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Adult Celiac Disease: Psychosocial Factors Affect Patient Symptoms and Health More Than Disease Itself

New research on psychosocial factors and celiac disease 09/15/2010 - Until the present study, no clinical research had been published regarding the relative effects of clinical and psychosocial variables on outcome in celiac disease.

A team of researchers examined psychosocial factors that may influence disease activity in celiac patients, such as relationships among demographics, psychosocial factors, and disease activity with health-related quality of life (HRQOL), health care utilization, and symptoms.

The research team included Spencer D. Dorn, Lincoln Hernandez, Maria T. Minaya, Carolyn B. Morris, Yuming Hu, Suzanne Lewis, Jane Leserman, Shrikant I. Bangdiwala, Peter H. R. Green and Douglas A. Drossman of the Center for Functional GI and Motility Disorders at the University of North Carolina, Chapel Hill, USA.

The team enrolled 101 adult patients with celiac disease with the goal of charting any relationships among demographics, psychosocial factors, and disease activity with health-related quality of life (HRQOL), health care utilization, and symptoms. All patients were newly referred to a tertiary care center with biopsy-proven celiac disease.

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The team examined: (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). They then conducted multivariate analyses to predict HRQOL, daily function, self-reported health, number of physician visits, and GI symptoms, such as pain and diarrhea.

They found that patients with psychological distress and poor coping skills suffered from impaired HRQOL and daily function.

Patients who reported poorer health generally showed poorer coping, longer symptom duration, lower education, and greater weight loss. Patients with poorer coping, abnormal tTG levels, and milder Marsh classification generally had more physician visits.

Patients with higher psychological distress and greater weight loss also showed higher pain scores. Patients with greater psychological distress and poorer coping also showed higher rates of diarrhea.

Their results show that among patients at celiac disease referral centers, psychosocial factors have a greater impact on health status and GI symptoms than does disease activity. Such factors should be considered as part of the patient's treatment and prognosis.

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6 Responses:

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said this on
20 Sep 2010 7:03:57 AM PST

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said this on
20 Sep 2010 2:30:15 PM PST
Gut bacteria, mechanisms of action of the intestinal microbiota in immune-mediated diseases, might be involved in the "relative effects" of clinical and psychosocial variables on outcome in celiac disease..

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said this on
20 Sep 2010 8:33:20 PM PST
I am sorry that Mr. Adams did not critique this study from a celiac's perspective. For myself, I find the findings flawed and potentially detrimental to the diagnosis and treatment of celiac disease.

The researchers conclude that psychosocial factors have greater impact on GI symptoms and health generally than CD itself. What they do not consider is that it may be the CD which is causing those so-called psychosocial factors. For instance, they find that subjects with psychological distress and poor coping skills suffered higher rates of diarrhea, poorer health, impaired daily function. They do not appear to have considered that people suffering from the degradations and humiliations, not to mention malnutrition, of chronic diarrhea are likely to suffer psychological distress and to cope poorly.

Likewise, they find that subjects with high psychological distress and greater weight loss had higher pain scores. Did they not consider that people with high levels of chronic pain are likely to have advanced intestinal destruction leading to severe malnutrition caused by the inability to process food, and that the chronic pain and malnutrition might possibly cause the psychological distress?

As with so many medical studies, the researchers are drawing questionable conclusions by misinterpreting and mis-attributing causality. This is a trend the celiac community should stand up against.

It is difficult enough getting research attention, and getting the medical community to be informed. We do not need researchers leading the medical community down the wrong path by misinforming them about how celiac disease does and does not work. This misinformation is not simply bad science, but potentially harmful to vulnerable, and frequently fragile, patients.

I hope in the future that will take the opportunity not just to reiterate the study abstracts, but to apply some critical thinking, and if necessary calling celiacs to action to hold such researchers to account for the flaws in their work.

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said this on
22 Sep 2010 9:05:59 PM PST
CeliBelli, I completely agree with you. There is so much preconception about cause and affect. I also think psychosomaticism is paid too much attention. Drug use is blamed too much in my family for early deaths, instead of recognizing the use of drugs and alcohol as symptoms. I am the first and only one diagnosed among my relatives. A lot of negative emotions are largely symptoms of malnutrition, as well as attack by one's own immune system, let alone the ignorance of and abuse by gluten consumers, and the friction caused by the very real dangers to celiacs at the hands of the majority.

Jeff Kelly
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said this on
25 Oct 2010 6:00:18 PM PST
Disparaging type article that we don't need--we lived the preconceived baloney for far too long as per Jefferson's other article on here which tells a more accurate story and presents a more accurate picture.

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said this on
03 Dec 2010 4:12:56 PM PST
Celiac disease is caused by two markers discoverable on a blood screen and endoscopy, period. Wheat has been engineered in recent years to contain five times as much gluten, a disaster for those of us who have celiac disease. Because there is no real money to be made by prescription drug makers or surgeons, the psychotropic drug industry is attempting to link yet another medical condition to some psychological element that they can add it to the hundreds of new entries in the DSM in recent years--all of which they "diagnose" as requiring their "services" and psychotropic medications (increasing their incomes); all it really requires is a gluten-free diet. I agree with Celli-Belli completely.

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