Introduction

The data on the impact of coeliac disease on work loss are still scarce [1-3]. We aimed to evaluate the amount of hours lost at work in adult coeliac patients on a gluten-free diet (GFD), focusing on the reasons behind the work loss (WL), and the relationship with quality of life (QOL) and psychological morbidity.

Aims & Methods

Adult patients with biopsy-proven CD under regular follow-up at two Italian centres were surveyed between October 2022 and January 2024. The survey consisted of specific questionnaires, including the Work Productivity and Activity Impairment questionnaire (WPAI:CD), gastrointestinal symptoms severity score (Visual Analog Scale, VAS), the Coeliac Disease-specific Quality Of Life scale (CD:QOL), the State-Trait Anxiety Inventory scale (STAI-Y1 & STAI-Y2), and the Beck Depression Inventory scale (BDI-II). Amount of hours lost at work in the previous 7 and 30 days were specifically investigated and statistically analysed.

Results

160 patients on a GFD (121 F, mean age at CD diagnosis 32±14 years, 6% in a GFD for less than 1 year, 63% for more than 5 years, 31% for 1 to 5 years) were enrolled. Eight/160 (6.0%) patients reported having lost working hours in the previous 7 days and 15/132 (11.3%) in the previous 30 days. Reasons for work loss at 30 days included symptoms persistence despite the GFD (40%), attendance of outpatient clinic (40%) and issues with GFD adherence (20%). The patients had a mean of 3.1 hours of missed work at 7 days and 5.0 hours at 30 days. Focusing on the patients that experienced WL in the previous 30 days, we have found that they were more likely to have ongoing symptoms despite the GFD (67% vs 93%, p=0.04), scored higher on the survey items regarding depression (median BDI-II score 7.00 vs 12.00, p=0.04), and self-reported a lower QOL (median CD:QOL score 85.00 vs 75.00, p=0.03).

Conclusion

Our clinical data-based study has shown that CD patients can experience a substantial work loss at 30 days, particularly in case of persistence of symptoms despite a GFD, which can have negative impacts on psychological health, as well as overall QOL. This aspect should be considered when trying to develop personalized strategies for the individual follow-ups of coeliac patients.

References

1. Bozorg SR et al. Clin Gastroenterol Hepatol. 2022; 20: 1068-1076.e6
2. Norström F et al. BMC Gastroenterol 2012; 12: 125
3. Ukkola A et al. BMC Gastroenterol 2012; 12: 136
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Introduction

Coeliac disease (CeD) has been linked to decreased quality of life (QOL) and psychological morbidity, either due to the disease course itself, or to the effort required to maintain strict adherence to a gluten-free diet (GFD) over the long-term. High levels of resilience, the ability to recover from adversity, have been associated with better QOL in patients affected by chronic diseases. However, data on resilience in coeliac patients are lacking.

Aims & Methods

We aimed to assess the resilience in patients with CeD on a GFD, and how this is associated with sociodemographic factors, clinical factors, quality of life, and psychological disorders such as anxiety and depression. Methods: Adult CeD patients on a GFD and under regular follow-up at four Italian centres were prospectively proposed participation to a survey between February-2022 to April-2023. Clinical and demographic data were collected. The Connor-Davidson Resilience Scale (CD-RISC), the Celiac Disease-specific Quality of Life Scale (CD-QOL), the State-Trait Anxiety Inventory scale (STAI-Y) and the Beck Depression Inventory scale (BDI) were used to evaluate degree of resilience, QOL anxiety and depression, respectively. A multivariate analysis, including all variables related to resilience to univariate analysis, was conducted using the backward elimination model to identify factors independently associated with the degree of resilience.

Results

We included in this study 305 patients (221 F, mean age at CeD diagnosis 36.6±16.3 years; mean age at enrolment 47.9±15.4 years) on a GFD for a mean of 11.3± 10.4 years. 298/305 (97.7%) patients had a high level of resilience (CD-RISC ≥35). QOL scores were good overall (median 84, IQR 73-91). Anxiety scores were suboptimal (STAI-Y1 median 39, IQR 32-49; TAI-Y2 median 40, IQR 33-49). Depression scores were low overall (BDI median 7, IQR 2-14). At the univariate analysis, resilience was statistically associated to gender (p=0.02), age at enrolment (p=0.01), civil status (p=0.1), quality of life (p<0.001), anxiety (p<0.001) and depression (p<0.001). Backward elimination multivariate regression analysis showed that trait- anxiety (STAI-Y2, p<0.01) and depression (BDI, p=0.02) were the only independent predictors of lower levels of resilience (CD-RISC).

