ioanna Stefani
- Pricing and Market Access, ICON Clinical Research, London, UK
| | | | - Jennifer Drahos
- Global Outcomes Research, Takeda Pharmaceuticals International, Cambridge, MA, USA
| | - Daniel A Leffler
- Clinical Science, Takeda Pharmaceuticals International, Cambridge, MA, USA; Division of Gastroenterology, Beth Israel Deaconness Medical Center, Boston, MA, USA
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17
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Francavilla R, Piccolo M, Francavilla A, Polimeno L, Semeraro F, Cristofori F, Castellaneta S, Barone M, Indrio F, Gobbetti M, De Angelis M. Clinical and Microbiological Effect of a Multispecies Probiotic Supplementation in Celiac Patients With Persistent IBS-type Symptoms: A Randomized, Double-Blind, Placebo-controlled, Multicenter Trial. J Clin Gastroenterol 2019; 53:e117-e125. [PMID: 29688915 PMCID: PMC6382041 DOI: 10.1097/mcg.0000000000001023] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
GOALS The goals of this study were to evaluate the efficacy and safety of a probiotic mixture in patients with celiac disease (CD) with irritable bowel syndrome (IBS)-type symptoms despite a strict gluten-free diet (GFD). BACKGROUND About 30% of patients with CD adherent to a GFD suffer from IBS-type symptoms; a possible cause resides in the imbalances of the intestinal microbiota in CD. Probiotics may represent a potential treatment. STUDY CD patients with IBS-type symptoms entered a prospective, double-blind, randomized placebo-controlled study. A 6-week treatment period was preceded by a 2-week run-in and followed by a 6-week follow-up phase. Clinical data were monitored throughout the study by validated questionnaires: IBS Severity Scoring System (IBS-SSS); Gastrointestinal Symptom Rating Scale (GSRS); Bristol Stool Form Scale (BSFS); and IBS Quality of Life Questionnaire (IBS-QOL). The fecal microbiota were assayed using plate counts and 16S rRNA gene-based analysis. RESULTS In total, 109 patients were randomized to probiotics (n=54) or placebo (n=55). IBS-SSS and GSRS decreased significantly in probiotics, as compared with placebo [(-15.9%±14.8% vs. 8.2%±25.9%; P<0.001) and (-19.8%±16.6% vs. 12.9%±31.6%; P<0.001)], respectively. Treatment success was significantly higher in patients receiving probiotics, as compared with placebo (15.3% vs. 3.8%; P<0.04). Presumptive lactic acid bacteria, Staphylococcus and Bifidobacterium, increased in patients receiving probiotic treatment. No adverse events were reported. CONCLUSIONS A 6-week probiotic treatment is effective in improving the severity of IBS-type symptoms, in CD patients on strict GFD, and is associated with a modification of gut microbiota, characterized by an increase of bifidobacteria.
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Affiliation(s)
| | | | | | | | | | | | | | - Michele Barone
- Department of Emergency and Organ Transplantation, University of Bari Aldo Moro
| | | | - Marco Gobbetti
- Faculty of Science and Technology, Piazza Università, Free University of Bozen, Bolzano, Italy
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Abstract
Celiac disease represents a problem in our society, not only because of its interest in terms of healthcare, but also because of its increasing prevalence in recent years and the impact it has on sufferers and their families. This integrative review investigated current knowledge about the experience of living with a gluten-free diet, as well as social support and the role played by nurses and/or associations in the process. A total of 18 articles were selected. Results revealed greater family support is needed to deal with the day-to-day issues of a gluten-free diet. Furthermore, women diagnosed with celiac disease have more psychological distress than men according to some studies. Sufferers of celiac disease report that more information is needed at all levels (hotel and catering, healthcare, social), which would help generate coping strategies. The few studies retrieved that talk about this topic show that following a gluten-free diet affects the personal, family, emotional, social, and financial dimensions of sufferers of celiac disease. The nurse tends to be the person whom those coping with the illness go to for support, although celiac disease associations are also a fundamental pillar in this support. Policy makers need to adapt health services to the needs of individuals with celiac disease.
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19
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Social and Emotional Fears and Worries Influencing the Quality of Life of Female Celiac Disease Patients Following a Gluten-Free Diet. Nutrients 2018; 10:nu10101414. [PMID: 30282900 PMCID: PMC6212919 DOI: 10.3390/nu10101414] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/21/2018] [Accepted: 09/26/2018] [Indexed: 12/13/2022] Open
Abstract
The gluten-free diet is effective in the majority of celiac disease (CD) patients, but it is burdensome and may influence quality of life (QoL). The aim of the study was to analyze the social and emotional fears and worries influencing the QoL of female CD patients following a gluten-free (GF) diet, as well as to indicate the sociodemographic interfering factors. The study was conducted on a group of 251 female CD patients, while emotional, social and worries subscales of the Celiac Disease Questionnaire (CDQ) were applied, as well as purchase-related emotions and behaviors were assessed. Respondents declaring worse economic status obtained significantly lower scores in the emotional, social and worries subscales of the CDQ than respondents declaring better economic status, while for other factors (CD duration, GFD adherence, BMI, place of residence and educational level) no significant association was stated in the multi-factor analysis. Moreover, respondents declaring worse economic status more often declared that a bad mood affected their purchase decisions than did respondents declaring better economic status. It was stated, that the economic status of CD patient could be one of the most important factors influencing their social and emotional fears and worries. It may be supposed that low economic status may lead some CD patients to choose to relieve stress by purchasing GF products instead of other products.
