Celiac.com 05/06/2008 - In the majority of people with celiac disease,strict adherence to a gluten-free diet can result in a quality of lifethat is on par with non-celiacs. Still a small percentage of celiacsseem to suffer from persistent gastrological discomfort in the form ofirritable bowel or irritable-bowel-like symptoms. Very few studies havebeen done on persistent gastrological problems in adults with celiacdisease. Those that have been done rely upon univariate statisticalanalysis in clinical samples at the secondary or tertiary care leveland fail to assess the potential influence of non-celiac diseasespecific factors, which are considered to be a risk factor of irritablebowel syndrome (IBS), such as mental disorders, or gender.
Ateam of researchers made up of doctors Winfried Hauser, Frauke Musial,Wolfgang Caspary, Jurgen Stein, and Andreas Stallmach set out todetermine rates of irritable bowel syndrome, irritable bowelsyndrome-related symptoms, and consecutive health care-seeking behaviorand their influence upon health-related quality of life (HRQL) and anyconceivable bio-psychosocial factors influencing adult patients withceliac disease. The research team made a medical and socio-demographicsurvey of 1000 adult celiac patients from the German Celiac Society bypost. The medical portion of the survey included bowel history. Theteam also had patients fill out a Short Form Health Survey (SFHS),along with the Hospital Anxiety and Depression Scale.
A totalof 446 patients indicated that they had biopsy-proven celiac disease. Of these 446patients, 18 were excluded because they indicated adherence to agluten-free diet for less than 1 year. Sixteen patients were tossed outbecause they reported a major non-adherence to the gluten-free diet. Thus,the study group was confined to 412 patients with self-reportedbiopsy-proven celiac disease who were on a strict gluten-free diet for at least one year. The survey showed that out of these 412 patients that met the criteria, 96 patients, or just over 23% metmodified Rome I criteria for Irritable Bowel Syndrome. Of those 96patients, 76 patients, or nearly 80%, made an effort to get help, bothmedical and non-medical, as a result of the bowel symptoms (we’ll callthe patients who sought help "irritable bowel syndrome patients").
Irritable bowel syndrome-like symptoms were shown to drive SFHS scores sharply downward. Mentalhealth disorders, being female, falling off the gluten-free dietall contributed to a greater likelihood of irritable bowel syndrome symptoms.
Theresults of the study seem strengthen the bio-psychosocial model of irritable bowel syndrome, in which biological and psychological factorsare understood to affect the clinical manifestation of celiac disease.Under this model, irritable bowel syndrome-like symptoms in adults withceliac disease are understood through a combination of clinical andsocio-psychological mechanisms. This model leads doctors to anunderstanding of celiac disease and other gastro-intestinal ailmentsthat goes beyond simple biological or psychological factors alone, andlooks at factors like adverse life events, stress, and hypochondriasisamong others.
Limited studies indicate that gender differencesin visceral perception, cardio-autonomic responses, gastrointestinalmotility, and brain activation patterns to visceral stimuli are afactor in irritable bowel syndrome. Gender differences in psychosocialfactors have not been fully studied.
The results of this studyalso support the need for further investigation to determine exactly whatfactors contribute to the bio-psychosocial model of what is called’celiac irritable bowel syndrome.’
Future psycho-physiologicalstudies in patients with celiac disease and irritable bowel syndromeshould look to determine if psychological discomfort can prolongmucosal inflammation, reduce visceral pain thresholds, or disturb gutmotility.
In the event that the right psychotherapeutictreatment for irritable bowel syndrome-like symptoms and/or mentaldisorder serve to improve reduced HRQOL in adult patients with celiacdisease and irritable bowel syndrome-like symptoms, it might benecessary to take a second look at interventional practices.
So,in a nutshell, this all means that things like mental health, gender,and other non-clinical factors might play a role in irritable bowelsyndrome-like symptoms in people with celiac disease, and that furtherstudy is needed to sort out all of the possibilities and determine ifthere might be better ways to treat celiac disease that will reduce oreliminate irritable bowel syndrome-like symptoms.
Psychosomatic Medicine 69:370 –376 (2007)