Quality of life in celiac disease patients Prospective analysis on the importance of clinical severity at diagnosis and the impact of treatment

Background/aims. Celiac disease (CD) patients are affected in their quality of life (QoL). Our objectives were to assess differences in quality of life of patients according to the clinical presentation at diagnosis, and to determine the time-course impact of a gluten-free diet. Patients/methods. We prospectively evaluated 132 newly diagnosed adult CD patients and 70 healthy controls using self-administered questionnaires: the Short Form-36 health survey, the Gastrointestinal Symptoms Rating Scale; the Beck Depression Inventory both, at diagnosis and at 3-, 6- and 12-months on treatment. Results. At diagnosis, patients with classical symptoms (n = 97) exhibited a significantly more pronounced alteration of all items of the three questionnaires than atypical/silent cases (n = 35) (p < 0.01 to <0.00001). Silent CD patients had even better baseline scores (p < 0.05 to <0.00001). Treatment produced a substantial and rapid (3-month) improvement of most outcome measures in classical and atypical patients but not in asymptomatic cases. Both subgroups attained comparable final scores with no differences comparing strictly adherents with partially compliant. Conclusions. Atypical/silent celiac disease patients have a significantly better baseline quality of life than those with classical symptoms. Treatment induces a rapid and significant improvement in symptomatic cases but not in silent patients with all subgroups having similar I-year scores comparable to healthy controls. (C) 2008 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.