title: Reflux and irritable bowel syndrome are negative predictors of quality of life in coeliac disease and inflammatory bowel disease.
abstract: OBJECTIVE
  An increased prevalence of reflux and irritable bowel syndrome (IBS) symptoms is associated with coeliac disease and inflammatory bowel disease (IBD). We aimed to determine the prevalence of reflux and IBS symptoms in a cohort of patients with coeliac disease and IBD and their relationship with quality of life (QoL) and psychological distress.
  
  
  METHODS
  Histologically proven coeliac disease (n=225), ulcerative colitis (UC) (n=228), Crohn's disease (CD) (n=230) patients and age/sex-matched controls (n=348) completed the Short-Form 36 (SF-36)-Item Health Survey, Hospital Anxiety and Depression Scale (HADS), reflux screen and Rome II criteria.
  
  
  RESULTS
  UC patients report higher SF-36 (QoL) scores than coeliac disease; CD fairing worse overall (P≤0.0001). Reflux prevalence: coeliac disease 66%; UC 62%; CD 72%; controls 50%. Patients report reflux of a greater severity: coeliac disease odds ratio=6.8, 95% confidence interval=3.6-12.7, P≤0.001; IBD odds ratio=2.2, 95% confidence interval=1.6-3.2, P≤0.0001. Stepwise reductions in SF-36 scores in association with increasing reflux severity were found (P≤0.0001). IBS prevalence: coeliac disease 22%; UC 16%; CD 24%; controls 6%. Concomitant IBS was associated with reduced SF-36 scores in patients (P≤0.0001).
  
  
  CONCLUSIONS
  Reflux and IBS are more prevalent in coeliac disease and IBD in comparison with age-matched and sex-matched controls. These additional symptoms are associated with reduced QoL and increasing likelihood of anxiety and depression. QoL may be improved if coeliac disease and IBD patients were assessed for reflux and IBS.
authors.affiliation: The Gastroenterology and Liver Unit, The Royal Hallamshire Hospital, Sheffield, UK. mdd06sb@sheffield.ac.uk
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Barratt
authors.forename: John S
authors.initials: JS
authors.lastname: Leeds
authors.forename: Kerry
authors.initials: K
authors.lastname: Robinson
authors.forename: Premal J
authors.initials: PJ
authors.lastname: Shah
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Lobo
authors.forename: Mark E
authors.initials: ME
authors.lastname: McAlindon
authors.forename: David S
authors.initials: DS
authors.lastname: Sanders
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology; D002446:Celiac Disease / Q000453:epidemiology* / Q000523:psychology; D003863:Depression / Q000453:epidemiology; D005260:Female; D005764:Gastroesophageal Reflux / Q000453:epidemiology* / Q000523:psychology; D006306:Health Surveys; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000453:epidemiology* / Q000523:psychology; D043183:Irritable Bowel Syndrome / Q000453:epidemiology* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011788:Quality of Life; D011795:Surveys and Questionnaires; D055815:Young Adult