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Knowles SR, Apputhurai P, Tye-Din JA. Development and validation of a brain fog scale for coeliac disease. Aliment Pharmacol Ther 2024; 59:1260-1270. [PMID: 38445780 DOI: 10.1111/apt.17942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/30/2024] [Accepted: 02/27/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Brain fog is a subjective cognitive impairment commonly reported in coeliac disease. A standardised tool to define and assess it is an important unmet need. AIMS To develop a patient-informed tool to assess brain fog in coeliac disease to support clinical care, research and drug development. METHODS A pilot online study defined patient descriptors of brain fog. A second study evaluated the factor structure and performance of the scale across two-time points ('Now' and in the 'Past week'). One month later, participants were invited to repeat the study with two online cognitive processing tests, the Stroop task and the trail making test. RESULTS Among adults with treated coeliac disease, 37 (91.9% F) participated in the pilot study and 510 (88.8% F) in the second study of whom 99 repeated the study 1 month later with 51 completing cognitive testing. The most common brain fog descriptors were 'difficulty focusing', 'difficulty thinking' and 'difficulty finding the right words and communicating'. The 12-item scale reflects 'cognitive impairment' and 'somatic and affective experience' and demonstrates strong psychometric properties. It tracked with patients report of brain fog being present or absent across two-time points. It did not significantly correlate with the cognitive tests. CONCLUSION The brain fog assessment and severity scale is the first patient-informed clinical outcomes assessment tool measuring brain fog in coeliac disease. It is brief and validated for two time-based formats. Further research coupling it with biomarker discovery is needed to confirm its validity as a predictor of cognitive performance.
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Affiliation(s)
- Simon R Knowles
- Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia
| | - Pragalathan Apputhurai
- Department of Health Sciences and Biostatistics, Swinburne University of Technology, Melbourne, Australia
| | - Jason A Tye-Din
- Immunology Division, Walter and Eliza Hall Institute, Melbourne, Australia
- Department of Gastroenterology, the Royal Melbourne Hospital, Melbourne, Australia
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Efe A, Tok A. Obsessive-Compulsive Symptomatology and Disgust Propensity in Disordered Eating Behaviors of Adolescents with Celiac Disease. Int J Behav Med 2024; 31:85-96. [PMID: 36781574 DOI: 10.1007/s12529-023-10163-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Considering the importance of underlying psychopathological mechanisms that mediate maladaptive eating behaviors in celiac disease (CD) in the determination of cognitive-behavioral therapeutic approaches, we investigated the impact of obsessive-compulsive symptomatology and disgust propensity on disordered eating attitudes (DEA) and poor gluten-free diet (GFD) compliance in adolescents with CD. METHOD Adolescents with biopsy-proven CD (n = 148, aged 12-18 years) were compared with age- and sex-matched controls (n = 104) in terms of eating attitudes/behaviors, obsessive-compulsive symptoms, and disgust propensity, as well as depression and anxiety to rule out depression- and anxiety-related covariates. The clinical implications associated with poor GFD compliance were determined using between-subgroup analysis. Multivariate linear regression and multiple logistic regression were used to identify predictors of DEA and GFD noncompliance, respectively. RESULTS In adolescents with CD, DEA was remarkably associated with obsessive-compulsive symptom severity and disgust propensity, especially in contamination and core disgust sub-dimensions. Obsessionality and disgust propensity were independent predictors of DEA, of which the obsessive-compulsive symptom severity was the most decisive predictor of DEA. Higher DEA severity and lower body mass index were independent predictors of poor GFD compliance. CONCLUSION Higher obsessionality, accompanied by disgust-related evaluative conditioning processes, may contribute to constructing a cognitive network consisting of hypervigilance and catastrophic interpretations towards benign somatic stimulations, food-related preoccupations, and avoidant behaviors in the disordered eating of adolescents with CD. The reciprocal relationship between lifelong GFD and DEA, mediated by obsessionality and disgust propensity, was supported by current findings that could guide clinicians in the management of maladaptive eating behaviors in adolescents with CD.
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Affiliation(s)
- Ayşegül Efe
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Dr. Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital, Babür Cd., No: 41, Altındağ, 06080, Ankara, Turkey.
| | - Ayşegül Tok
- Department of Child Hepatology, Gastroenterology and Nutrition, University of Health Sciences, Dr. Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
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Crocco M, Malerba F, Calvi A, Zampatti N, Gandullia P, Madeo A, Tappino B, Proietti S, Bonassi S. Health-related quality of life in children with coeliac disease and in their families: A long-term follow-up study. J Pediatr Gastroenterol Nutr 2024; 78:105-112. [PMID: 38291681 DOI: 10.1002/jpn3.12049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 10/06/2023] [Accepted: 10/25/2023] [Indexed: 02/01/2024]
Abstract
OBJECTIVES The aim of the study was to assess long-term health-related quality of life (HRQoL) in children and adolescents with coeliac disease (CD), and their parents. METHODS We re-evaluated prospectively the HRQoL and clinical characteristics of 80 families, assessed 5 years earlier, using a disease-specific questionnaire, the CD Dutch Questionnaire (CDDUX), and a generic questionnaire, the Paediatric Quality of Life Inventory (PedsQL). RESULTS After a 10-year follow-up, there was no significant change in the total CDDUX and PedsQL scores in children and their parents when compared to the evaluation conducted 5 years earlier. The total CDDUX score reflected a neutral QoL, while for the generic PedsQL was good-very good. The only significant decrease after 5 years was the PedsQL subdomain Emotional functioning. Patients who admitted voluntarily eating gluten reported lower score in CDDUX Diet. Lower scores in subdomain "Physical functioning" (PedsQL) were reported in patients with positivity of TTG or associated diseases. CONCLUSIONS The CDDUX score indicated a consistently stable and neutral QoL perception among coeliac patients and caregivers, even after 10-year postdiagnosis, suggesting minimal fluctuations in the impact of CD on disease-specific health domains over time. Furthermore, the consistently good PedsQL score could be a reflection of the resilience of coeliac families in coping with this chronic condition. Gluten-free diet compliance was confirmed to be determinant of HRQoL in the long term. The study confirms the importance of extending surveillance on these patients, possibly using different questionnaires, to assess QoL from different perspectives.
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Affiliation(s)
- Marco Crocco
- Pediatric Gastroenterology and Endoscopy Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Genoa, Italy
| | - Federica Malerba
- Pediatric Gastroenterology and Endoscopy Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Genoa, Italy
| | - Angela Calvi
- Pediatric Gastroenterology and Endoscopy Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Noemi Zampatti
- Pediatric Gastroenterology and Endoscopy Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Genoa, Italy
| | - Paolo Gandullia
- Pediatric Gastroenterology and Endoscopy Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Annalisa Madeo
- Pediatric Gastroenterology and Endoscopy Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Barbara Tappino
- Laboratory for the Study of Inborn Errors of Metabolism (LABSIEM), IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Stefania Proietti
- Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, Rome, Italy
- Department of Human Sciences and Quality of Life Promotion, San Raffaele University, Rome, Italy
| | - Stefano Bonassi
- Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, Rome, Italy
- Department of Human Sciences and Quality of Life Promotion, San Raffaele University, Rome, Italy
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Belpınar A, Dağ YS, Arıcıoğlu Sülün A, Yayan EH, Varol Fİ. The effect of anxiety and depression levels of children with celiac disease on quality of life. J Pediatr Nurs 2023; 73:e260-e265. [PMID: 37805380 DOI: 10.1016/j.pedn.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/24/2023] [Accepted: 09/24/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE This study was conducted to examine the effect of anxiety and depression levels on quality of life in children with celiac disease. DESIGN AND METHOD This descriptive and correlational study was conducted with 98 children diagnosed with celiac disease who applied to the pediatric outpatient clinic of a university hospital in Eastern Anatolia between September 2021 and August 2022. Data were collected using the State-Trait Anxiety Scale, Depression Scale, and Quality of Life Scale through face-to-face interviews conducted by the researchers. Percentage distribution, mean, independent samples t-test, Pearson correlation analysis and regression analysis were used to analyze the data. RESULTS It was found that 62% of the participant children were female and their mean age was 11.69 ± 4.15 years. The mean scores of state anxiety, trait anxiety, depression and quality of life of children with celiac disease were 42.46 ± 5.42 (high), 43.83 ± 7.08 (high), 23.37 ± 4.79 (high) and 43.67 ± 19.67 (low), respectively. Regression analysis revealed that anxiety had a statistically significant relationship with quality of life. CONCLUSIONS It was found that children with celiac disease experienced high levels of depression and anxiety along with physical functionality and psychosocial health problems and this negatively affected their quality of life. It is recommended that children with celiac disease should be followed up and supported psychosocially. PRACTICE IMPLICATIONS That healthcare professionals can contribute to reducing the depression and axienty and improving the quality of life by strengthening the social support systems of childrens with celiac disease.
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Affiliation(s)
- Ayşe Belpınar
- Department of Medical Services and Techniques, Health Assistance Vocational School, Yozgat Bozok University, Yozgat, Turkey.
| | - Yeliz Suna Dağ
- Pediatric Nursing Department, Faculty of Health Sciences, Fırat University, Elazığ, Turkey
| | - Ayşe Arıcıoğlu Sülün
- Pediatric Nursing Department, Faculty of Health Sciences, Ordu University, Ordu, Turkey
| | - Emriye Hilal Yayan
- Pediatric Nursing Department Faculty of Nursing, İnönü University, Malatya, Turkey
| | - Fatma İlknur Varol
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Faculty of Medicine, Inonu University, Malatya, Turkey
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Ersig AL, Young EE, Brown RL, Malecki K. Genetic Variation, Stress, and Physiological Stress Response in Adults With Food Allergy or Celiac Disease. Biol Res Nurs 2023; 25:300-309. [PMID: 36280595 DOI: 10.1177/10998004221134826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Persistently high chronic stress can lead to maladaptive psychological, behavioral, and physiological stress responses and poor mental and physical health, highlighting the importance of identifying individuals at increased risk. Chronic health condition diagnosis and genetics are 2 characteristics that can influence stress, stress response, and health outcomes. PURPOSE Food allergy (FA) and celiac disease (CD) require constant vigilance in daily life and can lead to increased stress. The purpose of this exploratory analysis was to examine the association of variants in selected stress-related genes with stress exposures, stress, clinical measures of physiological stress response, and mental health symptoms in adults with and without FA or CD. METHODS We compared stress exposures, symptoms of PTSD, depression, anxiety, and stress, BMI, and waist-hip ratio between cases and controls. We analyzed the association of SNPs in genes with known or hypothesized associations with stress-related measures in 124 cases and 124 matched controls: CRHBP (rs7718461, rs10474485), CRHR1 (rs242940) and OXTR (rs2268490). For this exploratory study, p-values ≤ 0.10 were considered suggestive. RESULTS For cases and controls, rs7718461 was associated with stress symptoms, rs2268490 with symptoms of stress and PTSD, and rs242940 with symptoms of stress, PTSD, anxiety, and depression. Further analyses found that stress-related outcomes in individuals with FA or CD may be influenced by SNP genotype. CONCLUSIONS Given these suggestive findings, larger prospective studies should examine similar relationships in individuals with other chronic health conditions, incorporating factors such as environmental exposures, individual experiences, and epigenetic modifications.
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Affiliation(s)
- Anne L Ersig
- 5228University of Wisconsin-Madison, School of Nursing, Madison, WI, USA
| | - Erin E Young
- 12251University of Kansas School of Medicine, Kansas City, KS, USA
| | - Roger L Brown
- 5228University of Wisconsin-Madison, School of Nursing, Madison, WI, USA
| | - Kristen Malecki
- Division of Environmental and Occupational Health Sciences, School of Public Health, 14681University of Illinois Chicago, Chicago, IL, USA
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Reiter J, Abuelhija H, Slae M, Millman P, Davidovics Z, Chaimov E, Gileles-Hillel A, Wilschanski M. Sleep disorders in children with celiac disease: a prospective study. J Clin Sleep Med 2023; 19:591-594. [PMID: 36546369 PMCID: PMC9978427 DOI: 10.5664/jcsm.10396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 12/24/2022]
Abstract
STUDY OBJECTIVES Celiac disease (CD), an immune-mediated enteropathy, has a clinical spectrum that is remarkably wide and includes neuropsychiatric manifestations. While studies of adults have shown sleep disturbances, there is limited data in children. Our objectives were to assess the association between sleep disturbances and CD in children, and the effect of a gluten-free diet. METHODS Parents of children 3-12 years old referred for endoscopy completed the Sleep Disturbance Scale for Children and modified Epworth Sleepiness Scale. Children with CD were compared with healthy controls and children with abdominal pain but no definitive findings on investigation. Parents of children with CD and abdominal pain were contacted after 6 months for follow-up. RESULTS We enrolled 101 patients, mean age 6.5 (2.8), 51% female, 38 with CD, 18 abdominal pain, and 45 healthy. Sleep Disturbance Scale for Children scores were 37.4 (8.7), 41.3 (11.3), and 45.4 (13.7) in healthy controls, CD, and abdominal pain, respectively (P = .024). There was a significant difference in the disorders of arousal domain (P = .044). There were no significant differences on the modified Epworth Sleepiness Scale. A trend toward improvement in Sleep Disturbance Scale for Children scores was seen in children with CD presenting with abdominal pain after 6 months on a gluten-free diet (P = .07). CONCLUSIONS In this first prospective study of sleep disturbances in children with CD, we show high rates of disturbed sleep compared with healthy children. Sleep disturbances did not improve on a gluten-free diet and may be driven by abdominal pain. CITATION Reiter J, Abuelhija H, Slae M, et al. Sleep disorders in children with celiac disease: a prospective study. J Clin Sleep Med. 2023;19(3):591-594.
