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

Address correspondence and reprint requests to: Winfried Häuser, MD, E-mail: whaeuser{at}klinikum-saarbruecken.de.

	Abstract

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; = 0.83; p = .006); female sex (OR = 2.34; = 0.85; p = .03), and occasional nonadherence to GFD (OR = 1.74; = 0.56; p = .05) were risk factors for IBS-type symptoms. Active medical comorbidities predicted IBS-patient status (OR = 0.40; = -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.