Alimentary TractPsychological well-being of adult coeliac patients treated for 10 years
Introduction
Coeliac disease (CD) is an enteropathy characterised by permanent intolerance to dietary gluten peptides in genetically susceptible individuals. Following withdrawal of gluten from the diet, clinical and histological remission is soon attained. Indeed, Mustalahti [1] found adults starting a gluten-free diet to score even better in the Psychological General Well-being (PGWB) index after 1 year of treatment than a non-coeliac control group.
CD is a lifelong condition, however, Holmes [2] in a follow-up study of 388 adults found depression to be the most common neuropsychiatric complication. Ciacci et al. [3] exploring the psychological dimensions of CD identified the depressive-anxiety factor as the main indicator of psychological disturbances in a series of long-treated young adult patients. In a study of 100 patients treated for 8 years, Fera et al. [4] found a high rate of affective disorders that increased with duration of treatment and suggested a close relationship to reduction in quality of life, a frequent finding in long-treated adults with CD [5], [6].
As recently pointed out by Accomando et al. [7] in the journal, uncertainty remains whether depression and anxiety are features of CD. The present study was designed to evaluate the psychological well-being using the PGWB index in middle-aged adults with longstanding CD in proven remission, using a population sample of same age as controls.
Section snippets
Patients
Out of 60 CD patients aged 45–64 years diagnosed at six Swedish gastroenterology departments in 1984–1988, all 51 (59% women) proven to be in remission 8–12 years later were studied. Patients with dermatitis herpetiformis were not enrolled. The most common principal reasons for referral for diagnosis were diarrhoea (33%), abnormal blood tests (25%), dyspepsia (16%) and tiredness (10%). The diagnosis was made by showing a flat intestinal mucosa, as later confirmed by a pathologist reviewing all
CD patients and controls
Adult CD patients treated for 8–12 years in proven remission achieved similar scores in all six domains of the PGWB as a population sample of same age (Fig. 1). Accordingly, no difference was seen between the PGWB index of the CD patients, 103 (95% CI = 99–107), and the controls, 103 (95% CI = 100–106). The CD men tended to score higher on the PGWB domains than the male controls, particularly within Well-being (P < 0.05) and General health (P < 0.03) (Table 1), yet reaching no obviously higher score in
Discussion
The present study is part of a comprehensive cohort study of Swedish adults with longstanding CD [5]. The main finding is that middle-aged adults in proven remission show similar level of psychological well-being as a local population sample of same age. The results may thus suggest that signs of depressed mood and anxiety are no inherent features of CD. In addition, the study lends support to an observation [5] that discrepancy exists in the subjective treatment outcome of men and women, at
Acknowledgements
We thank C. Grännö, S. Hultén, G. Midhagen, M. Ström, H. Svensson, T. Valdimarsson and T. Wickström for recruiting the study patients and C. Grant for reviewing the slides. K. Ekberg kindly provided access to population controls. The study was supported by a grant from the Medical Research Council of Southeast Sweden.
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