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20
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Halmos EP, Deng M, Knowles SR, Sainsbury K, Mullan B, Tye-Din JA. Food knowledge and psychological state predict adherence to a gluten-free diet in a survey of 5310 Australians and New Zealanders with coeliac disease. Aliment Pharmacol Ther 2018; 48:78-86. [PMID: 29733115 DOI: 10.1111/apt.14791] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 03/17/2018] [Accepted: 04/10/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND A gluten-free diet treats coeliac disease, but its efficacy depends on strict adherence. A variety of patient factors may influence adherence but have not been well described at a population level. AIM To comprehensively assess the patient factors that influence gluten-free diet adherence in patients with coeliac disease. METHODS Patients with coeliac disease completed an online survey comprising the validated Celiac Dietary Adherence Test in addition to data on demographics, details of diagnosis and management and assessment of diet knowledge, quality of life and psychological distress. Survey data were analysed for predictors of adherence and quality of life. RESULTS Of 7393 responses, 5310 completed the Celiac Dietary Adherence Test and 3230 (61%) were adherent to a gluten-free diet. Multivariate regression showed older age, being male, symptoms after gluten ingestion, better food knowledge and lower risk of psychological distress were independent predictors of adherence (each P ≤ 0.008). Additionally, dietary adherence was associated with better quality of life (P < 0.001; multiple regression). Respondents who considered themselves to have poor food knowledge were more likely to incorrectly identify gluten-free foods, but could still recognise gluten-containing foods, suggesting that poor knowledge may lead to over-restriction of diet. CONCLUSIONS Poor knowledge of a gluten-free diet and psychological wellbeing were independent modifiable risk factors for inadequate adherence to a gluten-free diet in patients with coeliac disease. Involvement of both a dietitian and mental health care professional, in the presence of psychological distress, is likely to be necessary to improve adherence and health outcomes.
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Affiliation(s)
- E P Halmos
- Department of Gastroenterology, The Royal Melbourne Hospital, Parkville, Vic., Australia.,Department of Gastroenterology, Central Clinical School, Monash University, Melbourne, Vic., Australia
| | - M Deng
- Cartovera Pty. Ltd., Adelaide, SA, Australia
| | - S R Knowles
- Department of Gastroenterology, The Royal Melbourne Hospital, Parkville, Vic., Australia.,Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Vic., Australia.,Department of Mental Health, St Vincent's Hospital, Fitzroy, Vic., Australia.,Department of Psychiatry, University of Melbourne, Parkville, Vic., Australia
| | - K Sainsbury
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - B Mullan
- Health Psychology & Behavioural Medicine Research Group, School of Psychology, Curtin University, Bentley, WA, Australia
| | - J A Tye-Din
- Department of Gastroenterology, The Royal Melbourne Hospital, Parkville, Vic., Australia.,Immunology Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Vic., Australia.,Department of Medical Biology, University of Melbourne, Parkville, Vic., Australia
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21
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Lee J, Clarke K. Effect of clinical and laboratory parameters on quality of life in celiac patients using celiac disease-specific quality of life scores. Scand J Gastroenterol 2017; 52:1235-1239. [PMID: 28685635 DOI: 10.1080/00365521.2017.1350283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Health-related quality of life (HR-QOL) in patients with celiac disease is reduced compared to the general population. We investigated the association between HR-QOL and clinical, laboratory findings using the previously validated CD-QOL (celiac disease-specific quality of life) instrument in patients with celiac disease. To our knowledge, no study has previously explored the relationship between HR-QOL and clinical, laboratory parameters in celiac patients. MATERIALS AND METHODS Patients who received care at the Allegheny Health Network Celiac Center, Pittsburgh, PA were asked to complete the CD-QOL questionnaire. A cross sectional study with predetermined clinical and laboratory parameters was performed. Data collected included IgA anti-tissue transglutaminase (tTG) antibody titers, iron studies, calcium, vitamin A, B12, 25 OH vitamin D, and E levels. Correlation between clinical findings and CD-QOL was also assessed. RESULTS Seventy-eight out of 124 patients who completed the questionnaire was included in the analysis. Patients with concomitant irritable bowel syndrome (IBS) had significantly reduced HR-QOL with CD-QOL score of 52.4 ± 11.3 vs. 44.6 ± 12.9 in those without IBS (p = .009). There was no difference in HR-QOL in relation to IgA tTG titers or vitamin D levels. Of note, there was a trend towards correlation between higher level of vitamin E and better QOL (r = -0.236, p = .074). CONCLUSIONS Celiac patients with concomitant IBS have reduced HR-QOL. There was no statistically significant association between HR-QOL and laboratory parameters or levels of micronutrients.
