title: Predictors of persistent symptoms and reduced quality of life in treated coeliac disease patients: a large cross-sectional study.
abstract: BACKGROUND
  Evidence suggests that many coeliac disease patients suffer from persistent clinical symptoms and reduced health-related quality of life despite a strict gluten-free diet. We aimed to find predictors for these continuous health concerns in long-term treated adult coeliac patients.
  
  
  METHODS
  In a nationwide study, 596 patients filled validated Gastrointestinal Symptom Rating Scale and Psychological General Well-Being questionnaires and were interviewed regarding demographic data, clinical presentation and treatment of coeliac disease, time and place of diagnosis and presence of coeliac disease-associated or other co-morbidities. Dietary adherence was assessed by a combination of self-reported adherence and serological tests. Odds ratios and 95% confidence intervals were calculated by binary logistic regression.
  
  
  RESULTS
  Diagnosis at working age, long duration and severity of symptoms before diagnosis and presence of thyroidal disease, non-coeliac food intolerance or gastrointestinal co-morbidity increased the risk of persistent symptoms. Patients with extraintestinal presentation at diagnosis had fewer current symptoms than subjects with gastrointestinal manifestations. Impaired quality of life was seen in patients with long duration of symptoms before diagnosis and in those with psychiatric, neurologic or gastrointestinal co-morbidities. Patients with persistent symptoms were more likely to have reduced quality of life.
  
  
  CONCLUSIONS
  There were a variety of factors predisposing to increased symptoms and impaired quality of life in coeliac disease. Based on our results, early diagnosis of the condition and consideration of co-morbidities may help in resolving long-lasting health problems in coeliac disease.
authors: Tampere Centre for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland.
authors: Pilvi
authors: P
authors: Paarlahti
authors: Kalle
authors: K
authors: Kurppa
authors: Anniina
authors: A
authors: Ukkola
authors: Pekka
authors: P
authors: Collin
authors: Heini
authors: H
authors: Huhtala
authors: Markku
authors: M
authors: Mäki
authors: Katri
authors: K
authors: Kaukinen
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002446:Celiac Disease / Q000150:complications* / Q000178:diet therapy*; D003248:Constipation / Q000209:etiology; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000209:etiology; D055050:Diet, Gluten-Free; D004415:Dyspepsia / Q000209:etiology; D005260:Female; D005502:Food / Q000009:adverse effects; D005764:Gastroesophageal Reflux / Q000209:etiology; D005767:Gastrointestinal Diseases / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011788:Quality of Life; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013959:Thyroid Diseases / Q000150:complications; D013997:Time Factors; D055815:Young Adult
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