Conclusion

Patients with CD have high levels of resilience overall. Higher treat-anxiety and depression scores predicted lower levels of resilience. Targeted interventions in this subgroup of patients may be helpful for their management and follow-up.

Introduction

A strict lifelong gluten-free diet (GFD) is the mainstay of treatment for coeliac disease (CD). However, persistence of gastrointestinal symptoms in coeliac patients despite a GFD is a relevant clinical scenario. The impact of highly processed foods (HPF) intake and the adherence to a correct Mediterranean diet (MD) on these symptoms, the quality of life (QOL), and the metabolic profile of coeliac patients on a GFD is not well understood. This study aimed to investigate the influence of HPF and MD on gastrointestinal symptoms, QOL, and metabolic profile in coeliac patients on a GFD. We hereby present partial data of this ongoing study.

Aims & Methods

Adult CD patients were prospectively enrolled between November-2023 and March-2024 at four Italian referral centers. For each enrolled patient, the following data were recorded: persistent symptoms over the previous 12 months and in the 7 days prior to enrolment by using the GSRS-CeD, adherence to a GFD, adherence to a MD evaluated by means of the Pyramid-based Mediterranean Diet Score (PyrMDS), the consumption of highly processed food evaluated by means of the sQ-HPF, the Celiac Disease-specific Quality of Life Scale (CD-QOL) and metabolic profile. These data were subsequently statistically analized.

Results

A total of 121 patients (83F, mean age 44±15 years) were enrolled. Overall, 61% of patients reported persistent gastrointestinal symptoms despite a GFD. Patients with persistent symptoms were more likely to be female (78% vs 53%, p<0.01), to have a lower HPF intake (26% vs 30%, p=0.02), a higher GSRS-CeD score (median 3 vs 18.5, p<0.001), and lower CD-QoL scores (mean CD-QoL 80 vs 88, p<0.001), but did not have higher PyrMDS scores (p=0.21). PyrMDS was inversely correlated with HPF intake (r=-0.20, p=0.03) and serum triglycerides (r=-0.22, p=0.05), and positively correlated with HDL cholesterol (r=0.20, p=0.08). At multivariate logistic regression adjusted for age and sex, persistence of gastrointestinal symptoms despite a GFD was associated with female sex (p<0.01), lower HPF intake (p=0.04), but not adherence to MD (p=0.31).

Conclusion

Persistence of gastrointestinal symptoms in coeliac patients despite a GFD is common, but unrelated to the adherence to a MD. Female sex and lower intake of HPF were associated with persistence on gastrointestinal symptoms despite a GFD despite a better metabolic profile. Optimising dietary treatment of coeliac patients with persistent gastrointestinal symptoms despite a GFD requires expert nutritional counselling.

Introduction

Coeliac disease-associated symptoms recover usually on a gluten-free diet (GFD) while its effect on the quality of life is not as straightforward. Some patients experience the diet burdensome and socially resctritive, which predispose them to negative experiences. Deciphering factors associated with reduced quality of life at coeliac disease diagnosis and significant improvement on GFD would be important for optimal treatment outcomes. We studied these issues in a prospective patient cohort.

Aims & Methods

Medical data on 178 adult coeliac disease patients were gathered at diagnosis and after one year on a strict GFD via structured interviews including Psychological General Well-Being (PGWB) and Gastrointestial Symptom Rating Scale questionnaires. Data were supplemented with available medical records. Decreased quality of life was defined as PGWB total score below the 25^th percentile and significant improvement as a change in PGWB total score above the 75^th percentile of the whole cohort. Logistic regression model was used to discover the factors associated with reduced quality of life and significant improvement on GFD.

Results

Decreased quality of life at diagnosis was associated with female sex (odds ratio 2.83, 95% confidence interval 1.15-6.97), severe gastrointestinal symptoms (4.02 [1.84-8.77]), presence of psychiatric comorbidities (17.7 [1.99-156]) and clinically vs. screen-detected presentation (2.54 [1.17-5.50]). Same factors increased risk for decreased quality of life on a GFD. Significant improvement in the quality of life was associated with reduced quality of life (5.98, [2.67-13.4]) and severe gastrointestinal symptoms (4.92 [2.24-10.8]) at diagnosis, autoimmune comorbidities (2.65 [1.12-6.31]), and clinically vs. screen-detected presentation (4.54 [1.98-10.5]).

Conclusion

Female sex, psychiatric comorbidities and severe gastrointestinal symptoms were associated with reduced quality of life both at coeliac disease diagnosis and on GFD. These patients may need additional support in health care, and good response to GFD should be documented. On the other hand, especially patients with severe symptoms and decreased quality of life at diagnosis as well as those with autoimmune comorbidities seemed to benefit from GFD.

