Gluten-free Diet and Quality of Life in Patients With Screen-Detected Celiac Disease

Eff Clin Pract. May-Jun 2002;5(3):105-13.

Abstract

Context: Since the advent of serologic testing for celiac disease, most persons who receive a diagnosis of celiac disease have few or no symptoms. Although pathologic changes of celiac disease resolve on a gluten-free diet, how a gluten-free diet affects the quality of life for patients with screen-detected celiac disease is unclear.

Objective: To evaluate the effect of a gluten-free diet on the quality of life of patients with screen-detected celiac disease.

Design: Prospective study of patients before and 1 year after initiating a gluten-free diet.

Participants: 19 patients with screen-detected celiac disease (found by serologically testing first-degree relatives of celiac patients) and 21 consecutive patients with symptom-detected disease. In all cases, celiac diagnosis was confirmed by finding villous atrophy and crypt hyperplasia on small-bowel biopsy.

Intervention: Gluten-free diet (explained during a single physician visit).

Main outcome measures: Gastrointestinal Symptoms Rating Scale (GSRS), in which scores range from 0 to 6 (higher scores represent worse symptoms); and quality of life measured with the Psychological General Well-Being Questionnaire (PGWB). Scores range from 22 to 132 (higher scores mean greater well-being).

Results: At baseline, patients with symptom-detected celiac disease had poorer quality of life and more gastrointestinal symptoms than those with screen-detected celiac disease. Reported compliance with the gluten-free diet was good. All mucosal lesions of the small bowel had resolved at the follow-up biopsy. After 1 year of following the diet, quality of life for patients with screen-detected disease significantly improved (mean PGWB score increased from 108 to 114; P <0.01). A similar increase was noted in patients with symptom-detected disease (mean PGWB score increased from 92 to 103; P <0.01). Gastrointestinal symptoms also improved in patients with screen-detected disease and in patients with symptom-detected disease (mean GSRS scores decreased from 1.8 to 1.4 and from 2.6 to 1.9, respectively; P <0.01 for both comparisons).

Conclusions: Gluten-free diet was associated with improved quality of life for patients with symptom-detected celiac disease and patients with screen-detected celiac disease. Concerns about the burden of a gluten-free diet, at least over the short term, may be unfounded.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Celiac Disease / diagnosis
  • Celiac Disease / diet therapy*
  • Celiac Disease / physiopathology
  • Diet, Protein-Restricted*
  • Digestive System / physiopathology
  • Female
  • Glutens*
  • Humans
  • Male
  • Middle Aged
  • Patient Compliance
  • Prospective Studies
  • Quality of Life*
  • Surveys and Questionnaires

Substances

  • Glutens