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Affiliation(s)
- Jungmin Lee
- a Division of Gastroenterology , Hepatology and Nutrition Allegheny Health Network , PA , USA
| | - Kofi Clarke
- a Division of Gastroenterology , Hepatology and Nutrition Allegheny Health Network , PA , USA
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22
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Meyer S, Rosenblum S. Activities, Participation and Quality of Life Concepts in Children and Adolescents with Celiac Disease: A Scoping Review. Nutrients 2017; 9:nu9090929. [PMID: 28837103 PMCID: PMC5622689 DOI: 10.3390/nu9090929] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 08/10/2017] [Accepted: 08/21/2017] [Indexed: 02/06/2023] Open
Abstract
Celiac disease (CD) is a food-related chronic condition and adherence to a strict gluten-free diet is the only available treatment. Adherence to the restrictive diet is challenging among children, especially adolescents. The aim was to describe existing knowledge about food-related activities, participation, and quality of life in daily life among children and adolescents with CD and to illuminate gaps in knowledge. The scoping review methodology was applied and literature searches were conducted in electronic databases. Twenty-three articles met the inclusion criteria. Food-related activities were identified, classified, and coded under the International Classification of Functioning, Disability, and Health adapted for children and youth (ICF-CY) concepts of activities and participation. A wide variety of study populations, objectives, methods, and tools involving 55 different food-related activities were found. Incorporation of the ICF-CY concepts and quality of life captures new insights into everyday challenges. Reviewing the CD literature using this different lens reveals areas yet to receive sufficient attention. Further research can deepen the understanding of daily functioning of children with CD and the underlying skills required to participate in daily food-related activities while adhering to the diet. This can lead to the development of standardized disease-specific assessment tools and suitable intervention programs.
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Affiliation(s)
- Sonya Meyer
- The Laboratory of Complex Human Activity and Participation, Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa 3498838, Israel.
| | - Sara Rosenblum
- The Laboratory of Complex Human Activity and Participation, Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa 3498838, Israel.
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Skjerning H, Hourihane J, Husby S, DunnGalvin A. A comprehensive questionnaire for the assessment of health-related quality of life in coeliac disease (CDQL). Qual Life Res 2017; 26:2831-2850. [DOI: 10.1007/s11136-017-1632-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2017] [Indexed: 12/18/2022]
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Meyer S, Rosenblum S. Children With Celiac Disease: Health-Related Quality of Life and Leisure Participation. Am J Occup Ther 2017; 70:7006220010p1-7006220010p8. [PMID: 27767940 DOI: 10.5014/ajot.2016.020594] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We compared health-related quality-of-life (HRQOL) perceptions of children with celiac disease (CD) with those of their parents to determine whether their leisure participation differs from that of children without CD and whether relationships exist between leisure participation and HRQOL. METHOD Children with CD and their parents completed a disease-specific HRQOL self-report questionnaire, the Celiac Disease DUX. These children and matched controls without CD completed the Children's Leisure Assessment Scale (CLASS). RESULTS Parents perceived HRQOL significantly more negatively than did children. No significant group differences were found in leisure participation. However, specific CLASS food-related activities and HRQOL significantly correlated. CONCLUSION Hearing the child's voice in addition to the parents' is important in determining the HRQOL of children with a chronic condition. Findings contribute to understanding of CD in the context of participation and well-being and can lead to development of occupational performance-based assessments and interventions for children with CD.
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Affiliation(s)
- Sonya Meyer
- Sonya Meyer, MSc, is Doctoral Student, Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa, Israel;
| | - Sara Rosenblum
- Sara Rosenblum, PhD, is Associate Professor and Head, Laboratory of Complex Human Activity and Participation, Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa, Israel
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Caring for a Celiac Partner: Gluten, but not Worry Free. Dig Dis Sci 2016; 61:3378-3380. [PMID: 27586032 DOI: 10.1007/s10620-016-4296-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Broide E, Matalon S, Kriger-Sharabi O, Richter V, Shirin H, Leshno M. Cost effectiveness of routine duodenal biopsies in iron deficiency anemia. World J Gastroenterol 2016; 22:7813-7823. [PMID: 27678365 PMCID: PMC5016382 DOI: 10.3748/wjg.v22.i34.7813] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/11/2016] [Accepted: 08/01/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the cost effectiveness of routine small bowel biopsies (SBBs) in patients with iron deficiency anemia (IDA) independent of their celiac disease (CD) serology test results.
METHODS We used a state transition Markov model. Two strategies were compared: routine SBBs during esophagogastroduodenoscopy (EGD) in all patients with IDA regardless their celiac serology status (strategy A) vs SBBs only in IDA patients with positive serology (strategy B). The main outcomes were quality adjusted life years (QALY), average cost and the incremental cost effectiveness ratio (ICER). One way sensitivity analysis was performed on all variables and two way sensitivity analysis on selected variables were done. In order to validate the results, a Monte Carlo simulation of 100 sample trials with 10, and an acceptability curve were performed.
RESULTS Strategy A of routine SBBs yielded 19.888 QALYs with a cost of $218.10 compared to 19.887 QALYs and $234.17 in strategy B. In terms of cost-effectiveness, strategy A was the dominant strategy, as long as the cost of SBBs stayed less than $67. In addition, the ICER of strategy A was preferable, providing the cost of biopsy stays under $77. Monte Carlo simulation demonstrated that strategy A yielded the same QALY but with lower costs than strategy B.
CONCLUSION Our model suggests that EGD with routine SBBs is a cost-effective approach with improved QALYs in patients with IDA when the prevalence of CD is 5% or greater. SBBs should be a routine screening tool for CD among patients with IDA, regardless of their celiac antibody status.
