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


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


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


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


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


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


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


CONCLUSIONS
Gluten-free diet was associated with improved quality of life for patients with symptom-detected celiac disease and patients with screen-detected celiac disease. Concerns about the burden of a gluten-free diet, at least over the short term, may be unfounded.
Mustalahti
Kirsi
K
Department of Pediatrics, Tampere University Hospital, Finland.
Lohiniemi
Susanna
S
Collin
Pekka
P
Vuolteenaho
Nanna
N
Laippala
Pekka
P
Mäki
Markku
M
D000328:Adult; D000368:Aged; D002446:Celiac Disease / Q000175:diagnosis / Q000178:diet therapy* / Q000503:physiopathology; D018753:Diet, Protein-Restricted; D004064:Digestive System / Q000503:physiopathology; D005260:Female; D005983:Glutens; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires
D005983:Glutens