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Gender and Mental Health are Factors in Irritable Bowel Disease-related Symptoms in Celiac Disease 05/06/2008 - In the majority of people with celiac disease, strict adherence to a gluten-free diet can result in a quality of life that is on par with non-celiacs. Still a small percentage of celiacs seem to suffer from persistent gastrological discomfort in the form of irritable bowel or irritable-bowel-like symptoms. Very few studies have been done on persistent gastrological problems in adults with celiac disease. Those that have been done rely upon univariate statistical analysis in clinical samples at the secondary or tertiary care level and fail to assess the potential influence of non-celiac disease specific factors, which are considered to be a risk factor of irritable bowel syndrome (IBS), such as mental disorders, or gender.

A team of researchers made up of doctors Winfried Hauser, Frauke Musial, Wolfgang Caspary, Jurgen Stein, and Andreas Stallmach set out to determine rates of irritable bowel syndrome, irritable bowel syndrome-related symptoms, and consecutive health care-seeking behavior and their influence upon health-related quality of life (HRQL) and any conceivable bio-psychosocial factors influencing adult patients with celiac disease. The research team made a medical and socio-demographic survey of 1000 adult celiac patients from the German Celiac Society by post. The medical portion of the survey included bowel history. The team also had patients fill out a Short Form Health Survey (SFHS), along with the Hospital Anxiety and Depression Scale.

516 of the questionnaires came back completed. Respondents were similar in gender ratio and median age from the whole membership directory of the German Celiac Society, a group of more than 18,000 people who reported suffering from celiac disease at the age of 18. Of these, 213 (41.3%) had a diagnosis of celiac disease that was made by a duodenal biopsy, 37 (7.2%) by serological tests (celiac disease-specific antibodies), 34 (6.6%) using stool tests for trans-glutaminase antibodies, and 232 (45.0%) using intestinal biopsy and serological tests.

A total of 446 patients indicated that they had biopsy-proven celiac disease. Of these 446 patients, 18 were excluded because they indicated adherence to a gluten-free diet for less than 1 year. Sixteen patients were tossed out because they reported a major non-adherence to the gluten-free diet. Thus, the study group was confined to 412 patients with self-reported biopsy-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% met modified Rome I criteria for Irritable Bowel Syndrome. Of those 96 patients, 76 patients, or nearly 80%, made an effort to get help, both medical and non-medical, as a result of the bowel symptoms (we’ll call the patients who sought help "irritable bowel syndrome patients").

Irritable bowel syndrome-like symptoms were shown to drive SFHS scores sharply downward. Mental health disorders, being female, falling off the gluten-free diet all contributed to a greater likelihood of irritable bowel syndrome symptoms.

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The results of the study seem strengthen the bio-psychosocial model of irritable bowel syndrome, in which biological and psychological factors are understood to affect the clinical manifestation of celiac disease. Under this model, irritable bowel syndrome-like symptoms in adults with celiac disease are understood through a combination of clinical and socio-psychological mechanisms. This model leads doctors to an understanding of celiac disease and other gastro-intestinal ailments that goes beyond simple biological or psychological factors alone, and looks at factors like adverse life events, stress, and hypochondriasis among others.

Limited studies indicate that gender differences in visceral perception, cardio-autonomic responses, gastrointestinal motility, and brain activation patterns to visceral stimuli are a factor in irritable bowel syndrome. Gender differences in psychosocial factors have not been fully studied.

The results of this study also support the need for further investigation to determine exactly what factors contribute to the bio-psychosocial model of what is called ’celiac irritable bowel syndrome.’

Future psycho-physiological studies in patients with celiac disease and irritable bowel syndrome should look to determine if psychological discomfort can prolong mucosal inflammation, reduce visceral pain thresholds, or disturb gut motility.

In the event that the right psychotherapeutic treatment for irritable bowel syndrome-like symptoms and/or mental disorder serve to improve reduced HRQOL in adult patients with celiac disease and irritable bowel syndrome-like symptoms, it might be necessary 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 bowel syndrome-like symptoms in people with celiac disease, and that further study is needed to sort out all of the possibilities and determine if there might be better ways to treat celiac disease that will reduce or eliminate irritable bowel syndrome-like symptoms.

Psychosomatic Medicine 69:370 –376 (2007) welcomes your comments below (registration is NOT required).