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Sarkhy A, El Mouzan MI, Saeed E, Alanazi A, Alghamdi S, Anil S, Assiri A. Socioeconomic Impacts of Gluten-Free Diet among Saudi Children with Celiac Disease. Pediatr Gastroenterol Hepatol Nutr 2016; 19:162-167. [PMID: 27738597 PMCID: PMC5061657 DOI: 10.5223/pghn.2016.19.3.162] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 02/15/2016] [Accepted: 02/18/2016] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To determine the socio-economic impact of gluten free diet (GFD) on Saudi children and their families. METHODS A cross-sectional study was conducted in which an online questionnaire was sent to all families registered in the Saudi celiac patients support group. We included only children (age 18 years of age and younger) with biopsy-confirmed celiac disease (CD). RESULTS A total of 113 children were included in the final analysis, the median age was 9.9 years; 62.8% were females. One hundred (88.5%) of the participating families reported that GFD food was not easily available in their areas, 17% of them reported that it was not available at all in their area. One hundred and six (93.8%) reported that the price of GFD food was very expensive and 70 (61.9%) families that the diet was heavily affecting their family budget. Significant social difficulties were reported among the participating families and their children including interference with the child's interaction with other children (49.6%), the families' ability to attend social gatherings (60.2%), the families' ability to eat in restaurants (73.5%), and the families' ability to travel (58.4%). CONCLUSION There is significant negative socio-economic impact of GFD on children with CD & their families. Health care providers should be aware of these psycho-social difficulties and be well trained to provide a proper education and psychological support for these patients and their families.
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Affiliation(s)
- Ahmed Sarkhy
- Division of Gastroenterology, Department of Pediatrics, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.; Prince Abdullah Bin Khalid Celiac Disease Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad I El Mouzan
- Division of Gastroenterology, Department of Pediatrics, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.; Prince Abdullah Bin Khalid Celiac Disease Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Elshazaly Saeed
- Prince Abdullah Bin Khalid Celiac Disease Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Aziz Alanazi
- Division of Gastroenterology, Department of Pediatrics, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Sharifa Alghamdi
- Division of Gastroenterology, Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Shirin Anil
- Consultant Epidemiologist, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Asaad Assiri
- Division of Gastroenterology, Department of Pediatrics, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.; Prince Abdullah Bin Khalid Celiac Disease Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Abstract
BACKGROUND Patients with celiac disease (CD) may be at an increased risk of cardiovascular disease (CVD), yet CVD risk factors are not well defined in CD. The validated Framingham Heart Study 10-year general CVD risk score (FRS) that incorporates traditional CVD risk factors including body mass index (BMI) has not been previously studied in CD patients. AIMS To compare BMI and FRS in CD patients with population-based controls. METHODS Biopsy-proven CD patients were ascertained retrospectively and data on BMI, systolic blood pressure, hypertension, smoking status, and diabetes were obtained at initial and follow-up visits. FRS was calculated and compared with 4 matched general population non-CD controls from the 2009 to 2010 National Health and Nutrition Examination Survey (NHANES). RESULTS Of 258 total CD patients, 38.3% were overweight or obese compared with 69.8% of controls (P<0.001). In total, 174 CD patients met the inclusion criteria for FRS calculation. Of these, the median FRS was lower in CD patients compared with controls (3.9 vs. 4.2; P=0.011). In CD patients, tobacco use was significantly lower (P<0.001), whereas systolic blood pressure was significantly higher (P<0.01) than controls. CONCLUSIONS Global CVD risk is lower among patients with CD compared with population controls. Lower BMI and tobacco use among CD patients could account for this difference. These results suggest that factors other than those measured by FRS could contribute to the increased risk of CVD in CD observed in some studies.
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White LE, Bannerman E, Gillett PM. Coeliac disease and the gluten-free diet: a review of the burdens; factors associated with adherence and impact on health-related quality of life, with specific focus on adolescence. J Hum Nutr Diet 2016; 29:593-606. [PMID: 27214084 DOI: 10.1111/jhn.12375] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Adherence and non-adherence to a gluten-free diet (GFD) may impact negatively on health-related quality of life (HRQoL). Understanding the factors that influence compliance could help inform management and also guide support. With a particular focus on adolescence, this narrative review critiques current literature on the burdens associated with following a GFD and the factors associated with adherence. Studies highlight a variety of burdens faced by individuals with coeliac disease, including the cost, access and availability of gluten-free (GF) foods, as well as the dilemmas experienced when eating out, travelling and socialising with friends. A number of studies report that adolescents face stigmatisation and feel isolated in social situations and at school. Additional burdens that are highlighted are a lack of knowledge regarding CD and GFD difficulties in interpreting food labels, as well as dissatisfaction with the organoleptic properties of GF foods. Factors associated with poor adherence in adolescence include older age, an absence of immediate symptoms, difficulties eating out and poor palatability of GF foods. Conversely, better emotional support and stronger organisation skills have been associated with superior adherence. Significant associations have been reported between HRQoL measures and adherence, although the findings are inconsistent. Limitations in research methodologies exist and data are restricted to just a few countries. Further research specific to adolescence is required to identify independent predictors of adherence.
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Affiliation(s)
- L E White
- Department of Health Sciences, Queen Margaret University, East Lothian, UK.
| | - E Bannerman
- Department of Health Sciences, Queen Margaret University, East Lothian, UK
| | - P M Gillett
- Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Sick Children, Edinburgh, UK
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Abstract
BACKGROUND AND AIMS Celiac disease (CD) is increasingly diagnosed through screening of at-risk groups (relatives of individuals and associated autoimmune disorders). The impact of diagnosis and treatment on screen-detected CD patients is poorly studied, particularly in the United States. We therefore compared the quality of life (QOL) between screen-detected and symptom-detected CD patients. METHODS Patients with a known diagnosis of CD were invited to complete 3 validated survey instruments: the CD Quality of Life (CDQOL), the CD Adherence Test for dietary adherence and the general Psychological General Well-Being index. In addition, demographic details, mode of presentation, and compliance with gluten-free diet (GFD) were assessed. RESULTS The overall response rate was high at 69%. Of 226 responses received, 211 were eligible for inclusion; the median age was 47, and the median duration of GFD was 4 years. One third of the sample (71, 34%) was screen detected. Of these, 57 (80%) had a relative diagnosed with CD, whereas 14 (20%) had an associated condition. Despite being screen detected, 49 (69%) reported symptoms before diagnosis. GFD adherence was excellent and did not differ between groups. Overall, there were no significant differences between screen-detected and symptom-detected patients with regard to CDQOL, CD Adherence Test, and Psychological General Well-Being scores. CONCLUSIONS Screen-detected and symptom-detected CD patients do not differ with regard to QOL or disease adherence as measured by validated disease-specific instruments. A high proportion of screen-detected patients reported symptoms before diagnosis, which often improve with GFD.