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Affiliation(s)
- Joel Reiter
- Pediatric Pulmonary and Sleep Unit, Department of Pediatrics, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hiba Abuelhija
- Pediatric Intensive Care Unit, Department of Pediatrics, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mordechai Slae
- Pediatric Gastroenterology Units, Department of Pediatrics, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Peri Millman
- Pediatric Gastroenterology Units, Department of Pediatrics, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Zev Davidovics
- Pediatric Gastroenterology Units, Department of Pediatrics, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Elinor Chaimov
- Pediatric Gastroenterology Units, Department of Pediatrics, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Alex Gileles-Hillel
- Pediatric Pulmonary and Sleep Unit, Department of Pediatrics, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michael Wilschanski
- Pediatric Gastroenterology Units, Department of Pediatrics, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Germone M, Phu T, Slosky C, Pan Z, Jones A, Stahl M, Mehta P, Shull M, Ariefdjohan M, Liu E. Anxiety and Depression in Pediatric Patients with Celiac Disease: A Large Cross-Sectional Study. J Pediatr Gastroenterol Nutr 2022; 75:181-185. [PMID: 35641896 DOI: 10.1097/mpg.0000000000003497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Mental health is a growing concern in pediatric celiac disease (CD). This study utilized the Revised Children's Anxiety and Depression Scale (RCADS) to investigate anxiety and depression symptom rates. Participants were children ages 8 to 17 years (M = 11.7, SD = 2.7; N = 175) with biopsy-proven CD (Median = 1.1 years post-diagnosis, IQR = 0-4) categorized into groups based on the child's age, caregiver or child respondent, presence or absence of comorbidities, and gluten-free diet duration. Self-reported RCADS scores showed 39% of children having clinically significant concerns for anxiety or depression ( P < 0.0001) but only 7% of caregiver-proxy RCADS scores indicated significant concerns for the child's anxiety and 14% for the child's depression. Rates of child-reported anxiety and depression symptoms were significantly higher for those without medical comorbidities than those with ( P = 0.04). Therefore, screening for mental health concerns, particularly anxiety and depression, should be routinely performed in pediatric patients with CD.
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Affiliation(s)
- Monique Germone
- From the Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO
- the Pediatric Mental Health Institute, Children's Hospital Colorado, Aurora, CO
- the Colorado Center for Celiac Disease, Digestive Health Institute, Children's Hospital Colorado, Aurora, CO
| | - Tiffany Phu
- the Pediatric Mental Health Institute, Children's Hospital Colorado, Aurora, CO
| | - Camryn Slosky
- From the Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Zhaoxing Pan
- the Biostatistics Core of Children's Hospital Colorado Research Institute
| | - Anna Jones
- the Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN
| | - Marisa Stahl
- the Colorado Center for Celiac Disease, Digestive Health Institute, Children's Hospital Colorado, Aurora, CO
- the Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Pooja Mehta
- the Colorado Center for Celiac Disease, Digestive Health Institute, Children's Hospital Colorado, Aurora, CO
- the Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Mary Shull
- the Colorado Center for Celiac Disease, Digestive Health Institute, Children's Hospital Colorado, Aurora, CO
- the Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Merlin Ariefdjohan
- From the Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Edwin Liu
- the Colorado Center for Celiac Disease, Digestive Health Institute, Children's Hospital Colorado, Aurora, CO
- the Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
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Canova C, Rosato I, Marsilio I, Valiante F, Zorzetto V, Cataudella G, D’Odorico A, Zingone F. Quality of Life and Psychological Disorders in Coeliac Disease: A Prospective Multicentre Study. Nutrients 2021; 13:nu13093233. [PMID: 34579108 PMCID: PMC8470791 DOI: 10.3390/nu13093233] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/11/2021] [Accepted: 09/14/2021] [Indexed: 01/27/2023] Open
Abstract
Coeliac disease (CeD) has been associated with psychological disorders and reduced quality of life. Our prospective study evaluated the changes in the quality of life, anxiety and depression in CeD patients up to two years after diagnosis. We recruited adult patients residing in the Veneto region with a new diagnosis of CeD. Several validated questionnaires were administered to measure quality of life, psychological symptoms and adherence to a gluten-free diet (GFD) at the time of diagnosis and after 1 and 2 years. Ninety-three patients reached the 1-year follow-up (81.7% were females with a median age at diagnosis of 35 years), and 55 patients reached the 2-year follow-up. We observed a significant improvement in quality of life, anxiety and depression scores at 1 year after diagnosis, particularly in patients who complied with a GFD. The improvements among classical CeD patients were similar to those observed in nonclassical patients except for anxiety, which improved only in patients with a classical presentation at diagnosis. Age, sex and other disease factors did not affect the change in quality of life (QoL) or other mood disorders. Most of the improvements measured 1 year after diagnosis and 2 years after diagnosis were not significant. In conclusion, QoL and mood disorders must be considered, and psychological counselling should be used when needed.
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Affiliation(s)
- Cristina Canova
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, 35131 Padova, Italy; (C.C.); (I.R.)
| | - Isabella Rosato
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, 35131 Padova, Italy; (C.C.); (I.R.)
| | - Ilaria Marsilio
- Department of Surgery, Oncology, Gastroenterology, University of Padua, 35124 Padova, Italy; (I.M.); (A.D.)
| | - Flavio Valiante
- Gastroenterology and Digestive Endoscopy Unit, ULSS 1 Dolomiti, Santa Maria del Prato Hospital, 32032 Feltre, Italy;
| | - Valerio Zorzetto
- Gastroenterology and Endoscopy Unit, ULSS 9, 37045 Legnago, Italy;
| | - Giovanni Cataudella
- Gastroenterology and Endoscopy Unit, San Bortolo Hospital, 36100 Vicenza, Italy;
| | - Anna D’Odorico
- Department of Surgery, Oncology, Gastroenterology, University of Padua, 35124 Padova, Italy; (I.M.); (A.D.)
| | - Fabiana Zingone
- Department of Surgery, Oncology, Gastroenterology, University of Padua, 35124 Padova, Italy; (I.M.); (A.D.)
- Correspondence: ; Tel.: +39-049-821-5656
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Carroccio A, Soresi M, Chiavetta M, La Blasca F, Compagnoni S, Giuliano A, Fayer F, Mandreucci F, Castellucci D, Seidita A, Affronti A, Florena AM, Mansueto P. Frequency and Clinical Aspects of Neurological and Psychiatric Symptoms in Patients with Non-Celiac Wheat Sensitivity. Nutrients 2021; 13:nu13061971. [PMID: 34201313 PMCID: PMC8227001 DOI: 10.3390/nu13061971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/19/2021] [Accepted: 06/04/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Non-Celiac Wheat Sensitivity (NCWS) is characterized by both intestinal and extra-intestinal symptoms. The study aims to investigate the frequency of neuropsychiatric manifestations in NCWS patients and identify their clinical and demographic characteristics. Methods: 278 clinical records of NCWS patients, diagnosed by a double-blind placebo-controlled wheat challenge between 2006 and 2020, were retrospectively revised. Fifty-two patients with Celiac Disease (CD) and 54 patients with Irritable Bowel Syndrome (IBS) served as controls. Results: 87% of the NCWS patients had an IBS-like clinical presentation. The NCWS group showed a longer duration of symptoms, a higher frequency of positive serum anti-nuclear antibodies than CD and IBS patients, and a higher frequency of DQ2/DQ8 haplotypes and duodenal mucosa lymphocytosis than IBS controls. In addition, 50% of NCWS patients showed neuropsychiatric manifestations, while lower percentages were observed in CD (25%) and IBS (28%) controls. Neuropsychiatric symptoms in NCWS were more frequently associated with the male sex, longer duration of symptoms, and IBS-diarrhea-like clinical presentation. Conclusions: Our data suggest that in patients with IBS-like symptoms and neuropsychiatric manifestations of unknown cause, it could be useful to investigate a correlation of these symptoms with wheat ingestion to identify NCWS patients with this ‘atypical’ manifestation.
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Affiliation(s)
- Antonio Carroccio
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), Unit of Internal Medicine, “V. Cervello Hospital”, University of Palermo, 90124 Palermo, Italy; (M.C.); (S.C.); (A.G.); (F.M.); (D.C.)
- Correspondence: ; Fax: +39-091-655-4815
| | - Maurizio Soresi
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), Unit of Internal Medicine, University of Palermo, 90124 Palermo, Italy; (M.S.); (F.L.B.); (F.F.); (P.M.)
| | - Marta Chiavetta
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), Unit of Internal Medicine, “V. Cervello Hospital”, University of Palermo, 90124 Palermo, Italy; (M.C.); (S.C.); (A.G.); (F.M.); (D.C.)
| | - Francesco La Blasca
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), Unit of Internal Medicine, University of Palermo, 90124 Palermo, Italy; (M.S.); (F.L.B.); (F.F.); (P.M.)
| | - Stella Compagnoni
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), Unit of Internal Medicine, “V. Cervello Hospital”, University of Palermo, 90124 Palermo, Italy; (M.C.); (S.C.); (A.G.); (F.M.); (D.C.)
| | - Alessandra Giuliano
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), Unit of Internal Medicine, “V. Cervello Hospital”, University of Palermo, 90124 Palermo, Italy; (M.C.); (S.C.); (A.G.); (F.M.); (D.C.)
| | - Francesca Fayer
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), Unit of Internal Medicine, University of Palermo, 90124 Palermo, Italy; (M.S.); (F.L.B.); (F.F.); (P.M.)
| | - Francesca Mandreucci
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), Unit of Internal Medicine, “V. Cervello Hospital”, University of Palermo, 90124 Palermo, Italy; (M.C.); (S.C.); (A.G.); (F.M.); (D.C.)
| | - Daniele Castellucci
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), Unit of Internal Medicine, “V. Cervello Hospital”, University of Palermo, 90124 Palermo, Italy; (M.C.); (S.C.); (A.G.); (F.M.); (D.C.)
| | - Aurelio Seidita
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT UPMC (University of Pittsburgh Medical Center), 90127 Palermo, Italy;
| | - Andrea Affronti
- Gastroenterology Unit, “V. Cervello Hospital”, 90124 Palermo, Italy;
| | - Ada Maria Florena
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), Pathology Unit, University of Palermo, 90124 Palermo, Italy;
| | - Pasquale Mansueto
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), Unit of Internal Medicine, University of Palermo, 90124 Palermo, Italy; (M.S.); (F.L.B.); (F.F.); (P.M.)
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10
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Bascuñán KA, Rodríguez JM, Osben C, Fernández A, Sepúlveda C, Araya M. Pandemic Effects and Gluten-Free Diet: An Adherence and Mental Health Problem. Nutrients 2021; 13:nu13061822. [PMID: 34071870 PMCID: PMC8229361 DOI: 10.3390/nu13061822] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 04/28/2021] [Accepted: 05/03/2021] [Indexed: 12/12/2022] Open
Abstract
The COVID-19 pandemic has been present for many months, influencing diets such as the gluten-free diet (GFD), which implies daily challenges even in non-pandemic conditions. Persons following the GFD were invited to answer online ad hoc and validated questionnaires characterizing self-perceptions of the pandemic, current clinical condition, dietary characteristics, adherence to GFD, anxiety, and depression. Of 331 participants, 87% experienced shortage and higher cost of food and 14.8% lost their jobs. Symptoms increased in 29% and 36.6% failed to obtain medical help. Although 52.3% increased food preparation at home and purchased alternative foodstuffs, 53.8% had consumed gluten-containing foods. The Health Eating Index was intermediate/"needs improvement" (mean 65.6 ± 13.3 points); in 49.9% (perception) and 44.4% (questionnaire), adherence was "bad". Anxiety and depression scores were above the cutoff in 28% and 40.4%, respectively. Adherence and mental health were strongly related. The likelihood of poor adherence was 2.3 times higher (p < 0.004) in participants declaring that pandemic altered GFD. Those suffering depressive symptoms were 1.3 times more likely to have poor adherence (p < 0.000). Depression and faulty GFD (mandatory for treatment) appear, affecting a high proportion of participants, suggesting that support measures aimed at these aspects would help improve the health condition of people that maintain GFD. Comparisons of data currently appearing in the literature available should be cautious because not only cultural aspects but conditions and timing of data collection are most variable.
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Affiliation(s)
- Karla A. Bascuñán
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago 7810000, Chile; (K.A.B.); (J.M.R.); (C.O.); (A.F.); (C.S.)
- Department of Nutrition, Faculty of Medicine, University of Chile, Santiago 8380453, Chile
| | - Juan Manuel Rodríguez
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago 7810000, Chile; (K.A.B.); (J.M.R.); (C.O.); (A.F.); (C.S.)
| | - Carla Osben
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago 7810000, Chile; (K.A.B.); (J.M.R.); (C.O.); (A.F.); (C.S.)
| | - Alan Fernández
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago 7810000, Chile; (K.A.B.); (J.M.R.); (C.O.); (A.F.); (C.S.)
- Department of Nutrition, Faculty of Medicine, University of Chile, Santiago 8380453, Chile
| | - Carlos Sepúlveda
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago 7810000, Chile; (K.A.B.); (J.M.R.); (C.O.); (A.F.); (C.S.)
- Laboratorio de Ciencias del Ejercicio, Clínica Meds, Santiago 7500000, Chile
| | - Magdalena Araya
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago 7810000, Chile; (K.A.B.); (J.M.R.); (C.O.); (A.F.); (C.S.)