Introduction

This study assessed typical symptoms (abdominal pain, bloating, diarrhoea, nausea, tiredness) in patients with celiac disease (CeD) following a gluten-free diet (GFD) and evaluated the association between symptom severity and quality of life (QoL) to address limited data in this area.

Aims & Methods

In the Virtual Celiac Symptoms Study (NCT05309330), patients reported daily symptoms using the Celiac Disease Symptom Diary 2.1^© (CDSD 2.1^©) over 12 weeks and completed patient-reported outcome measures (PROMs), with 7-day look-back, at specified timepoints, including the Impact of Celiac Disease Symptoms Questionnaire (ICDSQ) and the Patient Global Impression of Severity (PGI-S) measure. Spearman’s correlation coefficient (SCC) and generalized linear regression evaluated associations between symptom severity and QoL PROM scores and mean differences were adjusted for key demographics.

Results

In total, 480 participants completed the study (mean [standard deviation] age: 31 [15] years, 81.7% female, 93.8% White). For all CeD symptoms measured, there was a positive linear association between CDSD 2.1^© symptom severity and PROM scores (p <0.001). The SCC between symptom severity and PROMs was 0.45–0.62 (PGI-S) and 0.33–0.56 (ICDSQ). The strongest correlations between gastrointestinal symptom severity (abdominal pain, bloating, diarrhoea, and nausea) and PROMs were between PGI-S score and abdominal pain (SCC: 0.62) and bloating (SCC: 0.59). Patients with severe/very severe abdominal pain versus none had mean (95% confidence interval [CI]) 63.1% (53.2–73.6) and 217.5% (165.1–280.2) greater PGI-S and ICDSQ scores, respectively.

Conclusion

The results indicate that higher symptom severity is strongly associated with worse QoL in patients with CeD following a GFD and that CDSD 2.1^© assesses patient-relevant symptom severity in CeD.

Disclosure

MA, NC, DAL, SG and RS are employees and shareholders of Takeda. LMM was an employee of Takeda at the time of the study. JRM and SS are employees of Analysis Group, Inc., which received research support from Takeda Development Center Americas, Inc. DA has served as a consultant for Takeda Pharmaceuticals and Ironwood Pharmaceuticals. MG is an employee of the Celiac Disease Foundation, which received financial support from Takeda Development Center Americas, Inc. EL serves as a consultant for Takeda Pharmaceuticals and is an author for UpToDate (celiac section) for which he receives royalties.

Introduction

Individuals with coeliac disease (CeD) commonly complain of persistent symptoms despite adhering to a gluten free diet (GFD). We analysed baseline data from the prospective pseudonymized German CeD Registry to identify factors associated with ongoing complaints.

Aims & Methods

​​​​​​After written informed consent, participants self-reported demographic, clinical and healthcare related information at baseline and yearly thereafter. Symptoms before diagnosis and during the four weeks prior to completing the baseline questionnaire were retrospectively assessed. Factors associated with symptoms after at least one year of gluten-free diet (GFD) were evaluated by multivariate logistic regression.

Results

From 11/2019 to 10/2021, 2164 participants provided baseline data: 78% were female, median age 36 years (range 1.1 to 93.2), median time since diagnosis 6.3 years (0 to 58.7), and median diagnostic delay (time from first symptom to diagnosis) 2.2 years (0 to 64.8). Most common symptoms before diagnosis included abdominal pain (83%), bloating (82%), fatigue (78%), and diarrhoea (71%). Individuals diagnosed in adulthood were more symptomatic compared to paediatric patients. Although 93.4% of participants reported improvement after diagnosis, a substantial proportion of those keeping a GFD >1year (n=1861, 86% of cohort) had ongoing symptoms. Factors associated with regularly experiencing above symptoms included female gender, having the same symptom before diagnosis, feeling insufficiently informed by their physician about CeD and implications for their daily life, and age at diagnosis (per decade), but not time since diagnosis (table).

Conclusion

Our findings revealed deficits in awareness, the diagnostic process, and post-diagnostic care. In this large cohort of patients with CeD we identified factors associated with persistence of symptoms despite keeping a GFD for at least one years. Early diagnosis, providing comprehensive education after confirmed diagnosis, and ensuring strict dietary adherence are pivotal for symptom resolution. A population-based mass-screening for CeD in childhood should be further explored. Implementing a multifaceted approach will enhance care for individuals with CeD and ultimately improve long-term health and well-being.