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Bakker SF, Tushuizen ME, von Blomberg BME, Bontkes HJ, Mulder CJ, Simsek S. Screening for coeliac disease in adult patients with type 1 diabetes mellitus: myths, facts and controversy. Diabetol Metab Syndr 2016; 8:51. [PMID: 27478507 PMCID: PMC4966870 DOI: 10.1186/s13098-016-0166-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 07/10/2016] [Indexed: 12/23/2022] Open
Abstract
This review aims at summarizing the present knowledge on the clinical consequences of concomitant coeliac disease (CD) in adult patients with type 1 diabetes mellitus (T1DM). The cause of the increased prevalence of CD in T1DM patients is a combination of genetic and environmental factors. Current screening guidelines for CD in adult T1DM patients are not uniform. Based on the current evidence of effects of CD on bone mineral density, diabetic complications, quality of life, morbidity and mortality in patients with T1DM, we advise periodic screening for CD in adult T1DM patients to prevent delay in CD diagnosis and subsequent CD and/or T1DM related complications.
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Affiliation(s)
- Sjoerd F. Bakker
- Department of Gastroenterology and Hepatology, VU University Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Maarten E. Tushuizen
- Department of Gastroenterology and Hepatology, VU University Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | | | - Hetty J. Bontkes
- Department of Pathology, Unit Medical Immunology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Chris J. Mulder
- Department of Gastroenterology and Hepatology, VU University Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Suat Simsek
- Department of Internal Medicine, North West Clinics, Alkmaar, The Netherlands
- Department of Internal Medicine, VU University Medical Centre, Amsterdam, The Netherlands
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Aksan A, Mercanlıgil SM, Häuser W, Karaismailoğlu E. Validation of the Turkish version of the Celiac Disease Questionnaire (CDQ). Health Qual Life Outcomes 2015; 13:82. [PMID: 26088079 PMCID: PMC4472159 DOI: 10.1186/s12955-015-0272-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 05/23/2015] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION The aim of the study was to translate, adapt and validate the Celiac Disease Questionnaire (CDQ), which was developed in Germany, for use in Turkey. METHODS The questionnaire was translated by a forward-backward translation method. Total CDQ score and four subscores (emotional state, gastrointestinal symptoms, worries, social problems) were calculated and their reliability assessed by internal consistency. Reliability of scales was evaluated by internal consistency. Test-retest reliability was assessed by means of a retest after 15 days. Face validity was assessed by patient volunteers and physicians and construct validity was assessed by means of confirmatory factor analysis. Convergent validity was determined by comparing responses to the CDQ with similar subscale scores of the Short Form-36 (SF-36) health survey. Discriminative concurrent criterion validity was determined by comparing the CDQ scores of patients with celiac disease (CD) on a gluten-free diet (GFD) with CD patients not on a GFD. RESULTS The Turkish version of the CDQ was completed by 205 patients with celiac disease (Female 146, mean age 31.1 year, ± 10.61). The Cronbach-α coefficent of the subscores ranged between 0.73 and 0.93. Test-retest reliability was 0.99 for all subscores. 42 patients with CD and five gastroenterologists assessed the items of the CDQ to be comprehensible and relevant to the health related quality of life (HRQOL) of CD patients. The confirmatory factor analysis demonstrated acceptable fit indices for the original four subscales of the CDQ. The correlations between the scales of the CDQ and the instrument for validation covering similar dimensions of the HRQOL ranged between 0.61 and 0.93. In all subscores and in the total score, patients not on a GFD showed a significantly reduced HRQOL (all p < 0.05) compared to patients on a GFD. CONCLUSION The Turkish version of the CDQ proved to be a reliable and valid instrument for measuring HRQOL in Turkish patients with celiac disease.
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Affiliation(s)
- Ayşegül Aksan
- Department of Nutrition and Dietetics, Hacettepe University Faculty of Health Sciences, 06100, Ankara, Turkey.