- Corporación de Apoyo al Celíaco (COACEL), Santiago 7810000, Chile
- Correspondence: ; Tel.: +56-9-95395667
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11
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Tittel SR, Dunstheimer D, Hilgard D, Knauth B, Fröhlich-Reiterer E, Galler A, Wurm M, Holl RW. Coeliac disease is associated with depression in children and young adults with type 1 diabetes: results from a multicentre diabetes registry. Acta Diabetol 2021; 58:623-631. [PMID: 33483854 PMCID: PMC8076130 DOI: 10.1007/s00592-020-01649-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/28/2020] [Indexed: 02/06/2023]
Abstract
AIMS To analyse the association between coeliac disease (CD) and depression in children, adolescents, and young adults with type 1 diabetes (T1D). METHODS We included 79,067 T1D patients aged 6-20 years, with at least six months of diabetes duration, and treatment data between 1995 and 2019 were documented in the diabetes patient follow-up registry. We categorized patients into four groups: T1D only (n = 73,699), T1 + CD (n = 3379), T1D + depression (n = 1877), or T1D + CD + depression (n = 112). RESULTS CD and depression were significantly associated (adjusted OR: 1.25 [1.03-1.53]). Females were more frequent in both the depression and the CD group compared with the T1D only group. Insulin pumps were used more frequently in T1D + CD and T1D + depression compared with T1D only (both p < .001). HbA1c was higher in T1D + depression (9.0% [8.9-9.0]), T1D + CD + depression (8.9% [8.6-9.2]), both compared with T1D only (8.2% [8.2-8.2], all p < .001). We found comorbid autism, attention deficit hyperactivity disorder, anxiety, schizophrenia, and eating disorders more frequently in the T1D + CD + depression group compared with T1D only (all p < .001). CONCLUSIONS CD and depression are associated in young T1D patients. The double load of T1D and CD may lead to an increased risk for depression. Depression was associated with additional psychological and neurological comorbidities. Aside from imperative CD screening after T1D diagnosis and regular intervals, depression screening might be helpful in routine care, especially in patients with diagnosed CD.
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Affiliation(s)
- Sascha René Tittel
- Institute for Epidemiology and Medical Biometry, ZIBMT, Ulm University, Albert-Einstein-Allee 41, 89081 Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Désirée Dunstheimer
- Paediatrics and Adolescent Medicine, Medical Faculty University of Augsburg, Augsburg, Germany
| | | | - Burkhild Knauth
- Department of Pediatrics and Adolescent Medicine, CJD Berchtesgaden, Berchtesgaden, Germany
| | - Elke Fröhlich-Reiterer
- Division of General Pediatrics, Department of Paediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria
| | - Angela Galler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Michael Wurm
- Clinic St. Hedwig, University Children’s Hospital Regensburg (KUNO Clinics), University of Regensburg, Regensburg, Germany
| | - Reinhard Walter Holl
- Institute for Epidemiology and Medical Biometry, ZIBMT, Ulm University, Albert-Einstein-Allee 41, 89081 Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
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12
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Weiman DI, Mahmud FH, Clarke ABM, Assor E, McDonald C, Saibil F, Lochnan HA, Punthakee Z, Marcon MA. Impact of a Gluten-Free Diet on Quality of Life and Health Perception in Patients With Type 1 Diabetes and Asymptomatic Celiac Disease. J Clin Endocrinol Metab 2021; 106:e1984-e1992. [PMID: 33524131 DOI: 10.1210/clinem/dgaa977] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Indexed: 02/13/2023]
Abstract
CONTEXT Celiac disease (CD) is a common comorbidity seen in patients with type 1 diabetes (T1D) and is frequently asymptomatic. As chronic conditions requiring significant lifestyle changes, there are limited reports assessing changes in health-related quality of life (HRQoL) during transition to a gluten-free diet (GFD) in patients with T1D who are asymptomatic for CD. OBJECTIVE This work aims to prospectively assess HRQoL and health perception in children and adults with T1D and asymptomatic CD after random assignment to GFD vs usual diet. METHODS Patients with T1D aged 8 to 45 years without CD symptoms were serologically screened for CD, with positive results confirmed with intestinal biopsy. Participants were randomly assigned in an open-label fashion to a GFD or gluten-containing diet (GCD) for 12 months. Generic and diabetes-specific HRQoL and self-perceived wellness (SPW) were assessed longitudinally. RESULTS A total of 2387 T1D patients were serologically screened. CD was biopsy-confirmed in 82 patients and 51 participants were randomly assigned to a GFD (N = 27) or GCD (N = 24). Excellent adherence to the assigned diets was observed. Overall, no changes in generic (P = .73) or diabetes-specific HRQoL (P = .30), or SPW (P = .41) were observed between groups over 12 months. Hemoglobin A1c (HbA1c) and gastrointestinal symptoms were consistent predictors of HRQoL and SPW. CONCLUSION HRQoL and SPW were not significantly affected by the adoption of a GFD over 12 months, but worsened with symptom onset and increased HbA1c. Our findings indicate that transition to a GFD can be made successfully in this population without adversely affecting quality of life.
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Affiliation(s)
- Daniel I Weiman
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Farid H Mahmud
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Antoine B M Clarke
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Esther Assor
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Charlotte McDonald
- Division of Endocrinology and Metabolism, St. Joseph's Health Care, Western University, London, Ontario, Canada
| | - Fred Saibil
- Division of Gastroenterology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Heather A Lochnan
- Department of Medicine and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Zubin Punthakee
- Division of Endocrinology, McMaster University, Hamilton, Ontario, Canada
| | - Margaret A Marcon
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Abstract
BACKGROUND A gluten-free diet (GFD) is required for the management of some conditions, whereas some Canadians may follow a GFD for discretionary reasons. We sought to estimate the prevalence of Canadians who adhere to a GFD, identify factors associated with adherence to a GFD, and describe and compare the location of food preparation and consumption for those who follow a GFD, those who report no dietary avoidances and those reporting other dietary avoidances. METHODS We used cross-sectional data from the 2015 Canadian Community Health Survey - Nutrition (n = 20 487). Demographic variables included sex, age group, ethnicity, highest level of household education and income adequacy. The relations between respondent characteristics and report of a GFD were estimated using logistic regression. Respondents were further categorized as avoiding dietary gluten, other dietary avoidances and no dietary avoidances. RESULTS An estimated 1.9% of Canadians follow a GFD. Women had 2 times higher odds (odds ratio [OR] 2.08, 95% confidence interval [CI] 1.32 to 3.27) of reporting a GFD than men. After adjustment for income adequacy, household education, sex, age group and ethnicity, residents of Ontario and Quebec had about half the odds (OR 0.52, 95% CI 0.31 to 0.87, and OR 0.55, 95% CI 0.32 to 0.94, respectively) of reporting a GFD compared with residents of Atlantic Canada. Canadians who followed a GFD consumed significantly fewer calories from foods prepared at restaurants than both Canadians who reported no dietary avoidances and those who reported dietary avoidances other than gluten. Canadians following a GFD reported that 2.0% (95% CI 1.1% to 2.9%) of their daily kilocalories were from foods prepared at restaurants, compared with 6.7% (95% CI 5.4% to 7.9%) for Canadians reporting 1 or more dietary avoidances other than gluten, and 6.4% (95% CI 6.0% to 6.9%) for those reporting no avoidances. INTERPRETATION The estimated 1.9% prevalence of dietary gluten avoidance likely includes individuals with celiac disease, wheat allergies and nonceliac gluten sensitivity, as well as individuals excluding gluten in the management of irritable bowel syndrome or for reasons related to dietary trends. Canadians eating GFDs consume fewer daily calories from restaurant-prepared foods than other Canadians, which may have social implications.
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Affiliation(s)
- Adriana Mudryj
- Department of Food and Human Nutritional Sciences (Mudryj, Waugh, Slater, Riediger), Faculty of Agricultural and Food Sciences, University of Manitoba; Department of Internal Medicine (Duerksen, Bernstein), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Department of Community Health Sciences (Slater, Riediger), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Anne Waugh
- Department of Food and Human Nutritional Sciences (Mudryj, Waugh, Slater, Riediger), Faculty of Agricultural and Food Sciences, University of Manitoba; Department of Internal Medicine (Duerksen, Bernstein), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Department of Community Health Sciences (Slater, Riediger), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Joyce Slater
- Department of Food and Human Nutritional Sciences (Mudryj, Waugh, Slater, Riediger), Faculty of Agricultural and Food Sciences, University of Manitoba; Department of Internal Medicine (Duerksen, Bernstein), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Department of Community Health Sciences (Slater, Riediger), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Donald R Duerksen
- Department of Food and Human Nutritional Sciences (Mudryj, Waugh, Slater, Riediger), Faculty of Agricultural and Food Sciences, University of Manitoba; Department of Internal Medicine (Duerksen, Bernstein), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Department of Community Health Sciences (Slater, Riediger), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Charles N Bernstein
- Department of Food and Human Nutritional Sciences (Mudryj, Waugh, Slater, Riediger), Faculty of Agricultural and Food Sciences, University of Manitoba; Department of Internal Medicine (Duerksen, Bernstein), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Department of Community Health Sciences (Slater, Riediger), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Natalie D Riediger
- Department of Food and Human Nutritional Sciences (Mudryj, Waugh, Slater, Riediger), Faculty of Agricultural and Food Sciences, University of Manitoba; Department of Internal Medicine (Duerksen, Bernstein), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Department of Community Health Sciences (Slater, Riediger), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.
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14
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Galli G, Esposito G, Dilaghi E, Annibale B, Lahner E, Conti L. Successful coping with SARS-CoV-2 infection of adult celiac patients assessed by telemedicine. Dig Liver Dis 2021; 53:391-393. [PMID: 33468430 PMCID: PMC7808248 DOI: 10.1016/j.dld.2021.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/02/2021] [Accepted: 01/10/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Gloria Galli
- Department of Surgical-Medical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy.
| | - Gianluca Esposito
- Department of Surgical-Medical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Emanuele Dilaghi
- Department of Surgical-Medical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Bruno Annibale
- Department of Surgical-Medical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Edith Lahner
- Department of Surgical-Medical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Laura Conti
- Department of Surgical-Medical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
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15
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Nikniaz Z, Asghari Jafarabadi M, Ghaffarifar S, Ravand Z, Akbari Namvar Z, Shirmohammadi M. The Persian Translation and validation of the celiac disease quality of life questionnaire (CDQOL). Health Qual Life Outcomes 2021; 19:52. [PMID: 33568144 PMCID: PMC7876810 DOI: 10.1186/s12955-021-01694-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 01/28/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Considering the importance of having a celiac disease-specific measure of the quality of life (QOL) in Persian, the present study aimed to translate the celiac disease quality of life questionnaire (CDQOL) into Persian and evaluate its psychometric properties. METHODS In this cross-sectional study, the Forward-Backward translation method was used. The content validation ratio (CVR) and the content validity index (CVI) were used for content validity assessment. The construct validity was assessed by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) on 220 celiac patients who were selected randomly from the celiac disease (CD) registry database. The correlations between the result of the Persian version of CDQOL (PCDQOL), self-rated QOL, and short form-36 (SF36) were analyzed using the Pearson correlation test. The internal consistency and test-retest reliability were measured through Cronbach's alpha and intraclass correlation coefficient (ICC). RESULTS In the present study, 220 celiac patients with a mean age of 35.54 ± 10.29 years participated. The mean CVI, CVR, and impact score of PCDQOL were 0.98, 0.96, and 4.82 respectively. Using EFA, four factors have extracted that had a good fit in CFA (Chi-square/DF = 1.74, RMSEA: 0.08, and CFI: 0.90, and NFI: 0.90). The results showed that there was a moderate to high correlation between PCDQOL, SF36 (r: 0.587, p = 0.02), and self-rated QOL (r: 0.64, p < 0.001). The questionnaire had high internal consistency (Cronbach alpha: 0.93) and test-retest reliability (ICC: 0.96 [0.86-0.99]). CONCLUSION The PCDQOL questionnaire could be used by physicians and nutritionists to assess HRQOL in celiac patients in Iran.
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Affiliation(s)
- Zeinab Nikniaz
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Asghari Jafarabadi
- Road Traffic Injury Research Center, Department of Epidemiology and Biostatistics, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saeedeh Ghaffarifar
- Medical Education Research Centre, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Ravand
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Akbari Namvar
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masood Shirmohammadi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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16
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Crocco M, Calvi A, Gandullia P, Malerba F, Mariani A, Di Profio S, Tappino B, Bonassi S. Assessing Health-Related Quality of Life in Children with Coeliac Disease: The Italian Version of CDDUX. Nutrients 2021; 13:nu13020485. [PMID: 33540585 PMCID: PMC7912899 DOI: 10.3390/nu13020485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 01/27/2021] [Accepted: 01/29/2021] [Indexed: 12/20/2022] Open
Abstract
We aimed to assess Health-Related Quality of Life (HRQoL) of Italian children and their parents with coeliac disease (CD) using the Coeliac Disease Dutch Questionnaire (CDDUX). The CDDUX underwent a cross-cultural adaptation in a multi-step process, according to international guidelines. A total of 224 children aged between 8–18 years and their parents were prospectively recruited. Cronbach α coefficient was determined as a measure of internal consistency of the questionnaire and inter-children/parent reliability by intraclass correlation coefficient. Univariate and bivariate regression models were used to evaluate correlations between clinical variables and children and parents subclasses of CDDUX and overall mean Paediatric Quality of Life Inventory (PedsQL). The Italian CDDUX proved to be valid and reliable, mean CDDUX total score revealing a neutral evaluation of the quality of life in children 52.6 ± 17.2 and parents 49.5 ± 17.9 (p = 0.07) with strong correlation with PedsQL. The only clinical variable which appeared to affect significantly quality of life both in children and parents was the lower age. A comparison with our results showed remarkable differences in the HRQoL of populations of various nationalities. The Italian version of the CDDUX questionnaire is a simple and reliable tool for assessing the HRQoL in children and adolescents with CD.
