Fatigue in adult coeliac disease

Abstract

Summary Background : Fatigue is reported by many adults at the moment of diagnosis of coeliac disease and during follow‐up. Aim : To evaluate the prevalence, characteristics and associations of fatigue in adult coeliac disease patients. Methods : The investigated sample comprised adults from Campania, Italy. A total of 130 coeliac disease patients were consecutively recruited in both treated (59 on gluten‐free diet) and untreated conditions (71 on normal diet). The control group was made up of 80 healthy controls. Coeliac disease patients and healthy controls underwent laboratory tests, a set of questionnaires for studying fatigue: visual analogue scale for fatigue, chronic fatigue syndrome questionnaire, fatigue severity scale and a modified version of the Zung self‐rating depression scale. Results : Coeliac disease patients showed a significantly lower body mass index than controls (P = 0.0001), lower serum iron (P = 0.04). The entire cohort of coeliac disease patients reported greater modified version of the Zung self‐rating depression scale score (P = 0.001), greater visual analogue scale for fatigue score (P = 0.0001) and greater chronic fatigue syndrome questionnaire score (P = 0.0001) compared with healthy controls. Coeliac disease patients on a gluten‐free diet had a significantly higher modified version of the Zung self‐rating depression scale score than coeliacs on a normal diet (P = 0.001). The prevalence of pathological modified version of the Zung self‐rating depression scale score was 17% in all coeliac disease patients and 0% in healthy controls. A significant correlation was found between modified version of the Zung self‐rating depression scale score and fatigue scale scores in coeliacs on a normal diet. Presence/absence of gastrointestinal symptoms did not show any significant correlation with modified version of the Zung self‐rating depression scale score and fatigue scale scores. In coeliacs on a gluten‐free diet, modified version of the Zung self‐rating depression scale and fatigue scales scores did not significantly differ from coeliacs on a normal diet and were not related to dietetic compliance. Conclusion : In coeliacs, fatigue is a common finding, which ameliorates with the gluten‐free diet and is strictly correlated to depression although coeliacs on a gluten‐free diet showed more frequent and more severe depression symptoms than coeliacs on a normal diet.

Intentional and inadvertent non-adherence in adult coeliac disease. A cross-sectional survey

“…The mainstay of treatment for CD is strict life-long adherence to a gluten-free diet (GFD). For most patients, this results in full clinical and histological remission (Holmes & Catassi, 2000) and is associated with improvements in symptoms and quality of life (Midhagan & Hallert, 2003), a decrease in long term health risks and health gains for problems associated with CD such as infertility, fatigue (Siniscalchi et al, 2005), and depression (Hallert & Sedvall, 1983;Hallert et al, 2002;Whitaker, West, Holmes and Logan, 2009). The GFD is restrictive and can be difficult for some patients to follow however and the most common cause of persistent symptoms is gluten consumption (Dewar et al, 2012;Hopper, Hadijvassiliou, Butt & Sanders, 2007).…”

Psychological morbidity of celiac disease: A review of the literature

“…Using the modified Self-Rating Depression Scale, Addolorato et al 51 described persistent depression after one year of GFD in celiac patients, Zingone et al 57 and Siniscalchi et al 58 showed that depression was present in CD at diagnosis, but that it persisted or even worsened in patients on a GFD. Nachman et al, 44 using the Beck Depression Inventory, showed that depressive symptoms were highly prevalent in untreated CD and there was a significant improvement in psychological symptoms after one year and four years of GFD.…”

“…In the last decade a small number of studies have more directly addressed these issues. Siniscalchi et al in 2005 demonstrated that celiac patients both at diagnosis and when on a GFD had higher levels of fatigue than healthy controls using a variety of validated scales. 58 Perhaps more surprisingly, fatigue was not significantly different between newly diagnosed celiac patients and those on an established GFD.…”

“…Siniscalchi et al in 2005 demonstrated that celiac patients both at diagnosis and when on a GFD had higher levels of fatigue than healthy controls using a variety of validated scales. 58 Perhaps more surprisingly, fatigue was not significantly different between newly diagnosed celiac patients and those on an established GFD. The same researchers from Naples have since shown that both treated and untreated celiac patients experience a worse quality of sleep than healthy volunteers 57 perhaps offering an explanation of the mechanisms behind this condition.…”

“…60 Finally, Ha¨user et al 52 described levels of anxiety greater in CD and in patients with inflammatory bowel diseases compared to controls and similar levels of depression among the three groups. Depression and anxiety may be associated with other factors including an unsatisfactory sexual life, 13 fatigue 58 and poor quality of sleep. 57 Furthermore, functional disorders, such as IBS [72][73][74] and functional dyspepsia 74,75 are frequently diagnosed in CD patients at diagnosis and in those on a long-term GFD.…”