title: Psychosocial factors are more important than disease activity in determining gastrointestinal symptoms and health status in adults at a celiac disease referral center.
abstract: BACKGROUND
  The relative effects of clinical and psychosocial variables on outcome in celiac disease (CD) has not previously been reported. In adult patients with (CD), we studied the relationships among demographics, psychosocial factors, and disease activity with health-related quality of life (HRQOL), health care utilization, and symptoms.
  
  
  METHODS
  Among 101 adults newly referred to a tertiary care center with biopsy-proven CD we assessed: (a) demographic factors and diet status; (b) disease measures (Marsh score, tissue transglutaminase antibody (tTG) level, weight change and additional blood studies); and (c) Psychosocial status (psychological distress, life stress, abuse history, and coping). Multivariate analyses were performed to predict HRQOL, daily function, self-reported health, number of physician visits, and GI symptoms (pain and diarrhea).
  
  
  RESULTS
  Impaired HRQOL and daily function was associated with psychological distress and poorer coping. Self-report of poorer health was associated with poorer coping, longer symptom duration, lower education, and greater weight loss. More physician visits were associated with poorer coping, abnormal tTG levels, and milder Marsh classification. Greater pain scores were seen in those with higher psychological distress and greater weight loss. Finally, diarrhea was associated with greater psychological distress and poorer coping.
  
  
  CONCLUSIONS
  In patients presenting to a CD referral center, psychosocial factors more strongly affect health status and GI symptoms than disease measures.
authors.affiliation: Center for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Spencer D
authors.initials: SD
authors.lastname: Dorn
authors.forename: Lincoln
authors.initials: L
authors.lastname: Hernandez
authors.forename: Maria T
authors.initials: MT
authors.lastname: Minaya
authors.forename: Carolyn B
authors.initials: CB
authors.lastname: Morris
authors.forename: Yuming
authors.initials: Y
authors.lastname: Hu
authors.forename: Suzanne
authors.initials: S
authors.lastname: Lewis
authors.forename: Jane
authors.initials: J
authors.lastname: Leserman
authors.forename: Shrikant I
authors.initials: SI
authors.lastname: Bangdiwala
authors.forename: Peter H R
authors.initials: PH
authors.lastname: Green
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Drossman
mesh_terms: D015746:Abdominal Pain / Q000523:psychology; D000223:Adaptation, Psychological; D002446:Celiac Disease / Q000453:epidemiology / Q000523:psychology*; D003967:Diarrhea / Q000523:psychology; D006304:Health Status; D006801:Humans; D015999:Multivariate Analysis; D011788:Quality of Life; D012017:Referral and Consultation; D012044:Regression Analysis; D018434:Sickness Impact Profile; D013315:Stress, Psychological / Q000453:epidemiology; D011503:Transglutaminases / Q000378:metabolism
chemical_list: D011503:Transglutaminases