| | - Seyit Mehmet Mercanlıgil
- Department of Nutrition and Dietetics, Hacettepe University Faculty of Health Sciences, 06100, Ankara, Turkey.,Department of Nutrition and Dietetics, Eastern Mediterranean University Faculty of Health Sciences, via Mersin 10, Famagusta, T.R. North Cyprus, Turkey
| | - Winfried Häuser
- Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, D-81865, Munich, Germany
| | - Eda Karaismailoğlu
- Biostatistics Department, Hacettepe University Faculty of Medicine , 06100, Ankara, Turkey
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Zingone F, Swift GL, Card TR, Sanders DS, Ludvigsson JF, Bai JC. Psychological morbidity of celiac disease: A review of the literature. United European Gastroenterol J 2015; 3:136-45. [PMID: 25922673 DOI: 10.1177/2050640614560786] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 10/29/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Celiac disease has been linked to decreased quality of life and certain mood disorders. The effect of the gluten free diet on these psychological aspects of the disease is still unclear. OBJECTIVES The objective of this article is to review the literature on psychological morbidity of celiac disease. METHODS We performed a PubMed search for the time period from 1900 until June 1, 2014, to identify papers on psychological aspects of celiac disease looking specifically at quality of life, anxiety, depression and fatigue. RESULTS Anxiety, depression and fatigue are common complaints in patients with untreated celiac disease and contribute to lower quality of life. While aspects of these conditions may improve within a few months after starting a gluten-free diet, some patients continue to suffer from significant psychological morbidity. Psychological symptoms may affect the quality of life and the dietary adherence. CONCLUSION Health care professionals need to be aware of the ongoing psychological burden of celiac disease in order to support patients with this disease.
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Affiliation(s)
- Fabiana Zingone
- University of Salerno, Department of Medicine and Surgery, Salerno, Italy
| | - Gillian L Swift
- Department of Gastroenterology, University Hospital Llandough, Cardiff, Wales, UK
| | - Timothy R Card
- Division of Epidemiology and Public Health, The University of Nottingham, Nottingham City Hospital, Nottingham, UK
| | - David S Sanders
- Department of Gastroenterology, Royal Hallamshire Hospital & the University of Sheffield, UK
| | - Jonas F Ludvigsson
- Department of Pediatrics, Örebro University Hospital, Örebro; and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Julio C Bai
- Department of Medicine, "C. Bonorino Udaondo" Gastroenterology Hospital, Universidad del Salvador, Buenos Aires, Argentina
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Sarkhy AA, El Mouzan MI, Saeed E, Alanazi A, Alghamdi S, Anil S, Assiri A. Clinical Characteristics of Celiac Disease and Dietary Adherence to Gluten-Free Diet among Saudi Children. Pediatr Gastroenterol Hepatol Nutr 2015; 18:23-9. [PMID: 25866730 PMCID: PMC4391997 DOI: 10.5223/pghn.2015.18.1.23] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 01/20/2015] [Accepted: 01/31/2015] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To describe the clinical characteristics of celiac disease (CD) among Saudi children and to determine the adherence rate to gluten free diet (GFD) and its determinant factors among them. METHODS A cross-sectional study was conducted, in which all the families registered in the Saudi Celiac Patients Support Group were sent an online survey. Only families with children 18 years of age and younger with biopsy-confirmed CD were included. RESULTS The median age of the 113 included children was 9.9 years, the median age at symptom onset was 5.5 years and the median age at diagnosis was 7 years, the median time between the presentation and the final diagnosis was 1 year. Sixty two of the involved children were females. Ninety two percent of the patients were symptomatic at the diagnosis while eight percent were asymptomatic. The commonest presenting symptoms included: chronic abdominal pain (59.3%), poor weight gain (54%), abdominal distention, gases, bloating (46.1%) and chronic diarrhea (41.6%). Sixty percent of the involved children were reported to be strictly adherent to GFD. Younger age at diagnosis and shorter duration since the diagnosis were associated with a better adherence rate. CONCLUSION CD has similar clinical presentations among Saudi children compared to other parts of the ward; however, the adherence to GFD is relatively poor. Younger age at diagnosis and shorter duration since the diagnosis were associated with a better adherence rate.
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Affiliation(s)
- Ahmed Al Sarkhy
- Division of Gastroenterology, Department of Pediatrics, King Khalid University Hospital, King Saud University, Saudi Arabia. ; Prince Abdullah Bin Khalid Celiac Disease Research Chair, King Saud University, Saudi Arabia
| | - Mohammad I El Mouzan
- Division of Gastroenterology, Department of Pediatrics, King Khalid University Hospital, King Saud University, Saudi Arabia. ; Prince Abdullah Bin Khalid Celiac Disease Research Chair, King Saud University, Saudi Arabia
| | - Elshazaly Saeed
- Prince Abdullah Bin Khalid Celiac Disease Research Chair, King Saud University, Saudi Arabia
| | - Aziz Alanazi
- Division of Gastroenterology, Department of Pediatrics, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Sharifa Alghamdi
- Division of Gastroenterology, Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Shirin Anil
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Asaad Assiri
- Division of Gastroenterology, Department of Pediatrics, King Khalid University Hospital, King Saud University, Saudi Arabia. ; Prince Abdullah Bin Khalid Celiac Disease Research Chair, King Saud University, Saudi Arabia
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Myléus A, Petersen S, Carlsson A, Hammarroth S, Högberg L, Ivarsson A. Health-related quality of life is not impaired in children with undetected as well as diagnosed celiac disease: a large population based cross-sectional study. BMC Public Health 2014; 14:425. [PMID: 24884747 PMCID: PMC4021079 DOI: 10.1186/1471-2458-14-425] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 04/24/2014] [Indexed: 12/15/2022] Open
Abstract
Background Knowledge regarding the health-related quality of life (HRQoL) of children with celiac disease remains limited and inconclusive. We investigated the HRQoL of three groups of 12-year-olds with: i) undetected celiac disease ii) clinically diagnosed celiac disease, and iii) without celiac disease. Methods A school-based cross-sectional multicenter screening study invited 18 325 children, whereof 68% consented to participate. Participants provided a blood sample, which was later analyzed for anti-tissue-tranglutaminase antibodies, and alongside filled in a questionnaire. When anti-tissue-tranglutaminase antibodies were elevated, a small intestinal biopsy verified the screening-detected celiac disease diagnosis. Self-reported HRQoL was measured using Kidscreen, a generic 52 items instrument with proven reliability and validity. Scores were linearly transformed into a 0–100 scale with higher values indicating better HRQoL. Mean values with standard deviations (mean ± SD) were compared, and uni- and multivariate logistic regression models tested the odds of a low HRQoL among children with undetected or diagnosed celiac disease, respectively. Results Children with undetected celiac disease (n = 238) reported similar HRQoL as children without celiac disease (n = 12 037) (83.0 ± 11.0 vs. 82.5 ± 11.3, P = 0.51), and also similar HRQoL (82.2 ± 12.2, P = 0.28) to that of children with diagnosed celiac disease (n = 90), of whom 92% were adherent to treatment. Having undetected celiac disease did not increase the odds of low overall HRQoL, independent of sex, area of residence, study year and occurrence of gastrointestinal symptoms (adjusted odds ratio 0.77, 95% CI 0.54-1.10). Comparable results were seen for diagnosed celiac disease cases (adjusted odds ratio 1.11, 95% CI 0.67-1.85). Conclusion Children with undetected celiac disease reported comparable HRQoL as their peers with diagnosed celiac disease, and those without celiac disease, when reporting prior to receiving the diagnosis through screening. Thus, children with celiac disease, both untreated and diagnosed, perceive their HRQoL as unimpaired by their disease.
