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

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