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Affiliation(s)
- Marco Crocco
- Department of Pediatrics, IRCCS Giannina Gaslini Institute, 16147 Genova, Italy;
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health, University of Genova, 16132 Genova, Italy
- Correspondence:
| | - Angela Calvi
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Giannina Gaslini Institute, 16147 Genova, Italy; (A.C.); (P.G.)
| | - Paolo Gandullia
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Giannina Gaslini Institute, 16147 Genova, Italy; (A.C.); (P.G.)
| | - Federica Malerba
- Department of Pediatrics, IRCCS Giannina Gaslini Institute, 16147 Genova, Italy;
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health, University of Genova, 16132 Genova, Italy
| | - Anthea Mariani
- Department of Pediatrics, Ospedale Santo Spirito, 65124 Pescara, Italy;
| | - Sonia Di Profio
- Psychology Unit, IRCCS Giannina Gaslini Institute, 16147 Genova, Italy;
| | - Barbara Tappino
- LABSIEM (Laboratory for the Study of Inborn Errors of Metabolism), IRCCS Giannina Gaslini Institute, 16147 Genova, Italy;
| | - Stefano Bonassi
- Department of Human Sciences and Quality of Life Promotion, San Raffaele University, 00166 Rome, Italy;
- Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, 00166 Rome, Italy
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Pedoto D, Troncone R, Massitti M, Greco L, Auricchio R. Adherence to Gluten-Free Diet in Coeliac Paediatric Patients Assessed through a Questionnaire Positively Influences Growth and Quality of Life. Nutrients 2020; 12:E3802. [PMID: 33322343 PMCID: PMC7764452 DOI: 10.3390/nu12123802] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 12/12/2022] Open
Abstract
Assessment of adherence to gluten-free diet (GFD) represents the cornerstone in the management of coeliac disease. The primary aim of this study was to assess diet adherence through a questionnaire adapted to children. The secondary aim was to identify influencing factors and outcomes related to diet adherence. In this study, data about diagnosis, education, quality of life (QoL) and anti-transglutaminase (anti-TG2) titers of 160 coeliac children were collected. For the assessment of diet adherence, all participants completed the questionnaire modified from Leffler et al. (2009), while a random sample of 37 also underwent an extensive dietary interview. According to the questionnaire, diet adherence was excellent in 95 (59.4%), fair in 46 (28.8%) and low in 19 (11.9%) patients. Children diagnosed with biopsy showed better adherence than those with a biopsy-sparing approach (p = 0.036). Adherence to GFD tended to worsen during the follow up, with the average length of follow up being associated with lower scores of diet adherence (p = 0.009). Moreover, adherence to GFD decreased throughout school career, dropping from elementary until high school (p = 0.037). A positive correlation was observed between adherence to GFD and growth percentiles, which increased when higher scores of adherence were achieved. Diet adherence positively correlated with QoL (p = 0.001). In conclusion, the questionnaire displayed good sensitivity in detecting problems in diet adherence, being useful as a screening tool. Better comprehension of influencing factors and outcomes may allow the development of new strategies to improve diet adherence.
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Affiliation(s)
- Deianira Pedoto
- Department of Medical Translational Sciences, University Federico II, 80131 Naples, Italy; (R.T.); (M.M.); (L.G.); (R.A.)
| | - Riccardo Troncone
- Department of Medical Translational Sciences, University Federico II, 80131 Naples, Italy; (R.T.); (M.M.); (L.G.); (R.A.)
- European Laboratory for the Investigation of Food-Induced Diseases, University Federico II, 80131 Naples, Italy
| | - Margherita Massitti
- Department of Medical Translational Sciences, University Federico II, 80131 Naples, Italy; (R.T.); (M.M.); (L.G.); (R.A.)
| | - Luigi Greco
- Department of Medical Translational Sciences, University Federico II, 80131 Naples, Italy; (R.T.); (M.M.); (L.G.); (R.A.)
- European Laboratory for the Investigation of Food-Induced Diseases, University Federico II, 80131 Naples, Italy
| | - Renata Auricchio
- Department of Medical Translational Sciences, University Federico II, 80131 Naples, Italy; (R.T.); (M.M.); (L.G.); (R.A.)
- European Laboratory for the Investigation of Food-Induced Diseases, University Federico II, 80131 Naples, Italy
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18
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Monzani A, Lionetti E, Felici E, Fransos L, Azzolina D, Rabbone I, Catassi C. Adherence to the Gluten-Free Diet during the Lockdown for COVID-19 Pandemic: A Web-Based Survey of Italian Subjects with Celiac Disease. Nutrients 2020; 12:nu12113467. [PMID: 33198212 PMCID: PMC7698218 DOI: 10.3390/nu12113467] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/01/2020] [Accepted: 11/09/2020] [Indexed: 12/20/2022] Open
Abstract
We aimed to assess the perceived impact of the lockdown, imposed to control the spreading of COVID-19, on the adherence of Italian celiac disease (CD) subjects to the gluten-free diet by a web-based survey. A total of 1983 responses were analyzed, 1614 (81.4%) by CD adults and 369 (18.6%) by parents/caregivers of CD children/adolescents. The compliance with the GFD was unchanged for 69% of the adults and 70% of the children, and improved for 29% of both. The factors increasing the probability to report stricter compliance were the presence of CD symptoms in the last year before the lockdown (odds ratio (OR) 1.98, 95% confidence interval (CI) 1.46–2.26), a partial usual adherence to gluten-free diet (GFD) (OR 1.91, 95% CI 1.2–3.06), and having tried recipes with naturally gluten-free ingredients more than usual (OR 1.58, 95% CI 1.28–1.96) for adults; the presence of CD symptoms in the last year (OR 2.05, 95% CI 1.21–3.47), still positive CD antibodies (OR 1.89, 95% CI 1.14–3.13), and other family members with CD (OR 2.24, 95% CI 1.3–3.85) for children/adolescents. Therefore, the lockdown led to a reported improved adherence to the GFD in one-third of the respondents, in particular in those with previous worse disease control, offering the opportunity to avoid sources of contamination/transgression and increase the use of naturally gluten-free products.
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Affiliation(s)
- Alice Monzani
- Division of Pediatrics, Department of Health Sciences, Università del Piemonte Orientale, 28100 Novara, Italy;
- Correspondence: ; Tel.: +39-03213733868; Fax: +39-03213733598
| | - Elena Lionetti
- Department of Pediatrics, Marche Polytechnic University, 60020 Ancona, Italy; (E.L.); (C.C.)
| | - Enrico Felici
- Pediatric and Pediatric Emergency Unit, Children Hospital, 15121 Alessandria, Italy;
| | - Lucia Fransos
- Piedmont Section, Italian Celiac Association, 10136 Turin, Italy;
| | - Danila Azzolina
- Department of Translational Medicine, Unit of Medical Statistics and Cancer Epidemiology, Università del Piemonte Orientale, 28100 Novara, Italy;
| | - Ivana Rabbone
- Division of Pediatrics, Department of Health Sciences, Università del Piemonte Orientale, 28100 Novara, Italy;
| | - Carlo Catassi
- Department of Pediatrics, Marche Polytechnic University, 60020 Ancona, Italy; (E.L.); (C.C.)
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Russo C, Wolf RL, Leichter HJ, Lee AR, Reilly NR, Zybert P, Green PHR, Lebwohl B. Impact of a Child's Celiac Disease Diagnosis and Management on the Family. Dig Dis Sci 2020; 65:2959-2969. [PMID: 32415563 DOI: 10.1007/s10620-020-06316-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 05/02/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Little attention has been paid to family-wide repercussions of a child's celiac disease diagnosis and concomitant gluten-free diet management. AIMS We quantitatively and qualitatively describe positive and negative family-wide effects of a child's celiac disease diagnosis and disease management. METHODS We interviewed 16 families with at least one child currently following a gluten-free diet, with a biopsy-confirmed celiac disease diagnosis ≥ 1 year prior. Mothers and fathers independently rated child's dietary adherence, concern about child's health status, burden in caring for child's dietary needs, and level of change in various aspects of life post- diagnosis. Children rated their own celiac-specific quality of life through a validated scale. Seventy-one in-depth semi-structured interviews were conducted with 16 children with celiac disease, 31 parents, and 24 siblings. RESULTS Mothers and fathers rated the effects of their child's celiac disease differently, with mothers reporting more lifestyle changes and heavier burden. Negative and positive themes emerged from the interviews. Mothers felt the burden of managing a gluten-free diet. Fathers felt guilty for carrying a celiac disease-associated gene and both fathers and siblings regretted limited food choices at restaurants and home. The need to be a more creative cook was seen as a positive effect by mothers. Fathers appreciated new family traditions. Siblings felt they had developed empathy for others. A framework is proposed to illustrate these family-wide interactions. CONCLUSIONS A child's celiac disease diagnosis and disease management affects the entire family. Our results will inform family-centered interventions that maximize quality of life for families.
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Affiliation(s)
- Carrie Russo
- Program in Nutrition, Department of Health and Behavioral Studies, Teachers College, Columbia University, 525 West 120th Street, Box 137, New York, NY, 10027, USA.
| | - Randi L Wolf
- Program in Nutrition, Department of Health and Behavioral Studies, Teachers College, Columbia University, 525 West 120th Street, Box 137, New York, NY, 10027, USA
| | - Hope J Leichter
- Department of International and Transcultural Studies, Teachers College, Columbia University, New York, NY, 10027, USA
| | - Anne R Lee
- Celiac Disease Center, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Norelle R Reilly
- Celiac Disease Center, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Patricia Zybert
- Program in Nutrition, Department of Health and Behavioral Studies, Teachers College, Columbia University, 525 West 120th Street, Box 137, New York, NY, 10027, USA
| | - Peter H R Green
- Celiac Disease Center, Columbia University Irving Medical Center, New York, NY, 10032, USA
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Marsilio I, Canova C, D’Odorico A, Ghisa M, Zingone L, Lorenzon G, Savarino EV, Zingone F. Quality-of-Life Evaluation in Coeliac Patients on a Gluten-Free Diet. Nutrients 2020; 12:nu12102981. [PMID: 33003417 PMCID: PMC7601879 DOI: 10.3390/nu12102981] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/21/2020] [Accepted: 09/24/2020] [Indexed: 12/19/2022] Open
Abstract
The treatment for coeliac disease (CD) has a considerable psychological impact on patients, which may vary depending on subjects and clinical characteristics. The aim of this study was to describe the quality of life (QoL) in CD patients during follow-up, evaluating which factors can influence it. Patients with CD who consecutively visited the outpatient clinic of CD Unit of the University Hospital of Padua from January to September 2019 were enrolled. Demographics and clinical information were collected, and all patients were asked to answer the CD-QoL and Biagi’s validated questionnaires. Student’s t-test and chi-square test were used to compare the continuous and categorical variables, respectively. One hundred patients were enrolled (86 females, mean age at test ± SD: 39.73 ± 13.51; mean age at diagnosis ± SD: 33.09 ± 12.92), with 61% of them having been diagnosed with CD within the previous 5 years. At the time of diagnosis, 43 CD patients reported classical CD presentation, 32 non-classical features, 16 only anaemia and 9 were asymptomatic. The mean CD-QoL value was overall high (80.54 ± 11.91). We found that the “health concerns” subscale score was significantly lower in subjects aged more than 35 years compared to younger subjects (p = 0.03). We also observed that the CD-QoL score in gluten-free diet (GFD)-adherent patients tended to be higher compared to subjects who were non-compliant, with a significantly higher percentage of patients with low score for the “dysphoria” subscale (p = 0.05). This study showed an overall good QoL in subjects on a GFD. However, subjects older and non-compliant to GFD appear to experience more health concerns and suffer from dysphoria, respectively.
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Affiliation(s)
- Ilaria Marsilio
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Section, University Hospital of Padua, 35128 Padua, Italy; (I.M.); (A.D.); (M.G.); (G.L.); (E.V.S.)
| | - Cristina Canova
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University Hospital of Padua, 35128 Padua, Italy;
| | - Anna D’Odorico
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Section, University Hospital of Padua, 35128 Padua, Italy; (I.M.); (A.D.); (M.G.); (G.L.); (E.V.S.)
| | - Matteo Ghisa
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Section, University Hospital of Padua, 35128 Padua, Italy; (I.M.); (A.D.); (M.G.); (G.L.); (E.V.S.)
| | | | - Greta Lorenzon
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Section, University Hospital of Padua, 35128 Padua, Italy; (I.M.); (A.D.); (M.G.); (G.L.); (E.V.S.)
| | - Edoardo Vincenzo Savarino
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Section, University Hospital of Padua, 35128 Padua, Italy; (I.M.); (A.D.); (M.G.); (G.L.); (E.V.S.)
| | - Fabiana Zingone
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Section, University Hospital of Padua, 35128 Padua, Italy; (I.M.); (A.D.); (M.G.); (G.L.); (E.V.S.)
- Correspondence:
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Abreu Paiva LM, Gandolfi L, Pratesi R, Harumi Uenishi R, Puppin Zandonadi R, Nakano EY, Pratesi CB. Measuring Quality of Life in Parents or Caregivers of Children and Adolescents with Celiac Disease: Development and Content Validation of the Questionnaire. Nutrients 2019; 11:nu11102302. [PMID: 31569610 PMCID: PMC6835388 DOI: 10.3390/nu11102302] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/10/2019] [Accepted: 09/17/2019] [Indexed: 12/13/2022] Open
Abstract
Celiac disease (CD) is an autoimmune disorder triggered by the ingestion of gluten and affects approximately 1% of the global population. Currently, the only treatment available is lifelong strict adherence to a gluten-free diet (GFD). Chronic diseases such as CD affect patients and their family members’ quality of life (QoL); particularly parents and caregivers who play an essential role in the child’s care and treatment. A higher level of psychological distress has been found in the parents of children with chronic ailments due to limited control over the child’s daily activities and the child’s illness. In this context, the validation of a specific questionnaire of QoL is a valuable tool to evaluate the difficulties faced by parents or caregivers of children with this chronic illness. A specific questionnaire for this population can elucidate the reasons for stress in their daily lives as well as the physical, mental, emotional, and social impact caused by CD. Therefore, this study aimed to develop and validate a specific questionnaire to evaluate the QoL of parents and caregivers of children and adolescents with CD. Overall results showed that a higher family income resulted in a higher score of the worries domain. In addition, having another illness besides CD decreased the QoL (except in the worries domain). The other variables studied did not present a statistically significant impact on the QoL, which was shown to be low in all aspects. Knowledge of the QoL is important to help implement effective strategies to improve celiac patients’ quality of life and reduce their physical, emotional, and social burden.
