Symptom Profiles Compatible With Disorders of Gut-Brain Interaction in Individuals With Coeliac Disease on a Long-Term Gluten-Free Diet.

Abstract

Background: Persistent gastrointestinal (GI) symptoms are frequently reported in patients with coeliac disease (CD). Knowledge about the role of disorders of gut-brain interaction (DGBI) as the cause of these persistent symptoms remains limited.

Objective: To assess the prevalence and factors associated with DGBI-compatible symptom profiles in individuals with CD on a long-term gluten-free diet (GFD).

Methods: Adult members of the Dutch Coeliac Society completed an online survey, including the Rome IV diagnostic questionnaire and validated questionnaires assessing psychological distress, non-GI somatic symptom severity, and health-related quality of life (QOL). Only individuals with CD adhering to a GFD ≥ 1 year were included. A population-based Dutch cohort served as the reference group.

Results: Among 1001 participants with CD (79.3% female; median age 50 years), 64.8% met the criteria for ≥ 1 DGBI-compatible symptom profile compared with 31.3% in the reference group (for confounders adjusted odds ratio (AOR) 3.2 (95% CI 2.6-3.8)). Irritable bowel syndrome showed the strongest association with CD (AOR 4.5 (95% CI 3.3-6.2)). Having DGBI-compatible symptom profiles was, like the reference group, associated with higher levels of psychological distress and non-GI somatic symptom severity and lower health-related QOL.

Conclusions: Rome IV DGBI-compatible symptom profiles are highly prevalent in individuals with CD on a long-term GFD and are associated with impaired QOL. While ongoing gluten exposure and other comorbidities could not be excluded, these findings support the consideration of DGBI in the evaluation and treatment of persistent symptoms in patients with CD.