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Predictors of Irritable Bowel-Type Symptoms and Healthcare-Seeking Behavior Among Adults With Celiac Disease

From the Department Internal Medicine I (W.H.), Klinikum Saarbrücken, Saarbrücken, Germany; Department of Internal Medicine V (F.M.), Kliniken Essen-Mitte, Knappschaftskrankenhaus, Essen, Germany; Department of Internal Medicine I (W.F.C., J.S.), Johann Wolfgang von Goethe-Universität Frankfurt, Frankfurt, Germany; Department of Internal Medicine I (A.S.), Friedrich-Schiller Universität Jena, Germany.

Address correspondence and reprint requests to Winfried Häuser, Department of Internal Medicine I, Klinikum Saarbrücken gGmbH, Winterberg 1, D-66119 Saarbruecken, Germany. E-mail: whaeuser{at}klinikum-saarbruecken.de

Objectives: To assess the frequency of irritable bowel syndrome (IBS)-type symptoms and consecutive healthcare-seeking behavior, their impact on health-related quality of life (HRQOL), and their possible biopsychosocial determinants in adult patients with celiac disease (CD).

Methods: A total of 1000 adult patients with CD from the German Celiac Society completed a medical (including bowel) and a sociodemographic questionnaire, the Short Form Health Survey (SF-36), and the Hospital Anxiety and Depression Scale through a postal survey.

Results: Of 412 respondents with reported biopsy-proven diagnosis with major adherence to a gluten-free diet (GFD) for 1 year, 96 (23.3%) patients fulfilled the modified Rome I criteria for IBS. Of these 96 patients, 76 (79.2%) sought help (medical and/or nonmedical) due to bowel symptoms (referred to as patients with IBS). IBS-type symptoms had a significant negative impact on the physical summary score of the SF-36 (p = .05). Mental disorder (OR = 2.29; ß = 0.83; p = .006); female sex (OR = 2.34; ß = 0.85; p = .03), and occasional nonadherence to GFD (OR = 1.74; ß = 0.56; p = .05) were risk factors for IBS-type symptoms. Active medical comorbidities predicted IBS-patient status (OR = 0.40; ß = –0.92; p = .001).

Conclusions: The data support the biopsychosocial model of IBS: IBS-type symptoms in adult patients with CD can be explained through an interaction of clinical and sociopsychological mechanisms.

Key Words: celiac disease • irritable bowel syndrome • biopsychosocial model

Abbreviations: CD = celiac disease; FGID = functional gastrointestinal disorder; GFD = gluten-free diet; HRQOL = health-related quality of life; IBD = inflammatory bowel disease; IBS = irritable bowel syndrome.

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