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Affiliation(s)
- Liliane Maria Abreu Paiva
- Interdisciplinary Laboratory of Biosciences and Celiac Disease Research Center, School of Medicine, University of Brasilia, Brasilia 70910-900, DF, Brazil.
| | - Lenora Gandolfi
- Interdisciplinary Laboratory of Biosciences and Celiac Disease Research Center, School of Medicine, University of Brasilia, Brasilia 70910-900, DF, Brazil.
| | - Riccardo Pratesi
- Interdisciplinary Laboratory of Biosciences and Celiac Disease Research Center, School of Medicine, University of Brasilia, Brasilia 70910-900, DF, Brazil.
| | - Rosa Harumi Uenishi
- Interdisciplinary Laboratory of Biosciences and Celiac Disease Research Center, School of Medicine, University of Brasilia, Brasilia 70910-900, DF, Brazil.
| | - Renata Puppin Zandonadi
- Department of Nutrition, School of Health Sciences, University of Brasilia, Brasilia 70910-900, DF, Brazil.
| | | | - Claudia B Pratesi
- Interdisciplinary Laboratory of Biosciences and Celiac Disease Research Center, School of Medicine, University of Brasilia, Brasilia 70910-900, DF, Brazil.
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Appak YÇ, Ertan D, Karakoyun M, Özyurt G, Özdemir T, Baran M. The cause of abdominal mass in a child with celiac disease: Rapunzel syndrome. A case report. SAO PAULO MED J 2019; 137:292-294. [PMID: 29590232 PMCID: PMC9743995 DOI: 10.1590/1516-3180.2017.0281141017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 10/14/2017] [Indexed: 12/15/2022] Open
Abstract
CONTEXT Rapunzel syndrome is a rare form of gastric trichobezoar that develops through outstretching of the bezoar from the stomach to the intestine. CASE REPORT A 12-year-old girl who had been diagnosed with celiac disease six years earlier was brought to the department of pediatric gastroenterology because of abdominal distension. A palpable mass was detected. A trichobezoar that stretched to the small intestine was removed surgically. The patient was diagnosed as having anxiety and depressive disorder, and treatment started. Following the treatment, her previous trichophagia completely disappeared. CONCLUSION Presence of trichobezoar should be kept in mind, especially when young girls who have psychiatric problems suffer from gastrointestinal symptoms.
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Affiliation(s)
- Yeliz Çağan Appak
- MD. Attending Physician, Department of Pediatric Gastroenterology, Tepecik Training and Research Hospital, Izmir, Turkey.
| | - Duygu Ertan
- MD. Pediatric Assistant, Department of Pediatrics, Tepecik Training and Research Hospital, İzmir, Turkey.
| | - Miray Karakoyun
- MD. Attending Physician, Department of Pediatric Gastroenterology, Tepecik Training and Research Hospital, Izmir, Turkey.
| | - Gonca Özyurt
- MD. Assistant Professor, Department of Child and Adolescent Psychiatry, Tepecik Training and Research Hospital, Izmir Katip Celebi University School of Medicine, İzmir, Turkey.
| | - Tunç Özdemir
- MD. Associate Professor, Department of Pediatric Surgery, Tepecik Training and Research Hospital, İzmir, Turkey.
| | - Maşallah Baran
- MD. Associate Professor, Department of Pediatric Gastroenterology, Tepecik Training and Research Hospital, Izmir Katip Celebi University School of Medicine, İzmir, Turkey.
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Morreale F, Agnoli C, Roncoroni L, Sieri S, Lombardo V, Mazzeo T, Elli L, Bardella MT, Agostoni C, Doneda L, Scricciolo A, Brighenti F, Pellegrini N. Are the dietary habits of treated individuals with celiac disease adherent to a Mediterranean diet? Nutr Metab Cardiovasc Dis 2018; 28:1148-1154. [PMID: 30143412 DOI: 10.1016/j.numecd.2018.06.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 06/26/2018] [Accepted: 06/26/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS The only treatment for celiac disease (CD) is strict, lifelong adherence to a gluten-free (GF) diet. To date, there are contrasting data concerning the nutritional adequacy of GF products and diet. There have been no studies that have assessed the adherence of individuals with CD to a Mediterranean diet (MD), a protective dietary regimen against major non-communicable diseases (NCDs). Therefore, we examined the adherence to an MD of a group of Italian individuals with CD and compared it with that of a healthy control group. METHODS AND RESULTS In a cross-sectional study, a sample of individuals with CD and a group of healthy subjects were included. The dietary habits of all participants were recorded using a validated food frequency questionnaire, and the adherence to an MD was determined using the Italian Mediterranean Index. Typical Mediterranean food consumption was not significantly different between individuals with CD and the healthy participants, except for fruits (P = 0.017). However, individuals with CD consumed significantly higher amounts of potatoes (P = 0.003) and red and processed meat (P = 0.005) than healthy participants. The resulting mean Italian Mediterranean Index was significantly higher in healthy participants than in individuals with CD (P < 0.001). CONCLUSION The results raise questions concerning the food choices of individuals with CD, suggesting the need of encouraging them to make better food choices more in line with an MD, which would improve their nutritional status and better protect them from NCDs at long term. PROTOCOL REGISTRATION ClinicalTrials.gov (ID NCT01975155) on November 4 2013.
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Affiliation(s)
- F Morreale
- Human Nutrition Unit, Department of Food and Drug, University of Parma, Parma, Italy
| | - C Agnoli
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - L Roncoroni
- Center for Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - S Sieri
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - V Lombardo
- Center for Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - T Mazzeo
- Human Nutrition Unit, Department of Food and Drug, University of Parma, Parma, Italy
| | - L Elli
- Center for Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M T Bardella
- Center for Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - C Agostoni
- Pediatric Intermediate Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Ospedale Cà Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - L Doneda
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - A Scricciolo
- Center for Prevention and Diagnosis of Celiac Disease, Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - F Brighenti
- Human Nutrition Unit, Department of Food and Drug, University of Parma, Parma, Italy
| | - N Pellegrini
- Human Nutrition Unit, Department of Food and Drug, University of Parma, Parma, Italy.
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24
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Roncoroni L, Bascuñán KA, Doneda L, Scricciolo A, Lombardo V, Branchi F, Ferretti F, Dell'Osso B, Montanari V, Bardella MT, Elli L. A Low FODMAP Gluten-Free Diet Improves Functional Gastrointestinal Disorders and Overall Mental Health of Celiac Disease Patients: A Randomized Controlled Trial. Nutrients 2018; 10:E1023. [PMID: 30081576 PMCID: PMC6115770 DOI: 10.3390/nu10081023] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 07/22/2018] [Accepted: 08/01/2018] [Indexed: 12/12/2022] Open
Abstract
A subset of patients with celiac disease (CD) on a gluten-free diet (GFD) reported the persistence of functional gastrointestinal disorders. Foods containing fermentable, oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) can trigger a broad range of gastrointestinal symptoms in sensitive individuals. We evaluated the effects of a low FODMAP diet (LFD) on gastrointestinal and psychological symptomatology in CD patients. A total of 50 celiac patients on GFDs and with persistence of gastrointestinal symptoms were included. The patients were randomly allocated to one of two dietary groups-one on a low FODMAP GFD (LF-GFD, n = 25) and the other on a regular GFD (R-GFD, n = 25)-for 21 days. Psychological symptomatology and quality of life were evaluated by the Symptom Checklist-90-R (SCL-90) and the Short Form (36) Health Survey (SF-36) questionnaires, respectively. Gastrointestinal symptomatology and general well-being were evaluated by visual analogue scale (VAS) scores. After 21 days, 21 and 23 patients completed the dietary treatment on LF-GFD and R-GFD, respectively. A reduced global SCL-90 index (p < 0.0003) was found in the LF-GFD group but not in the R-GFD one. However, the SF-36 scores did not differ between groups after treatment. The VAS for abdominal pain was much lower, and the VAS for fecal consistency enhanced after treatment in the LF-GFD group. General well-being increased in both groups but with a much higher improvement in the LF-GFD (p = 0.03). A short-term LFD regimen helps to improve the psychological health and gastrointestinal symptomatology with enhanced well-being of CD patients with persisting functional gastrointestinal symptomatology. The long-term clinical effects of LFD in particular subgroups of CD patients need further evaluation.
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Affiliation(s)
- Leda Roncoroni
- Centre for the Prevention and Diagnosis of Celiac Disease/Division of Gastroenterology and Endoscopy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
- Department of Biomedical, Surgical and Dental Sciences, University of Milano, 20100 Milan, Italy.
| | - Karla A Bascuñán
- Centre for the Prevention and Diagnosis of Celiac Disease/Division of Gastroenterology and Endoscopy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
- Department of Nutrition, University of Chile, 8380453 Santiago, Chile.
| | - Luisa Doneda
- Department of Biomedical, Surgical and Dental Sciences, University of Milano, 20100 Milan, Italy.
| | - Alice Scricciolo
- Centre for the Prevention and Diagnosis of Celiac Disease/Division of Gastroenterology and Endoscopy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
| | - Vincenza Lombardo
- Centre for the Prevention and Diagnosis of Celiac Disease/Division of Gastroenterology and Endoscopy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
| | - Federica Branchi
- Centre for the Prevention and Diagnosis of Celiac Disease/Division of Gastroenterology and Endoscopy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
| | - Francesca Ferretti
- Centre for the Prevention and Diagnosis of Celiac Disease/Division of Gastroenterology and Endoscopy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
| | - Bernardo Dell'Osso
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20100 Milan, Italy.
- Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford University, Stanford, CA 94305-5723, USA.
- CRC "Aldo Ravelli" for Neuro-technology & Experimental Brain Therapeutics, University of Milan, 20100 Milan, Italy.
| | - Valeria Montanari
- Centre for the Prevention and Diagnosis of Celiac Disease/Division of Gastroenterology and Endoscopy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
| | - Maria Teresa Bardella
- Centre for the Prevention and Diagnosis of Celiac Disease/Division of Gastroenterology and Endoscopy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
| | - Luca Elli
- Centre for the Prevention and Diagnosis of Celiac Disease/Division of Gastroenterology and Endoscopy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
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Slim M, Rico-Villademoros F, Calandre EP. Psychiatric Comorbidity in Children and Adults with Gluten-Related Disorders: A Narrative Review. Nutrients 2018; 10:E875. [PMID: 29986423 PMCID: PMC6073457 DOI: 10.3390/nu10070875] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 06/26/2018] [Accepted: 07/04/2018] [Indexed: 12/22/2022] Open
Abstract
Gluten-related disorders are characterized by both intestinal and extraintestinal manifestations. Previous studies have suggested an association between gluten-related disorder and psychiatric comorbidities. The objective of our current review is to provide a comprehensive review of this association in children and adults. A systematic literature search using MEDLINE, Embase and PsycINFO from inception to 2018 using terms of ‘celiac disease’ or ‘gluten-sensitivity-related disorders’ combined with terms of ‘mental disorders’ was conducted. A total of 47 articles were included in our review, of which 28 studies were conducted in adults, 11 studies in children and eight studies included both children and adults. The majority of studies were conducted in celiac disease, two studies in non-celiac gluten sensitivity and none in wheat allergy. Enough evidence is currently available supporting the association of celiac disease with depression and, to a lesser extent, with eating disorders. Further investigation is warranted to evaluate the association suggested with other psychiatric disorders. In conclusion, routine surveillance of potential psychiatric manifestations in children and adults with gluten-related disorders should be carried out by the attending physician.
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Affiliation(s)
- Mahmoud Slim
- Division of Neurology, The Hospital for Sick Children, The Peter Gilgan Centre for Research and Learning, 686 Bay St., Toronto, ON M5G 0A4, Canada.
| | - Fernando Rico-Villademoros
- Instituto de Neurociencias, Universidad de Granada, Avenida del Conocimiento s/n, 18100 Armilla, Granada, Spain.
| | - Elena P Calandre
- Instituto de Neurociencias, Universidad de Granada, Avenida del Conocimiento s/n, 18100 Armilla, Granada, Spain.
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Jinga M, Popp A, Balaban DV, Dima A, Jurcut C. Physicians' attitude and perception regarding celiac disease: A questionnaire-based study. Turk J Gastroenterol 2018; 29:419-426. [PMID: 30249556 PMCID: PMC6284647 DOI: 10.5152/tjg.2018.17236] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND/AIMS Despite its high prevalence, affecting about 1% of the general population, celiac disease (CD) remains heavily underdiagnosed. Among the reasons for underdiagnosis, awareness among medical professionals has been little studied. The aim of this survey was to determine physicians' knowledge in regard to CD in adult patients. MATERIALS AND METHODS An 18-items questionnaire pointing out general features, clinical presentation, diagnosis and management of CD patients was addressed to physicians from different medical specialties, in training or board-certified, from one universitary center. RESULTS Altogether 153 physicians were invited to complete the survey (69.3% female, 35.9% gastroenterologists). Overall, 69.9% of the physicians questioned considered CD as a rare disorder. Lymphoma increased risk was highlighted in significant higher proportion by gastroenterologists when compared with physicians of other medical specialty. Chronic diarrhea, weight loss, iron-deficiency anemia, and abdominal pain were the first four conditions recognized as associated with CD, by 94.1%, 76.5%, 61.4%, and 54.2% study participants, respectively. About one-third of respondents (34.5%) affirmed to perform total serum IgA testing in all patients tested for CD. Intestinal biopsy confirmation of a positive celiac serology was reported by 65.4% physicians, with a higher proportion among gastroenterologists: 81.5% versus 56.6%. In regard to CD management, both groups concluded that referral to specialized centers should be recommended. CONCLUSION This study highlights poor awareness among the physicians' in regard to important CD features and diagnostic recommendations in adult patients. More efforts are warranted to improve awareness on CD features among physicians of different medical specialties.