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Affiliation(s)
- Anna Myléus
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden.
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Pimenta-Martins A, Pinto E, Gomes AM. Perceção do estado de saúde e da qualidade de vida numa amostra de celíacos portugueses. GE JORNAL PORTUGUÊS DE GASTRENTEROLOGIA 2014; 21:109-116. [DOI: 10.1016/j.jpg.2013.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Makharia GK, Mulder CJJ, Goh KL, Ahuja V, Bai JC, Catassi C, Green PHR, Gupta SD, Lundin KEA, Ramakrishna BS, Rawat R, Sharma H, Sood A, Watanabe C, Gibson PR. Issues associated with the emergence of coeliac disease in the Asia–Pacific region: a working party report of the World Gastroenterology Organization and the Asian Pacific Association of Gastroenterology. J Gastroenterol Hepatol 2014; 29:666-77. [PMID: 24783246 DOI: 10.1111/jgh.12514] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM Once thought to be uncommon in Asia, coeliac disease (CD) is now being increasingly recognized in Asia–Pacific region. In many Asian nations, CD is still considered to be either nonexistent or very rare. In recognition of such heterogeneity of knowledge and awareness, the World Gastroenterology Organization and the Asian Pacific Association of Gastroenterology commissioned a working party to address the key issues in emergence of CD in Asia. METHODS A working group consisting of members from Asia–Pacific region, Europe, North America, and South America reviewed relevant existing literature with focus on those issues specific to Asia–Pacific region both in terms of what exists and what needs to be done. RESULTS The working group identified the gaps in epidemiology, diagnosis, and management of CD in Asian–Pacific region and recommended the following: to establish prevalence of CD across region, increase in awareness about CD among physicians and patients, and recognition of atypical manifestations of CD. The challenges such as variability in performance of serological tests, lack of population-specific cut-offs values for a positive test, need for expert dietitians for proper counseling and supervision of patients, need for gluten-free infrastructure in food supply and creation of patient advocacy organizations were also emphasized. CONCLUSIONS Although absolute number of patients with CD at present is not very large, this number is expected to increase over the next few years or decades. It is thus appropriate that medical community across the Asia–Pacific region define extent of problem and get prepared to handle impending epidemic of CD.
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Health-related quality of life in children and adolescents with celiac disease: patient-driven data from focus group interviews. Qual Life Res 2014; 23:1883-94. [DOI: 10.1007/s11136-014-0623-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2014] [Indexed: 12/20/2022]
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Paarlahti P, Kurppa K, Ukkola A, Collin P, Huhtala H, Mäki M, Kaukinen K. Predictors of persistent symptoms and reduced quality of life in treated coeliac disease patients: a large cross-sectional study. BMC Gastroenterol 2013; 13:75. [PMID: 23631482 PMCID: PMC3651340 DOI: 10.1186/1471-230x-13-75] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 04/16/2013] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Pilvi Paarlahti
- Tampere Centre for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Kalle Kurppa
- Tampere Centre for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Anniina Ukkola
- Tampere Centre for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Pekka Collin
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland
| | - Heini Huhtala
- Tampere School of Health Sciences, University of Tampere, Tampere, Finland
| | - Markku Mäki
- Tampere Centre for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Katri Kaukinen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland
- Seinäjoki Central Hospital, Seinäjoki, Finland
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Taavela J, Kurppa K, Collin P, Lähdeaho ML, Salmi T, Saavalainen P, Haimila K, Huhtala H, Laurila K, Sievänen H, Mäki M, Kaukinen K. Degree of damage to the small bowel and serum antibody titers correlate with clinical presentation of patients with celiac disease. Clin Gastroenterol Hepatol 2013; 11:166-71.e1. [PMID: 23063678 DOI: 10.1016/j.cgh.2012.09.030] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 09/02/2012] [Accepted: 09/20/2012] [Indexed: 01/11/2023]
Abstract
BACKGROUND & AIMS In patients with celiac disease, gluten-induced lesions of the small-bowel mucosa develop gradually. However, it is not clear whether clinical presentation correlates with the degree of mucosal damage based on histology analysis. We investigated whether the degree of mucosal damage to the small bowel correlates with clinical presentation and serum markers of celiac disease. METHODS We collected results from serology tests and mucosal biopsy samples from 638 consecutive patients with celiac disease and compared them with reported gastrointestinal symptoms, health-related quality-of-life scores, results from laboratory tests, and bone mineral densities of patients. We assessed mucosal injury based on the ratio of villous height to crypt depth, numbers of intraepithelial CD3(+) cells, and semiquantitative Marsh classification criteria. Correlations were established based on the Pearson or Spearman coefficients. RESULTS The ratio of the villous height to crypt depth correlated with the severity of gastrointestinal symptoms, quality-of-life scores, laboratory test results, numbers of intraepithelial CD3(+) cells, and serum levels of antibodies associated with celiac disease. There was no correlation between the ratio of villous height to crypt depth and bone mineral density. The number of intraepithelial CD3(+) cells was not associated with symptoms, whereas the Marsh classification and serum levels of antibodies associated with celiac disease correlated with gastrointestinal symptoms, laboratory test results, and numbers of intraepithelial CD3(+) cells. CONCLUSIONS The ratio of small-bowel villous height to crypt depth and results from serology tests correlate with reported symptoms and quality of life of patients with celiac disease. Patient-reported outcomes are therefore of value, in addition to histology findings, in assessing patients with celiac disease.
