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Psychosocial Factors Are More Important Than Disease Activity in Determining Gastrointestinal Symptoms and Health Status in Adults at a Celiac Disease Referral Center

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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.

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Abbreviations

BMI:

Body mass index

BSI:

Brief symptom inventory

BSS:

Bristol stool scale

CD:

Celiac disease

CSQ:

Coping strategies questionnaire

IBD:

Inflammatory bowel disease

IBS:

Irritable bowel syndrome

IBS-QOL:

Irritable bowel syndrome quality of life scale

LES:

Life experiences survey

PHQ:

Physician health questionnaire

SIP:

Sickness impact profile

tTG:

Tissue transglutaminase antibody

VAS:

Visual analog scale

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Acknowledgments

This study was supported in part by a grant from the NIH Gastrointestinal Biopsychosocial Research Center R24DK067674 and T32 DK 007634.

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Authors and Affiliations

  1. Center for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, NC, USA

    Spencer D. Dorn, Carolyn B. Morris, Yuming Hu, Jane Leserman, Shrikant I. Bangdiwala & Douglas A. Drossman

  2. Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, 4150 Bioinformatics Bldg. CB 7080, Chapel Hill, NC, 27599-7080, USA

    Spencer D. Dorn & Douglas A. Drossman

  3. Section of Gastroenterology and Hepatology, Department of Medicine, Tulane University Health Sciences Center, New Orleans, LA, USA

    Lincoln Hernandez

  4. Celiac Disease Center at Columbia University, New York, NY, USA

    Maria T. Minaya & Peter H. R. Green

  5. Division of Digestive and Liver Diseases, Department of Medicine, Columbia University, New York, NY, USA

    Suzanne Lewis & Peter H. R. Green

Authors
  1. Spencer D. Dorn
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  2. Lincoln Hernandez
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  3. Maria T. Minaya
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  4. Carolyn B. Morris
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  5. Yuming Hu
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  6. Suzanne Lewis
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  7. Jane Leserman
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  8. Shrikant I. Bangdiwala
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  9. Peter H. R. Green
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  10. Douglas A. Drossman
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Corresponding author

Correspondence to Douglas A. Drossman.

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Dorn, S.D., Hernandez, L., Minaya, M.T. et al. Psychosocial Factors Are More Important Than Disease Activity in Determining Gastrointestinal Symptoms and Health Status in Adults at a Celiac Disease Referral Center. Dig Dis Sci 55, 3154–3163 (2010). https://doi.org/10.1007/s10620-010-1342-y

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  • DOI: https://doi.org/10.1007/s10620-010-1342-y

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