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Affiliation(s)
- Mariana Jinga
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Dr Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
| | - Alina Popp
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Alessandrescu-Rusescu Institute for Mother and Child Health, Bucharest, Romania
| | | | - Alina Dima
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ciprian Jurcut
- Dr Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
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Levran N, Wilschanski M, Livovsky J, Shachar E, Moskovitz M, Assaf-Jabrin L, Shteyer E. Obesogenic habits among children and their families in response to initiation of gluten-free diet. Eur J Pediatr 2018; 177:859-866. [PMID: 29594339 DOI: 10.1007/s00431-018-3128-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 03/01/2018] [Accepted: 03/02/2018] [Indexed: 12/25/2022]
Abstract
UNLABELLED Initiation of a lifelong, gluten-free diet (GFD) in children with celiac disease (CD) influences the child's life in many ways. The aim of this study was to assess the influence of GFD on the child and his/her family's eating habits and lifestyle behaviors. To study this, we asked children and their parents completed the Family Eating and Activity Habits Questionnaire (FEAHQ) at the time of diagnosis of CD and at least 6 months after initiation of GFD and a questionnaires assessing symptoms related to CD and adherence to the GFD diet. We analyzed questionnaires from 40 children with CD and their families. There were 21 females, ranging in age from 4 to 15.7 years (median age 7.4 years±2.8 years). The control group comprised 15 healthy children. After initiation of GFD the family ate more junk food including snacks and candies (p = 0.05), with the significant change reported by children and fathers (p = 0.001 and 0.03 respectively). All family members in the control group had significantly less snacks. Parents and children reported a significant increase in obesogenic eating styles, such as eating from the cooking pot and eating while doing other activities (mothers, p = 0.001; fathers, 0.02; and children, 0.02 respectively). CONCLUSIONS Our study shows that initiation of GFD in children with CD leads to changes in eating habits and staple food eating that may lead to a more obesogenic environment. Care givers, pediatricians, gastroenterologists, and dieticians alike should be aware of these implications and educate families towards a healthier lifestyle and diet beyond the GFD itself. What's Known: • Gluten-free diet has been shown to affect various psychosocial aspects of children with celiac disease. • Obesity and celiac are associated. What is New: • Initiation of gluten-free diet led to increased eating of junk food both in the patient and his/her family. • After initiation of GFD pro-obesogenic eating habits is increased.
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Affiliation(s)
- Neriya Levran
- Pediatric Gastroenterology Unit, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Michael Wilschanski
- Pediatric Gastroenterology Unit, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Jessica Livovsky
- Pediatric Gastroenterology Unit, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Edna Shachar
- Pediatric Gastroenterology Unit, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Moti Moskovitz
- Department of Pediatric Dentistry, Hebrew University, Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Lama Assaf-Jabrin
- Department of Pediatric Dentistry, Hebrew University, Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Eyal Shteyer
- Pediatric Gastroenterology Unit, Hebrew University-Hadassah Medical Center, Jerusalem, Israel.
- The Juliet Keidan Institute of Pediatric Gastroenterology, Pediatric Gastroenterology Institute, Shaare Zedek Medical Center, Jerusalem, Israel.
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Joelson AM, Geller MG, Zylberberg HM, Green PHR, Lebwohl B. The Effect of Depressive Symptoms on the Association between Gluten-Free Diet Adherence and Symptoms in Celiac Disease: Analysis of a Patient Powered Research Network. Nutrients 2018; 10:nu10050538. [PMID: 29701659 PMCID: PMC5986418 DOI: 10.3390/nu10050538] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/16/2018] [Accepted: 04/23/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The prevalence of depression in celiac disease (CD) is high, and patients are often burdened socially and financially by a gluten-free diet. However, the relationship between depression, somatic symptoms and dietary adherence in CD is complex and poorly understood. We used a patient powered research network (iCureCeliac®) to explore the effect that depression has on patients' symptomatic response to a gluten-free diet (GFD). METHODS We identified patients with biopsy-diagnosed celiac disease who answered questions pertaining to symptoms (Celiac Symptom Index (CSI)), GFD adherence (Celiac Dietary Adherence Test (CDAT)), and a 5-point, scaled question regarding depressive symptoms relating to patients' celiac disease. We then measured the correlation between symptoms and adherence (CSI vs. CDAT) in patients with depression versus those without depression. We also tested for interaction of depression with regard to the association with symptoms using a multiple linear regression model. RESULTS Among 519 patients, 86% were female and the mean age was 40.9 years. 46% of patients indicated that they felt "somewhat," "quite a bit," or "very much" depressed because of their disorder. There was a moderate correlation between worsened celiac symptoms and poorer GFD adherence (r = 0.6, p < 0.0001). In those with a positive depression screen, there was a moderate correlation between worsening symptoms and worsening dietary adherence (r = 0.5, p < 0.0001) whereas in those without depression, the correlation was stronger (r = 0.64, p < 0.0001). We performed a linear regression analysis, which suggests that the relationship between CSI and CDAT is modified by depression. CONCLUSIONS In patients with depressive symptoms related to their disorder, correlation between adherence and symptoms was weaker than those without depressive symptoms. This finding was confirmed with a linear regression analysis, showing that depressive symptoms may modify the effect of a GFD on celiac symptoms. Depressive symptoms may therefore mask the relationship between inadvertent gluten exposure and symptoms. Additional longitudinal and prospective studies are needed to further explore this potentially important finding.
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Affiliation(s)
- Andrew M Joelson
- Department of Internal Medicine, New York Presbyterian Hospital, New York, NY 10032, USA.
| | | | - Haley M Zylberberg
- Celiac Disease Center, Department of Medicine, Columbia University Medical Center, 180 Fort Washington Avenue, Suite 936, New York, NY 10032, USA.
| | - Peter H R Green
- Celiac Disease Center, Department of Medicine, Columbia University Medical Center, 180 Fort Washington Avenue, Suite 936, New York, NY 10032, USA.
| | - Benjamin Lebwohl
- Celiac Disease Center, Department of Medicine, Columbia University Medical Center, 180 Fort Washington Avenue, Suite 936, New York, NY 10032, USA.
- Deartment of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY 10032, USA.
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Vaquero L, Comino I, Vivas S, Rodríguez-Martín L, Giménez MJ, Pastor J, Sousa C, Barro F. Tritordeum: a novel cereal for food processing with good acceptability and significant reduction in gluten immunogenic peptides in comparison with wheat. J Sci Food Agric 2018; 98:2201-2209. [PMID: 28963718 DOI: 10.1002/jsfa.8705] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 09/15/2017] [Accepted: 09/22/2017] [Indexed: 05/24/2023]
Abstract
BACKGROUND Tritordeum is a novel cereal obtained from the hybridization between durum wheat and a wild barley. This study evaluates acceptance, digestibility and immunotoxic properties of tritordeum, a novel cereal for food processing. Nineteen healthy volunteers participated in a study with different diets to compare tritordeum bread with wheat and gluten-free breads. RESULTS Tritordeum breads had a similar acceptance to the wheat bread usually consumed, and the acceptance was significantly higher than the gluten-free bread and standardized wheat bread supplied in the study. There was no evidence for gastrointestinal symptoms among volunteers during the study. The reductions in the numbers of immunogenic epitopes in tritordeum in comparison with wheat were 78% for α-gliadins, 57% for γ-gliadins and 93% for ω-gliadins. The analysis of gluten immunogenic peptides (GIP) in stool samples showed a significantly lower excretion in the tritordeum ingestion phase than in the wheat ingestion phase. CONCLUSIONS These results suggest that tritordeum may be an option of interest for general food processing, and especially for those who want to reduce their intake of gluten. However, it is not suitable for celiac disease sufferers as it contains gluten. © 2017 Society of Chemical Industry.
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Affiliation(s)
- Luis Vaquero
- Departamento de Gastroenterología, Hospital de León, Instituto de Biomedicina, Universidad de León, León, Spain
| | - Isabel Comino
- Departamento de Microbiología y Parasitología, Facultad de Farmacia, Universidad de Sevilla, Sevilla, Spain
| | - Santiago Vivas
- Departamento de Gastroenterología, Hospital de León, Instituto de Biomedicina, Universidad de León, León, Spain
| | - Laura Rodríguez-Martín
- Departamento de Gastroenterología, Hospital de León, Instituto de Biomedicina, Universidad de León, León, Spain
| | - María J Giménez
- Departamento de Mejora Genética Vegetal, Instituto de Agricultura Sostenible (IAS-CSIC), Córdoba, Spain
| | - Jorge Pastor
- Novapan SL, Calle del Chopo 68-70, 50171, La Puebla de Alfinden, Zaragoza, Spain
| | - Carolina Sousa
- Departamento de Microbiología y Parasitología, Facultad de Farmacia, Universidad de Sevilla, Sevilla, Spain
| | - Francisco Barro
- Departamento de Mejora Genética Vegetal, Instituto de Agricultura Sostenible (IAS-CSIC), Córdoba, Spain
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Leffler DA, Acaster S, Gallop K, Dennis M, Kelly CP, Adelman DC. A Novel Patient-Derived Conceptual Model of the Impact of Celiac Disease in Adults: Implications for Patient-Reported Outcome and Health-Related Quality-of-Life Instrument Development. Value Health 2017; 20:637-643. [PMID: 28408006 DOI: 10.1016/j.jval.2016.12.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 12/02/2016] [Accepted: 12/21/2016] [Indexed: 06/07/2023]
Abstract
BACKGROUND Celiac disease is a chronic inflammatory condition with wide ranging effects on individual's lives caused by a combination of symptoms and the burden of adhering to a gluten-free diet (GFD). OBJECTIVES To further understand patients' experience of celiac disease, the impact it has on health-related quality of life (HRQOL), and to develop a conceptual model describing this impact. METHODS Adults with celiac disease on a GFD reporting symptoms within the previous 3 months were included; patients with refractory celiac disease and confounding medical conditions were excluded. A semistructured discussion guide was developed exploring celiac disease symptoms and impact on patients' HRQOL. An experienced interviewer conducted in-depth interviews. The data set was coded and analyzed using thematic analysis to identify concepts, themes, and the inter-relationships between them. Data saturation was monitored and concepts identified formed the basis of the conceptual model. RESULTS Twenty-one participants were recruited, and 32 distinct gluten-related symptoms were reported and data saturation was reached. Analysis identified several themes impacting patients' HRQOL: fears and anxiety, day-to-day management of celiac disease, physical functioning, sleep, daily activities, social activities, emotional functioning, and relationships. The conceptual model highlights the main areas of impact and the relationships between concepts. CONCLUSIONS Both symptoms and maintaining a GFD have a substantial impact on patient functioning and HRQOL in adults with celiac disease. The conceptual model derived from these data may help to design future patient-reported outcomes as well as interventions to improve the quality of life in an individual with celiac disease.
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Affiliation(s)
- Daniel A Leffler
- Celiac Center, Beth Israel Deaconess Medical Center, Boston, MA, USA; Celiac Research Program, Harvard Medical School, Boston, MA, USA.
| | | | | | - Melinda Dennis
- Celiac Center, Beth Israel Deaconess Medical Center, Boston, MA, USA; Celiac Research Program, Harvard Medical School, Boston, MA, USA
| | - Ciarán P Kelly
- Celiac Center, Beth Israel Deaconess Medical Center, Boston, MA, USA; Celiac Research Program, Harvard Medical School, Boston, MA, USA
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Smith LB, Lynch KF, Kurppa K, Koletzko S, Krischer J, Liu E, Johnson SB, Agardh D. Psychological Manifestations of Celiac Disease Autoimmunity in Young Children. Pediatrics 2017; 139:e20162848. [PMID: 28219962 PMCID: PMC5330402 DOI: 10.1542/peds.2016-2848] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Psychological symptoms can be associated with celiac disease; however, this association has not been studied prospectively in a pediatric cohort. We examined mother report of psychological functioning in children persistently positive for tissue transglutaminase autoantibodies (tTGA), defined as celiac disease autoimmunity (CDA), compared with children without CDA in a screening population of genetically at-risk children. We also investigated differences in psychological symptoms based on mothers' awareness of their child's CDA status. METHODS The Environmental Determinants of Diabetes in the Young study followed 8676 children to identify triggers of type 1 diabetes and celiac disease. Children were tested for tTGA beginning at 2 years of age. The Achenbach Child Behavior Checklist assessed child psychological functioning at 3.5 and 4.5 years of age. RESULTS At 3.5 years, 66 mothers unaware their child had CDA reported more child anxiety and depression, aggressive behavior, and sleep problems than 3651 mothers of children without CDA (all Ps ≤ .03). Unaware-CDA mothers also reported more child anxiety and depression, withdrawn behavior, aggressive behavior, and sleep problems than 440 mothers aware of their child's CDA status (all Ps ≤.04). At 4.5 years, there were no differences. CONCLUSIONS In 3.5-year-old children, CDA is associated with increased reports of child depression and anxiety, aggressive behavior, and sleep problems when mothers are unaware of their child's CDA status. Mothers' knowledge of their child's CDA status is associated with fewer reports of psychological symptoms, suggesting that awareness of the child's tTGA test results affects reporting of symptoms.
