title: Impact of symptoms on quality of life before and after diagnosis of coeliac disease: results from a UK population survey.
abstract: BACKGROUND
  Coeliac disease is a common chronic autoimmune disorder. Underdiagnosis is common and the quality of life impact of symptoms may be severe. We report a study of symptom duration and quality of life before and after diagnosis in a representative sample of people with diagnosed coeliac disease in the UK.
  
  
  METHODS
  Postal questionnaire of 2000 people with diagnosed coeliac disease, requesting information on date of diagnosis, type and duration of symptoms, and quality of life before and after diagnosis using the EQ-5D instrument.
  
  
  RESULTS
  The survey response rate was 40% (788/2000). Mean duration of symptoms prior to diagnosis was 13.2 years, with some evidence of shorter duration in recent years. Respondents reported a mean of 13 consultations with their GP about their symptoms prior to diagnosis. The mean utility value of pre-diagnosis quality of life was 0.56, compared to 0.84 at time of survey, a highly statistically significant improvement of 0.27 (95% c.i. 0.25, 0.30).
  
  
  CONCLUSIONS
  The symptoms of undiagnosed coeliac disease are associated with a prolonged and substantial decrement to quality of life. These results strengthen the case for detailed examination of the cost-effectiveness of improved methods of detection and diagnosis, including population screening.
authors.affiliation: Health Economics Research Centre, Department of Public Health, University of Oxford, Old Road Campus, Oxford, UK. alastair.gray@dphpc.ox.ac.uk
authors.forename: Alastair M
authors.initials: AM
authors.lastname: Gray
authors.forename: Irene N
authors.initials: IN
authors.lastname: Papanicolas
mesh_terms: D000328:Adult; D002446:Celiac Disease / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011159:Population Surveillance; D011788:Quality of Life / Q000523:psychology*; D017678:Sex Distribution; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D006113:United Kingdom