Predictors of irritable bowel-type symptoms and healthcare-seeking behavior among adults with celiac disease.
OBJECTIVE
To assess the frequency of irritable bowel syndrome (IBS)-type symptoms and consecutive healthcare-seeking behavior, their impact on health-related quality of life (HRQOL), and their possible biopsychosocial determinants in adult patients with celiac disease (CD).


METHODS
A total of 1000 adult patients with CD from the German Celiac Society completed a medical (including bowel) and a sociodemographic questionnaire, the Short Form Health Survey (SF-36), and the Hospital Anxiety and Depression Scale through a postal survey.


RESULTS
Of 412 respondents with reported biopsy-proven diagnosis with major adherence to a gluten-free diet (GFD) for > or =1 year, 96 (23.3%) patients fulfilled the modified Rome I criteria for IBS. Of these 96 patients, 76 (79.2%) sought help (medical and/or nonmedical) due to bowel symptoms (referred to as patients with IBS). IBS-type symptoms had a significant negative impact on the physical summary score of the SF-36 (p = .05). Mental disorder (OR = 2.29; beta = 0.83; p = .006); female sex (OR = 2.34; beta = 0.85; p = .03), and occasional nonadherence to GFD (OR = 1.74; beta = 0.56; p = .05) were risk factors for IBS-type symptoms. Active medical comorbidities predicted IBS-patient status (OR = 0.40; beta = -0.92; p = .001).


CONCLUSIONS
The data support the biopsychosocial model of IBS: IBS-type symptoms in adult patients with CD can be explained through an interaction of clinical and sociopsychological mechanisms.
Häuser
Winfried
W
Department of Internal Medicine I, Klinikum Saarbrücken gGmbH, Saarbruecken, Germany. whaeuser@klinikum-saarbruecken.de
Musial
Frauke
F
Caspary
Wolfgang F
WF
Stein
Jürgen
J
Stallmach
Andreas
A
D000328:Adult; D002446:Celiac Disease / Q000150:complications / Q000523:psychology*; D005260:Female; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011788:Quality of Life