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Affiliation(s)
- Laura B Smith
- Diabetes Center & Health Informatics Institute, Department of Pediatrics, and
| | - Kristian F Lynch
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Kalle Kurppa
- Centre for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Sibylle Koletzko
- Dr von Hauner Children's Hospital, Ludwig Maximilian University, Munich, Germany
| | - Jeffrey Krischer
- Diabetes Center & Health Informatics Institute, Department of Pediatrics, and
| | - Edwin Liu
- Digestive Health Institute, University of Colorado, Children's Hospital Colorado, Denver, Colorado
| | - Suzanne Bennett Johnson
- Department of Medical Humanities and Social Sciences, Florida State University College of Medicine, Tallahassee, Florida; and
| | - Daniel Agardh
- Unit of Diabetes and Celiac Disease, Malmö University, Malmö, Sweden
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Ll'ina LV, Petrash VV, Tkachenko EI, Oreshko LS, Litaeva MP, Soloveva EA. THE PSYCHO-PHYSIOLOGICAL STATUS IN CELIAC DISEASE. Eksp Klin Gastroenterol 2016; 12:50-52. [PMID: 29889422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Based on the results of a comprehensive study of 35 people aged from 19 to 52 years, among them 20 women and 15 men with celiac disease features of their physiological status were studied, reflecting the severity of the disease and quality of life. The diagnosis was based on the clinical and anamnestic data, endoscopy, histomorphological, immunological and genetic exams. Psychophysiological analysis showed that in celiac disease is characterized by the formation reactions with anxiety, anxiety-phobic, neurotic, affective, and hypochondriacal symptoms. The results of the study emphasized the importance of adaptive physiological capacity of the body to build tolerance to the development of psycho-vegetative, hypochondriacaldepressive and other disorders.
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Johanson L. The Gluten-Free Frenzy: Fad or Fitting? Medsurg Nurs 2015; 24:213-217. [PMID: 26434032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Although the gluten-free diet has been recognized as therapeutic for individuals suffering from celiac disease, it has been promoted recently for other indications, such as autism, chronic fatigue syn- drome, and irritable bowel syndrome, or simply as a healthy dietary choice for anyone. The basics of the gluten-free diet are explored, with evidence-based indications and nursing implications when patients choose gluten-free.
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Abstract
Case finding for celiac disease (CD) is becoming increasingly common practice and is conducted in a wide range of clinical situations ranging from the presence of gastrointestinal symptoms to failure to thrive in children, prolonged fatigue, unexpected weight loss and anemia. Case finding is also performed in associated conditions, such as autoimmune thyroid disease, dermatitis herpetiformis and type 1 diabetes, as well as in patients with irritable bowel syndrome, unexplained neuropsychiatric disorders and first-degree relatives of patients with diagnosed CD. This aggressive active case finding has dramatically changed the clinical characteristics of newly diagnosed patients. For instance, higher numbers of patients who present with extraintestinal symptoms are now being diagnosed with CD. Current recommendations state that due to a high risk for complications if the disease remains undiagnosed, patients with extraintestinal symptoms due to CD require appropriate diagnosis and treatment. Despite criticism regarding the cost-effectiveness of case finding in CD, such an aggressive approach has been considered cost-effective for high-risk patients. The diagnosis of CD among patients with extraintestinal symptoms requires a high degree of awareness of the clinical conditions that carry a high risk for underlying CD. Also, understanding the correct use of specific serology and duodenal histology is key for an appropriate diagnostic approach. Both procedures combined are able to confirm diagnosis in the vast majority of cases. However, in certain circumstances, serology and even duodenal histology cannot confirm or rule out CD. A common cause of negative IgA serology is IgA deficiency. For such eventuality, IgG-based serological tests can help confirm the diagnosis. Importantly, some histologically diagnosed cases still remain seronegative despite exclusion of IgA deficiency. On the other hand, duodenal histology may be normal despite the presence of CD-specific antibodies and active CD. This has been clearly demonstrated in some cases of untreated dermatitis herpetiformis, but may also be due to the patchy condition of CD or lesions that are not adequately recognized by nonexpert endoscopists and/or pathologists. The effectiveness of agluten-free diet depends on the clinical end point addressed. A good example is the outcome of bone loss. While risk for fracture normalizes after the first year of dietary treatment, bone parameters measured by densitometry may not be normalized in the long-term follow-up. Moreover, it is still unclear how far an early gluten-free diet will positively affect associated autoimmune diseases like type 1 diabetes and autoimmune thyroiditis.
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Casellas F, Rodrigo L, Lucendo AJ, Fernández-Bañares F, Molina-Infante J, Vivas S, Rosinach M, Dueñas C, López-Vivancos J. Benefit on health-related quality of life of adherence to gluten-free diet in adult patients with celiac disease. Rev Esp Enferm Dig 2015; 107:196-201. [PMID: 25824917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Celiac disease (CD) affects health-related quality of life (HRQOL) of patients suffering it. The exclusion of gluten from the diet (GFD) improves HRQOL, but involves difficulties in following the diet that could adversely affect HRQOL. OBJECTIVE To determine the effect of adherence to the diet on HRQOL of adult CD patients. METHODS A prospective, cross-sectional, multicenter study of CD patients treated with a GFD for longer than 1 year. Adherence to the GFD was measured using the Morisky scale, and health status using the specific CD-QOL questionnaire and the generic EuroQol-5D questionnaire. RESULTS 366 patients from 7 hospitals were included: 71.5% of patients reported a perfect treatment adherence, 23.5% unintentional poor adherence and 5% intentional poor adherence. Good adherence to a GFD was related to a higher mean score onthe CD-QOL (75 vs. 68, respectively, p < 0.05) and EuroQol-5D (0.9 vs. 0.8, respectively, p < 0.05). Ease of adherence to a GFD was also related to a better HRQOL (total CD-QOL score of 82 vs. 67 in patients who consider the GFD difficult to follow, p < 0.05). Good symptom control was also related to a better HRQOL (total CD-QOL score of 78 vs. 67 in asymptomatic vs. symptomatic patients, p < 0.01). The worse scored dimension of CD-QOL was related to "inadequate treatment". CONCLUSIONS In CD, good adherence to a GFD and adequate symptom control result in improved HRQOL. Many patients consider that the lack of therapeutic alternatives to diet worsens their quality of life.
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Santolaria-Piedrafita S, Montoro-Huguet M. Celiac disease, gluten-free diet and health-related quality of life. Rev Esp Enferm Dig 2015; 107:193-195. [PMID: 25824916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Tkachenko E, Oreshko LS, Soloveva EA, Shabanova AA, Zhuravleva MS. [Connective tissue dysplasia in patients with celiac desease as a problem of violation of adaptation reserve islands of the body]. Eksp Klin Gastroenterol 2015:4-10. [PMID: 25993866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Clinically significant dysplasia of connective tissue in patients with celiac disease is often responsible for various visceral disorders. Different disturbances of motor and evacuation functions are often determined in this patients (gastroesophageal reflux, duodenogastral reflux, spastic and hyperkinetic dyskinesia). The clinical course of the celiac disease, associated with connective tissue dysplasia, is characterized by asthenovegetative syndrome, reduced tolerance to physical activity, general weakness, fatigue and emotional instability. These data should be considered in choosing a treatment.
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Crespo Pérez L, Tavío Hernández E, Téllez Villajos L, Aicart Ramos M, Cuño Roldán JL, Zarza Sanz B, Cano Ruiz A. [Ataxia and frontal syndrome in a young woman resolved with a gluten-free diet]. Gastroenterol Hepatol 2014; 38:545-7. [PMID: 25458545 DOI: 10.1016/j.gastrohep.2014.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 08/25/2014] [Accepted: 09/10/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Laura Crespo Pérez
- Servicio de Gastroenterología, Hospital Universitario Ramón y Cajal, Madrid, España.
| | | | - Luís Téllez Villajos
- Servicio de Gastroenterología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Marta Aicart Ramos
- Servicio de Gastroenterología, Hospital Universitario Ramón y Cajal, Madrid, España
| | | | - Beatriz Zarza Sanz
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Ana Cano Ruiz
- Servicio de Gastroenterología, Hospital Universitario Ramón y Cajal, Madrid, España
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Nordyke K, Rosén A, Emmelin M, Ivarsson A. Internalizing the threat of risk--a qualitative study about adolescents' experience living with screening-detected celiac disease 5 years after diagnosis. Health Qual Life Outcomes 2014; 12:91. [PMID: 24915870 PMCID: PMC4081505 DOI: 10.1186/1477-7525-12-91] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 05/30/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Mass screening could identify those with unrecognized celiac disease (CD), but the experience of being detected through screening and living with screening-detected CD should be explored before considering this as acceptable intervention. For this study we invited screening-detected adolescents to describe their experience living with screening-detected CD five years after diagnosis with the aim to explore how their perceptions, practices, and beliefs evolved. METHODS Adolescents who were diagnosed through a population-based CD screening were invited to write narratives after being diagnosed. Of 153 adolescents who were eventually diagnosed through the screening, 91 wrote narratives one year after diagnosis and 72 five years after diagnosis. A qualitative content analysis resulted in a theme and categories that describe the experience living with screening-detected CD five years after diagnosis. RESULTS The overall theme--Internalizing the threat of risk--illustrates that being detected through screening and the internalized threat of future health complications have impacted how these adolescents felt about the diagnosis, coped with the gluten-free diet (GFD), and thought about CD screening. This theme is supported by four categories: maintaining an imposed disease identity describes how they continued to define their diagnosis in relation to the screening. They also expressed moving from forced food changes to adapted diet routines by describing habits, routines, coping strategies, and the financial burden of the GFD. They had enduring beliefs of being spared negative consequences, however, even after five years, some doubted they had CD and worried that being detected and eating a GFD might not be beneficial, i.e. continuing to fear it is "all in vain". CONCLUSIONS There was maintenance and evolution in the perceptions, practices, and beliefs of the adolescents after five years. Some have adjusted to the disease and adapted new habits and coping strategies to deal with the GFD, while others still doubt they have CD or that being detected was beneficial. The transition to adapting to the disease and GFD is ongoing, illustrating the importance of providing ongoing support for those with screening-detected CD as they adjust to this chronic disease and the GFD.
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Affiliation(s)
- Katrina Nordyke
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Anna Rosén
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Maria Emmelin
- Department of Clinical Sciences, Social Medicine and Global Health, Lund University, Lund, Sweden
| | - Anneli Ivarsson
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Vohra P. My journey through the lives of patients with coeliac disease. Natl Med J India 2014; 27:164-165. [PMID: 25668090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Pankaj Vohra
- Paediatric Gastroenterology, Hepatology and Nutrition, Max Super Specialty Hospital, Saket and Patpargunj, New Delhi, India
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Martínez Cerezo FJ, Castillejo G, Guillen N, Morente V, Simó JM, Tena FJ, Marsal J, Pascual D. [Psychological alterations in patients with adult celiac disease]. Gastroenterol Hepatol 2014; 37:240-5. [PMID: 24576676 DOI: 10.1016/j.gastrohep.2013.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 12/09/2013] [Accepted: 12/18/2013] [Indexed: 11/18/2022]
Abstract
UNLABELLED Patients with recently-diagnosed adult celiac disease were evaluated with the Gastrointestinal Symptom rating Scale (GSRS) and Psychological General Well-Being Index (PGWBI) to evaluate their psychological alterations, the association between any alterations and gastrointestinal symptoms, and their outcome after starting a gluten-free diet. The patients underwent nutritional assessment and then started a gluten-free diet; they were reassessed 6 months later. Quantitative variables are expressed as the median and 25th-75th percentiles. RESULTS We included 21 patients, 17 women and 4 mena, with a mean age of 43 years (31-47). The results of histological analysis were compatible with Marsh I lesions in 6 patients, Marsh IIIa in 6 and Marsh IIIb in 9. At baseline, 8 patients showed severe psychological distress, 4 showed moderate distress and 9 showed no distress. The GSRS score was 34 (17-43) and the PGWBI was 64 (48-87), with a significant correlation between the 2 indexes (rho=-.58, P=.006). At 6 months, 3 patients had severe psychological distress, 5 had moderate distress, 9 showed no distress and 4 showed psychological well-being. The GSRS score at 6 months was 13 (8-17) and the PGWBI was 83 (68-95) (P<.05 compared with baseline data for the 3 indicators). The 6 axes of the PGWBI showed significant improvement. At 6 months, no correlation was found between the GSRS and PGWBI. CONCLUSIONS Patients with celiac disease have psychological alterations whose intensity is related to gastrointestinal symptoms. These symptoms improve after the start of a gluten-free diet.
