Digestive Diseases and Sciences

, Volume 55, Issue 11, pp 3154–3163

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

  • Spencer D. Dorn
  • Lincoln Hernandez
  • Maria T. Minaya
  • Carolyn B. Morris
  • Yuming Hu
  • Suzanne Lewis
  • Jane Leserman
  • Shrikant I. Bangdiwala
  • Peter H. R. Green
  • Douglas A. Drossman
Original Article



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.


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).


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.


In patients presenting to a CD referral center, psychosocial factors more strongly affect health status and GI symptoms than disease measures.


Celiac Disease Illness Outcomes Psychological 



Body mass index


Brief symptom inventory


Bristol stool scale


Celiac disease


Coping strategies questionnaire


Inflammatory bowel disease


Irritable bowel syndrome


Irritable bowel syndrome quality of life scale


Life experiences survey


Physician health questionnaire


Sickness impact profile


Tissue transglutaminase antibody


Visual analog scale


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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Spencer D. Dorn
    • 1
    • 2
  • Lincoln Hernandez
    • 3
  • Maria T. Minaya
    • 4
  • Carolyn B. Morris
    • 1
  • Yuming Hu
    • 1
  • Suzanne Lewis
    • 5
  • Jane Leserman
    • 1
  • Shrikant I. Bangdiwala
    • 1
  • Peter H. R. Green
    • 4
    • 5
  • Douglas A. Drossman
    • 1
    • 2
  1. 1.Center for Functional GI and Motility DisordersUniversity of North CarolinaChapel HillUSA
  2. 2.Division of Gastroenterology and Hepatology, Department of MedicineUniversity of North Carolina School of MedicineChapel HillUSA
  3. 3.Section of Gastroenterology and Hepatology, Department of MedicineTulane University Health Sciences CenterNew OrleansUSA
  4. 4.Celiac Disease Center at Columbia UniversityNew YorkUSA
  5. 5.Division of Digestive and Liver Diseases, Department of MedicineColumbia UniversityNew YorkUSA

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