Alimentary Tract
Psychological well-being of adult coeliac patients treated for 10 years

https://doi.org/10.1016/j.dld.2006.01.004Get rights and content

Abstract

Background

Adults with longstanding coeliac disease generally report reduced quality of life. Uncertainty remains whether this is a sign of depression, thought to be a feature of the disorder.

Aim

To assess the psychological well-being in adults with long-treated coeliac disease.

Patients and methods

Fifty-one coeliac disease adults (59% women) aged 45–64 years diagnosed in 1984–1988 and showing evidence of remission 8–12 years later were examined by the Psychological General Well-being index. One hundred and eighty-two (57% women) adults of same age served as population controls.

Results

The coeliac disease patients showed no more signs of anxiety, depressed mood or distress than the controls as assessed by the Psychological General Well-being index, 103 (95% confidence interval (95% CI) = 99–107) versus 103 (95% CI = 100–106). However, unlike controls, the coeliac disease women showed a significantly lower Psychological General Well-being index than the coeliac disease men, 97 (95% CI = 91–103) versus 111 (95% CI = 106–117) (P < 0.003).

Conclusion

Long-treated adult coeliac disease patients showed no difference in psychological well-being to population controls, suggesting that signs of depressed mood is no feature of well-treated coeliac disease. The observation that coeliac disease women living in Sweden experience poorer outcome of treatment than coeliac disease men is a cause of concern and calls for further studies.

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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