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Affiliation(s)
- Francisco J Martínez Cerezo
- Unidad de Enfermedad Celíaca, Servicios de Aparato Digestivo, Pediatría, Nutrición y Dietética, Anatomía Patológica y Análisis Clínicos, Hospital Universitari Sant Joan de Reus, Tarragona, España.
| | - Gemma Castillejo
- Unidad de Enfermedad Celíaca, Servicios de Aparato Digestivo, Pediatría, Nutrición y Dietética, Anatomía Patológica y Análisis Clínicos, Hospital Universitari Sant Joan de Reus, Tarragona, España
| | - Núria Guillen
- Unidad de Enfermedad Celíaca, Servicios de Aparato Digestivo, Pediatría, Nutrición y Dietética, Anatomía Patológica y Análisis Clínicos, Hospital Universitari Sant Joan de Reus, Tarragona, España
| | - Vanessa Morente
- Unidad de Enfermedad Celíaca, Servicios de Aparato Digestivo, Pediatría, Nutrición y Dietética, Anatomía Patológica y Análisis Clínicos, Hospital Universitari Sant Joan de Reus, Tarragona, España
| | - Josep M Simó
- Unidad de Enfermedad Celíaca, Servicios de Aparato Digestivo, Pediatría, Nutrición y Dietética, Anatomía Patológica y Análisis Clínicos, Hospital Universitari Sant Joan de Reus, Tarragona, España
| | - Francisco J Tena
- Unidad de Enfermedad Celíaca, Servicios de Aparato Digestivo, Pediatría, Nutrición y Dietética, Anatomía Patológica y Análisis Clínicos, Hospital Universitari Sant Joan de Reus, Tarragona, España
| | - Joan Marsal
- Unidad de Enfermedad Celíaca, Servicios de Aparato Digestivo, Pediatría, Nutrición y Dietética, Anatomía Patológica y Análisis Clínicos, Hospital Universitari Sant Joan de Reus, Tarragona, España
| | - Domingo Pascual
- Unidad de Enfermedad Celíaca, Servicios de Aparato Digestivo, Pediatría, Nutrición y Dietética, Anatomía Patológica y Análisis Clínicos, Hospital Universitari Sant Joan de Reus, Tarragona, España
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Irastorza I, Tutau C, Vitoria JC. A trichobezoar in a child with undiagnosed celiac disease: A case report. World J Gastroenterol 2014; 20:1357-1360. [PMID: 24574811 PMCID: PMC3921519 DOI: 10.3748/wjg.v20.i5.1357] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 07/09/2013] [Accepted: 07/19/2013] [Indexed: 02/06/2023] Open
Abstract
Celiac disease is a chronic, immune-mediated enteropathy caused by a permanent sensitivity to ingested gluten cereals that develops in genetically susceptible individuals. The classic presentation of celiac disease includes symptoms of malabsorption but has long been associated with cognitive, emotional, and behavioral disorders. We describe an 8-year-old patient with non-scarring alopecia and diagnosed with trichotillomania. Furthermore, she presented with a 3-year history of poor appetite and two or three annual episodes of mushy, fatty stools. Laboratory investigations showed a normal hemoglobin concentration and a low ferritin level. Serologic studies showed an elevated tissue immunoglobulin G anti-tissue transglutaminase level. A duodenal biopsy showed subtotal villous atrophy and crypt hyperplasia, and a large gastric trichobezoar was found in the stomach. Immediately after beginning a gluten-free diet, complete relief of trichotillomania and trichophagia was achieved. In this report, we describe a behavioral disorder as a primary phenomenon of celiac disease, irrespective of nutritional status.
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Biagetti C, Naspi G, Catassi C. Health-related quality of life in children with celiac disease: a study based on the Critical Incident Technique. Nutrients 2013; 5:4476-85. [PMID: 24225846 PMCID: PMC3847743 DOI: 10.3390/nu5114476] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 11/01/2013] [Accepted: 11/06/2013] [Indexed: 02/02/2023] Open
Abstract
Celiac Disease (CD) is a chronic autoimmune disease triggered by dietary gluten. Gluten avoidance, which is the only available treatment for CD, could impact on quality of life of children with CD. We present the results of a qualitative study on the emotional impact of gluten free diet (GFD) on the everyday life of children affected with CD. We investigated 76 celiac patients aged 2–18 years (average age: 9.5 years). By using the Critical Incident Technique (CIT), we defined emotions related to difficulties and awkward situations experienced by the patients. Written answers to open-ended questions from either children (older than 8 years) and parents (children younger than 8 years) were analyzed qualitatively. We found 80 dilemmas experienced in three different arenas (food situations at school, meals at home, meals outside) and characterized lived experiences of children with CD in everyday life (specific emotions, difficulties in relationships and in management of daily life). Children with CD experience strong emotions related to the GFD, permeating several aspects of everyday life. These dilemmas may be missed by a conventional, questionnaire-based approach to the psycho-social consequences of CD treatment.
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Affiliation(s)
- Chiara Biagetti
- Department of Pediatrics, Università Politecnica delle Marche, Via Corridoni 11, Ancona 60123, Italy.
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Ciacci C, Siniscalchi M, Bucci C, Zingone F, Morra I, Iovino P. Life events and the onset of celiac disease from a patient's perspective. Nutrients 2013; 5:3388-98. [PMID: 23989754 PMCID: PMC3798910 DOI: 10.3390/nu5093388] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 08/09/2013] [Accepted: 08/12/2013] [Indexed: 02/06/2023] Open
Abstract
Stressful events have been investigated in various immune-mediated diseases but not in celiac disease. Our aim was to examine the relationship of stressful events assessed by the standardized interview of Paykel with the diagnosis of celiac disease in comparison to patients, with a diagnosis of gastroesophageal reflux disease used as the control group. Adults with celiac disease (n = 186) reported more frequent and more severe life events in the years prior to the diagnosis than control patients (n = 96) (67.2% vs. 37.5%, p < 0.001, mean Paykel score 11.5 vs. 13.4, p = 0.001, respectively). Findings were not significantly different between celiac disease and control patients for the time lapse between the event and the diagnosis (mean 5.5 vs. 5.7 months). Pregnancy was defined as a negative event by 20.3% of celiac women, but never by control women. Findings were confirmed when analyses were repeated in the subgroup of patients of both groups with diagnosis made within one year of onset of symptoms. Data indicate that, before diagnosis, the number of stressful events in celiac disease was more frequent although less severe than in the control group suggesting that life events may favor the clinical appearance of celiac disease or accelerate its diagnosis.
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Affiliation(s)
- Carolina Ciacci
- Department of Medicine and Surgery, University of Salerno, via S.Allende 84081, Salerno 84081, Italy.
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Bakker SF, Pouwer F, Tushuizen ME, Hoogma RP, Mulder CJ, Simsek S. Compromised quality of life in patients with both Type 1 diabetes mellitus and coeliac disease. Diabet Med 2013; 30:835-9. [PMID: 23534496 DOI: 10.1111/dme.12205] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 02/23/2013] [Accepted: 03/22/2013] [Indexed: 12/20/2022]
Abstract
AIMS Type 1 diabetes mellitus and coeliac disease are two chronic illnesses associated with each other. Both diseases and their treatments can seriously impair quality of life. The objective of the present study was to investigate health-related quality of life in adult patients diagnosed with both Type 1 diabetes and coeliac disease and compare this with healthy control subjects and control subjects who have Type 1 diabetes only. METHODS A generic measure of health-related quality of life (RAND-36) and a measure of diabetes-specific quality of life (DQOL) questionnaires were sent to patients diagnosed with both Type 1 diabetes and coeliac disease. The control group consisted of patients with Type 1 diabetes without coeliac disease matched for age, gender and socio-economic status. Generic quality of life scores were compared with data from healthy Dutch control subjects. RESULTS Fifty-seven patients with Type 1 diabetes and coeliac disease were included and no associations between clinical characteristics and quality of life were observed. Women reported a lower quality of life in social functioning, vitality and mental health than men (all P < 0.05). A lower diabetes-specific quality of life was observed regarding diabetes-related worries and social worries in patients with Type 1 diabetes and coeliac disease compared with patients with Type 1 diabetes. Compared with healthy control subjects, quality of life in patients with Type 1 diabetes and coeliac disease was significantly lower, particularly social functioning (Cohen's d = 0.76) and general health perception (Cohen's d = 0.86). CONCLUSIONS The additional diagnosis of coeliac disease and treatment by gluten-free diet in adult patients with Type 1 diabetes has a considerable, negative impact on quality of life and diabetes-specific quality of life. Women are particularly affected and social functioning and general health perception is compromised.
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Affiliation(s)
- S F Bakker
- Department of Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam
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Paavola A, Kurppa K, Ukkola A, Collin P, Lähdeaho ML, Huhtala H, Mäki M, Kaukinen K. Gastrointestinal symptoms and quality of life in screen-detected celiac disease. Dig Liver Dis 2012; 44:814-8. [PMID: 22673312 DOI: 10.1016/j.dld.2012.04.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 04/10/2012] [Accepted: 04/23/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Active serological screening has proved an effective means of increasing the diagnostic rate in celiac disease. The effects of a long-term gluten-free diet on possible gastrointestinal symptoms and psychological well-being in screen-detected patients have nevertheless remained obscure. METHODS Abdominal symptoms and quality of life were measured in a large cohort of treated screen-detected celiac adults. Comparisons were made with corresponding symptom-detected patients and with non-celiac controls. Dietary adherence was assessed both by structured interview and by serological testing. RESULTS In both screen- and symptom-detected celiac groups, 88% of the patients were adherent. On a diet, both screen- and symptom-detected patients reported significantly more gastrointestinal symptoms than non-celiac controls. Those screen-detected patients who reported having no symptoms at the time of diagnosis, also remained asymptomatic during the diet. Despite persistent symptoms, psychological well-being in screen-detected patients was comparable with that in non-celiac controls, whereas the symptom-detected patients showed lower quality of life. CONCLUSION Long-term treated screen-detected celiac patients, especially women, suffer from gastrointestinal symptoms on a gluten free diet similarly to symptom-detected patients. However, despite a similar frequency of persistent symptoms, the quality of life was unimpaired in the screen found, but remained low in the symptom-detected group.
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Affiliation(s)
- Aku Paavola
- School of Medicine, University of Tampere, Tampere, Finland
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Pelegrí Calvo C, Soriano del Castillo JM, Mañes Vinuesa J. [Quality of life and diagnosis process in adult celiacs from the Valencian Community]. NUTR HOSP 2012; 27:1293-1297. [PMID: 23165576 DOI: 10.3305/nh.2012.27.4.5871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 04/19/2012] [Indexed: 06/01/2023] Open
Abstract
INTRODUCTION In adult patients, the diagnostic process for celiac disease (CD) is often very late and generates health complications that would be avoided by earlier diagnosis. The diseases of wich these patients were diagnosed before setting the diagnosis of CD were many and diverse. In addition, following a gluten-free diet (GFD) leads to a reduction in the quality of life for patients, who find it difficult to travel, to find accredited restaurants with menus without gluten, to interpretate food labels or to go to friends' houses. OBJECTIVE To determine the delay in diagnosis, the satisfaction of the information provided by different sources and circumstances related to the quality of life. METHOD A retrospective cross-sectional observational study in 98 adult celiac through a validated questionnaire for celiac patientes. RESULTS The average delay in diagnosis was 11 years and the average of doctors consulted prior to confirmation of the CD was 6. Osteoporosis or osteopenia were nearly twice as common among those who took more than five years to be diagnosed. Some 90% say they transgress the dietary pattern, however, 58% show clinical symptoms due to unnoticed consumption of gluten. The impact of GFD on the quality of life is very high. CONCLUSIONS Long delays in diagnosis suggest the need for greater awareness among physicians about the EC and the use of serological tests in potential patients or risk groups.
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Affiliation(s)
- C Pelegrí Calvo
- Área de Nutrición y Bromatología, Facultad de Farmacia, Universitat de València, València, España.
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Abstract
OBJECTIVES Coeliac disease (CD) is an autoimmune condition managed by a lifelong therapeutic gluten-free diet. Previous research suggests that the chronicity of CD, the limitations imposed by the gluten-free diet, and the risk of other associated diseases can have a negative impact on health-related quality of life (HRQoL) and psychological well-being. The aim of this study was to explore the illness perceptions and self-efficacy beliefs of adults with CD in the United Kingdom and to report their subjective levels of HRQoL and psychological well-being. DESIGN The study employed a cross-sectional postal questionnaire design. METHOD Participants (n= 288) were adults with CD recruited via Coeliac UK. Measures of well-being, HRQoL, self-efficacy, illness perceptions, and dietary self-management were analysed. Preliminary descriptive and univariate procedures were employed before bivariate tests of association or difference were carried out. Backward stepwise multiple regression analysis was used to investigate the predictive strength of variables on well-being, quality of life, and self-efficacy. Logistic regression was used to look at the influence of variables on adherence. RESULTS. Results indicate that HRQoL and psychological well-being were comparable to those found in previous related studies. Participants with weak beliefs in the serious consequences of CD and poorer emotional reactions to the condition had a greater likelihood of having enhanced HRQoL, improved psychological well-being, and higher self-efficacy. Strong beliefs in personal control and a greater perceived understanding of CD were associated with greater self-efficacy. CONCLUSIONS Perceived self-efficacy and illness perceptions could play a role in informing psychological interventions for individuals with CD.
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Affiliation(s)
- Sarah Ford
- Department of Clinical Psychology, University of Birmingham, UK
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Ukkola A, Mäki M, Kurppa K, Collin P, Huhtala H, Kekkonen L, Kaukinen K. Patients' experiences and perceptions of living with coeliac disease - implications for optimizing care. J Gastrointestin Liver Dis 2012; 21:17-22. [PMID: 22457855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND AND AIMS Little is known regarding the impact of coeliac disease on daily living from patients' own viewpoints. The aim of the study was to investigate patients' perceptions of their disease, dietary treatment and self-rated healthcare needs. METHODS This prospective study involved 698 newly detected adult coeliac disease patients diagnosed due to classical abdominal symptoms, extraintestinal symptoms or active screening in at-risk groups. Participants were asked about their experiences of living with coeliac disease and of adopting a gluten-free diet, as well as their disease-related needs at diagnosis and after one year on treatment. RESULTS All patients were equally satisfied that they had been diagnosed with coeliac disease irrespective of initial clinical presentation. However, young patients and those with extraintestinal symptoms or asymptomatic and detected by screening in at-risk groups rated the impact on daily living of the disease and adherence to a gluten-free diet with significantly more disapproval than those with classical symptoms. The former groups clarify also reported dietary lapses and a negative attitude to the disease more frequently. Negative perceptions were associated with dissatisfaction with the quality of doctor-patient communication and younger age at diagnosis. CONCLUSIONS Established doctor-patient communication is essential in minimizing the disease burden. Particularly young and screen-detected asymptomatic patients and those with extraintestinal manifestations require extensive support.
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Affiliation(s)
- Anniina Ukkola
- School of Medicine, University of Tampere and Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Finland
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