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8 Responses:

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said this on
07 May 2008 4:41:08 AM PST
Many of us have found that other foods are producing IBS. There is no mention of whether the study looked at whether the folks who continued to have IBS symptoms were assessed to find out if perhaps casien or soy might be a factor in the continued discomfort. There is also the assumption among most medical professionals that things that are put onto the skin, such as shampoos and lotions etc. are safe no matter what is in them. How many of the study group were still using gluten containing personal care products?
Also many of us suffer needlessly because our medications are a gluten source. Many trust pharms and their doctors to know if something is safe and as a result have long standing contamination from items such as supplements, over the counter meds, prescrition meds, wheat germ oils, alcohol and vinager and other items that are thought to be safe that in the reality are not.
For folks that have neuro impact in the celiac spectrum of disease adherence to a gluten free diet is often not enough to stop the autoimmune process that is inflaming the brain and blood. They need to avoid the items that many of us are taught are 'safe by processing'. Many who continue to have issues will achieve resolution by ferreting out the other items we are forming antibodies to and becoming zero tolerance strict with the gluten-free diet. Something doctors don't seem to think many of us can do.
IBS is not a diagnosis, it is a symptom. Unfortunately in our pharmadriven society there is too much of a rush to label and not enough time spent looking for the cause of the symptom.
It is unfortunate that many doctors and researchers seem to ignore that the impact of your body fighting a substance that it considers poison can result in neuro impact. The depression and anxiety are too often a symptom and not a cause. The rush to medicate folks for depression rather than find the physical trigger for it keeps many of us suffering for years.

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said this on
12 May 2008 12:51:49 AM PST
People with Celiac may have other food intolerance, and food allergies. They can cause GI problems, if ingested. Doctors usually ignore this fact, and push mind altering drugs on people who don't need them. I have been allergic to corn all of my life, as well as other foods and sulfites. If I accidentally eat any of them, because they are not properly labeled in food products, I get sick. Mind control drugs would not help. Avoidance of the problem food is the only thing that does help. This is not rocket science, but is ignored by doctors.

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said this on
12 May 2008 9:59:49 AM PST
Interesting, but no one has proven that the link mentioned in the article is a causative one. It seems almost useless to include 'anxiety' and 'depression' as mental health disorders when they are also common characteristics of people who are sick and have not been diagnosed or helped yet. Has anyone conducted a study yet to find out how often 'anxiety' and 'depression' are present in people with undiagnosed illnesses? Would be hard to construct - but a good contribution to science.

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said this on
12 May 2008 6:47:33 PM PST
Gluten and/ or lactose intolerance in infants would cause extreme pain and untreated would lead to helpless or dissociative reactions which would lead to parents responding less lovingly and more fearfully. Allergies treated with dulling antihistamines would also lead to maladaptive cognitive functioning and, without sharpness and persistence, it is VERY DIFFICULT to get a doctor to look into intestinal symptoms, fogginess, etc. I shudder to think how many 'mental problems' started out as reactions to abuse and gluten abuses us without visible bruises. Think of the 'shame' of gaseousness and how a child might feel in school. Combine IBS symptoms with periods and having to sit still for 8 hours. I could go on and on. Pain starts the cycle.

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said this on
13 May 2008 8:13:38 AM PST
After my daughter went on a gluten-free diet she improved immensely; however within six months she was having stomach problems again. Her pediatrician said it was IBS. We followed the recommendations for this condition, but it was soon apparent this was not helping. Thank God for a Naturopath Doctor who identified other food allergies that were upsetting her intestines (soy, milk, eggs). When these were eliminated, she was a happy gal again.

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said this on
14 May 2008 8:43:07 PM PST
There is legitimacy to the issues raised in this article. I propose inhaled dermatitis or irritable bowel triggered by handling gluten items - I own a restaurant and exposure to large amounts of gluten has sent me home with a stomach ache and skin rash.

g harrison
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said this on
23 May 2008 7:57:33 AM PST
I was almost convinced that I was a hypochondriac until I discovered it was gluten that was causing the multitude of symptoms that had afflicted me for over 25 years. When doctors don't have an answer, they make you feel as though you are inventing the problem. May be they don't listen to females or take them seriously and attribute their continued symptoms of IBS as female traits or manifestations of mental illness instead of recognizing their own biases have led to the demographics of the statistics in the first place. What drug company funded this study?

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said this on
26 Sep 2010 8:05:34 AM PST
Women always lose out. That's why I try not to listen to my male doctors. I'm sick but I'll continue to search for the real answer. I wish men realized we are not inventing these symptoms. Women simply suffer more than men. Thanks for the encouraging article.

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