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Affiliation(s)
- Juha Taavela
- Pediatric Research Centre, University of Tampere and Tampere University Hospital, Tampere, Finland
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Epifanio MS, Genna V, Vitello MG, Roccella M, La Grutta S. Parenting stress and impact of illness in parents of children with coeliac disease. Pediatr Rep 2013; 5:e19. [PMID: 24416498 PMCID: PMC3883085 DOI: 10.4081/pr.2013.e19] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 11/04/2013] [Indexed: 11/28/2022] Open
Abstract
Coeliac disease (CD) is a chronic disease which could stress patients and their family. Although, poor attention has been paid to the quality of life in CD children and to the functioning of families with CD children. The study aims to evaluate the parenting perception of the CD impact and the parenting distress level. A group of 74 parents of CD children compiled the Impact Childhood Illness Scale and the Parenting Stress Index which is also compiled by 74 parents of health children. The assessment does not reveal a significant impact of CD on patient's personal life although some critical areas emerged. Results evidenced an higher level of parenting stress in parents of CD children than parents of healthy children. CD, if suitably managed, has not a critical impact on parenting perception. Although, CD certainly put parents through an higher risk of a distress related to parenting role than parents with health children. A early identification of parenting distress in a pediatric chronic illness could facilitate the adjustment to pathology.
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Affiliation(s)
| | - Vitalba Genna
- Departments of Psychology, University of Palermo , Italy
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Nakajima K, Oshida H, Muneyuki T, Kakei M. Pancrelipase: an evidence-based review of its use for treating pancreatic exocrine insufficiency. CORE EVIDENCE 2012; 7:77-91. [PMID: 22936895 PMCID: PMC3426252 DOI: 10.2147/ce.s26705] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Pancreatic exocrine insufficiency (PEI) is often observed in patients with pancreatic diseases, including chronic pancreatitis, cystic fibrosis, and tumors, or after surgical resection. PEI often results in malnutrition, weight loss and steatorrhea, which together increase the risk of morbidity and mortality. Therefore, nutritional interventions, such as low-fat diets and pancreatic enzyme replacement therapy (PERT), are needed to improve the clinical symptoms, and to address the pathophysiology of pancreatic exocrine insufficiency. PERT with delayed-release pancrelipase is now becoming a standard therapy for pancreatic exocrine insufficiency because it significantly improves the coefficients of fat and nitrogen absorption as well as clinical symptoms, without serious treatment-emergent adverse events. The major adverse events were tolerable gastrointestinal tract symptoms, such as stomach pain, nausea, and bloating. Fibrosing colonopathy, a serious complication, is associated with high doses of enzymes. Several pancrelipase products have been approved by the US Food and Drug Administration in recent years. Although many double-blind, placebo-controlled trials of pancrelipase products have been conducted in recent years, these studies have enrolled relatively few patients and have often been less than a few weeks in duration. Moreover, few studies have addressed the issue of pancreatic diabetes, a type of diabetes that is characterized by frequent hypoglycemia, which is difficult to manage. In addition, it is unclear whether PERT improves morbidity and mortality in such settings. Therefore, large, long-term prospective studies are needed to identify the optimal treatment for pancreatic exocrine insufficiency. The studies should also examine the extent to which PERT using pancrelipase improves mortality and morbidity. The etiology and severity of pancreatic exocrine insufficiency often differ among patients with gastrointestinal diseases or diabetes (type 1 and type 2), and among elderly subjects. Finally, although there is currently limited clinical evidence, numerous extrapancreatic diseases and conditions that are highly prevalent in the general population may also be considered potential targets for PERT and related treatments.
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Affiliation(s)
- Kei Nakajima
- Division of Clinical Nutrition, Department of Medical Dietetics, Faculty of Pharmaceutical Sciences, Josai University, Keyakidai, Sakado
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Lee AR, Ng DL, Diamond B, Ciaccio EJ, Green PHR. Living with coeliac disease: survey results from the USA. J Hum Nutr Diet 2012; 25:233-8. [DOI: 10.1111/j.1365-277x.2012.01236.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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