Experiences and own management regarding residual symptoms among people with coeliac disease

The psychosocial experiences of adults diagnosed with coeliac disease: a qualitative evidence synthesis

BACKGROUND

Coeliac disease is a chronic autoimmune condition associated with intestinal and extraintestinal symptoms. Coeliac Disease is managed through strict adherence to a gluten-free diet, which, though usually effective, is challenging to maintain. This review synthesised qualitative research on the psychosocial experiences of adults living with coeliac disease.

METHODS

Keyword searches were conducted of the academic databases CINAHL, EMBASE, MEDLINE, PsychINFO, SCOPUS and Web of Science for articles published (2005-2021), followed by forward and backward searches. Thematic synthesis of included articles was carried out on sections reporting findings or results, discussion, conclusions, and supporting data. The inductive thematic synthesis identified descriptive and analytical themes from the included studies.

RESULTS

Of 1284 records identified, 17 articles from 15 original studies were included in the thematic synthesis. The majority of studies were from Europe (76%), with the remainder from North America and Australia. Data represented 371 adults with coeliac disease (72% female; 17-85 years old, diagnosed < 1-42 years ago) across eight countries. Findings identified six analytical themes relating to the psychosocial experience of coeliac disease: 'Living with ongoing risk'; 'Losing more than gluten'; 'A changed identity'; 'A changed relationship with food'; 'The gluten-free diet creates a multifaceted burden'; and 'Learning how to live well with Coeliac Disease'.

CONCLUSIONS

Coeliac disease changes adults' psychosocial experiences. Adaptation involves ongoing learning, and development of psychological acceptance facilitates adjustment. Increased public education about coeliac disease may reduce stigma and risk. Psychosocial assessment and support could improve quality of life post-diagnosis.

Evaluation of Daily Lives of Children and Adolescents with Celiac Disease and Nursing Approaches

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.

Patient Work and Their Contexts: Scoping Review

Background

Having patients self-manage their health conditions is a widely promoted concept, but many patients struggle to practice it effectively. Moreover, few studies have analyzed the nature of work required from patients and how such work fits into the context of their daily life.

Objective

This study aimed to review the characteristics of patient work in adult patients. Patient work refers to tasks that health conditions impose on patients (eg, taking medications) within a system of contextual factors.

Methods

A systematic scoping review was conducted using narrative synthesis. Data were extracted from PubMed, Excerpta Medica database (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO, including studies from August 2013 to August 2018. The included studies focused on adult patients and assessed one or more of the following: (1) physical health–related tasks, (2) cognitive health–related tasks, or (3) contextual factors affecting these tasks. Tasks were categorized according to the themes that emerged: (1) if the task is always visible to others or can be cognitive, (2) if the task must be conducted collaboratively or can be conducted alone, and (3) if the task was done with the purpose of creating resources. Contextual factors were grouped according to the level at which they exert influence (micro, meso, or macro) and where they fit in the patient work system (the macroergonomic layer of physical, social, and organizational factors; the mesoergonomic layer of household and community; and the microergonomic triad of person-task-tools).

Results

In total, 67 publications were included, with 58 original research articles and 9 review articles. A variety of patient work tasks were observed, ranging from physical and tangible tasks (such as taking medications and visiting health care professionals) to psychological and social tasks (such as creating coping strategies). Patient work was affected by a range of contextual factors on the micro, meso, or macro levels. Our results indicate that most patient work was done alone, in private, and often imposing cognitive burden with low amounts of support.

Conclusions

This review sought to provide insight into the work burden of health management from a patient perspective and how patient context influences such work. For many patients, health-related work is ever present, invisible, and overwhelming. When researchers and clinicians design and implement patient-facing interventions, it is important to understand how the extra work impacts one’s internal state and coping strategy, how such work fits into daily routines, and if these changes could be maintained in the long term.

Illness beliefs among people living with treated coeliac disease

BACKGROUND

Evidence suggests that many people with coeliac disease (CD) suffer from continuing illness despite following a strict gluten-free diet. Beliefs affect how people experience and manage their residual symptoms. Illness beliefs therefore provide a useful framework for understanding these problems.

AIM

To explore illness beliefs among people living with treated coeliac disease.

METHODS

The design was qualitative descriptive with semi-structured interviews including 22 adults with coeliac disease. Data were analysed with qualitative content analysis. The study follows the ethical guidelines given in the Declaration of Helsinki and was approved by the local ethical committee (DN 2014/92-31).

FINDING

The source of experienced continuing illness, despite following a gluten-free diet, was believed to be a bodily imbalance affecting participants' lives in many ways, both private and in contact with the health services. Due to a feeling of exhaustion and lack of energy, this imbalance had prevented them from participating in school, work life and social activities. Since the participants had often been ill for many years before diagnosis, they believed their intestine to be so damaged that it was no longer possible to achieve a bodily balance.

CONCLUSIONS

Illness beliefs in people diagnosed and treated for CD showed that they explained various continuing conditions, physiological and/or psychological, by a bodily imbalance, originally caused by the CD. By uncovering these illness beliefs, the possibility of finding an adequate and facilitative strategy grows stronger.

Wheat Fermentation With Enterococcus mundtii QAUSD01 and Wickerhamomyces anomalus QAUWA03 Consortia Induces Concurrent Gliadin and Phytic Acid Degradation and Inhibits Gliadin Toxicity in Caco-2 Monolayers

Foods containing high amounts of either phytic acid or gliadin can pose a risk for development of iron deficiency and celiac disease, respectively. The present study was conducted to evaluate the effects of preselected gliadin degrading strains, Enterococcus mundtii QAUSD01 and Wickerhamomyces anomalus QAUWA03, on phytic acid and gliadin degradation in six wheat cultivars (Lasani 2008, Seher 2006, Chakwal 97, Shafaq 2006, Bars 2009, Barani 83). Tight junction proteins, trans-epithelial resistance (TER) and ruffle formation in Caco-2 cells were evaluated relative to Saccharomyces cerevisiae-mediated fermented and unfermented controls. Phytic acid degradation was demonstrated in all six cultivars fermented with E. mundtii QAUSD01 and W. anomalus QAUWA03 consortia. Among the six fermented cultivars, Shafaq 2006 showed relatively higher degradation of gliadin. In comparison to the other tested wheat varieties, fermentation of Lasani 2006 was associated with minimal toxic effects on Caco-2 cells in terms of ruffle formation, tight junction proteins and TER, which can be attributed to extensive degradation of toxic gliadin fragments.