[Specific features of rehabilitation in patients with gluten-sensitivity celiac disease].

AIM: To elaborate recommendations for rehabilitation of patients with gluten-sensitivity celiac disease (GCD) on the basis of a long-term follow-up. SUBJECTS AND METHODS: Eighty-seven patients with GCD were followed up for as long as 31 years. Of those, 72.4% of the patients kept strictly to their gluten-free diet (GFD) throughout the follow-up; 9.2% did not follow the diet periodically; and 18.4% did not at all. The sera from 71 patients were tested for IgA and IgG anti-gliadin antibodies (AGAb) and anti-tissue transglutaminase antibodies (ATTGAb) at as long as 19-year follow-up. AGAb and ATTGAb were estimated by enzyme immunoassay (IMMCO Diagnostics). All the patients underwent endoscopic and histological examinations of the small bowel mucosa (SBM). RESULTS: To support the validity of keeping to the GFD, the time course of clinical, laboratory, and morphological changes were analyzed in 63 and 24 GFD followers and non-followers, respectively. The GFD non-followers were more frequently found to have diarrheic syndrome, symptoms of malabsorption syndrome, lower serum concentrations of hemoglobin, total protein, iron, and calcium; no SBM structural recovery was seen in any patient. When the GFD was long adhered to, there was also a reduction in detection rates and AGAb and ATTGAb concentrations. CONCLUSION: The adherence to the GFD was ascertained to contribute to fuller rehabilitation in the patients. However, even the patients who had strictly kept to their GFD showed periods of an exacerbation and incomplete SBM structural recovery. Therefore, the rehabilitation system for patients with GCD must involve diagnostic, therapeutic, and organizational measures that promote not only rapid clinical recovery, but also better quality of life in these patients.

[The organization of comprehensive rehabilitation of the children presenting with inflammatory intestinal diseases and celiacia under the conditions of a health resort].

In this study we report the experience with the provision of rehabilitative services for the children presenting with long-standing chronic diseases of the digestive organs (ulcerative colitis, Crohn's disease, celiac disease) based at a regional health resort. The possibility of comprehensive rehabilitation was substantiated with the contribution by non-medical specialists including a psychologist, social worker, and educator. A number of organizational problems related to rehabilitation logistics and scientific support have been successfully solved. Standard programs comprising the mechanisms of comprehensive rehabilitation and methods for the evaluation of its effectiveness are proposed.

Disease characteristics as determinants of the labour market position of adolescents and young adults with chronic digestive disorders.

BACKGROUND: Job prospects can be problematic for young patients with chronic digestive disorders. OBJECTIVES: To compare the employment status and disease burden in young adult patients with several chronic digestive disorders with healthy controls, and to determine whether labour participation depends on disease characteristics, such as type of diagnosis and burden of disease. PARTICIPANTS: In total 622 patients categorized into five diagnostic groups--inflammatory bowel disease (IBD) (n=274), chronic liver diseases (n=78), congenital digestive disorders (n=104), food allergy (n=77), celiac disease (n=89)--and a population-based control group (n=248), age 15-24 years. METHODS: Labour participation and burden of disease (i.e. consequences of the disease in daily life) were assessed by a postal questionnaire. Multivariate statistics were computed to investigate the relationship between disease characteristics and labour participation. RESULTS: Patients with IBD or chronic liver diseases were found to have limited job prospects. Patients with chronic liver diseases, IBD and food allergy reported more disease burden regarding several indicators compared with controls. Logistic regression analyses including background characteristics revealed socio-economic status (educational level of parents) and nocturnal toilet use as important determinants of employment. In addition, gender and medication intake were found to be most determinative for a full-time position. CONCLUSIONS: The possible impact of IBD and chronic liver diseases on the labour participation of young adults should be recognized and deserves extra attention from gastroenterologists so that young patients can be supported to increase their job opportunities.

Health-related quality of life in adult coeliac disease in Germany: results of a national survey.

OBJECTIVE: No national survey on the present clinical spectrum and health-related quality of life (HRQOL) in people with coeliac disease has been conducted in Germany until now. METHODS: The German Coeliac Society DZG posted a set of questionnaires (self-developed socio-demographic and medical questionnaire, the Short Form Health Survey, the Hospital Anxiety and Depression Scale and the Giessen Symptom Check List) to 1000/18 355 of their members who were >/=18 years (every 18th member following consecutive postal codes of the membership directory). RESULTS: Four hundred and forty-six usable questionnaires were returned (diagnosis proven by biopsy; 78% female, median age 45.5 years). The median interval between the first medical examination due to symptoms of coeliac disease and the final diagnosis was 1 year. Ninety-eight percent reported a reduction of initial symptoms, 85% an improvement of HRQOL with a median gain in weight of 8 kg after starting a gluten-free diet (median duration of 6 years). Sixty-seven percent adhered all the time to the dietary regimen and 26% adhered most of the time. The most frequent diseases associated with coeliac disease were osteoporosis (15%), oral aphtae (12%) and dermatitis herpetiformis (9%). Because of the presence of gastrointestinal symptoms 26% of the patients met the modified Rome I criteria for irritable bowel symptom. Compared to representative samples from the German population, coeliac disease patients had higher scores for anxiety , fatigue, dyspeptic and musculoskeletal pain, and a reduced HRQOL in 9/10 scales of the SF-36 (all P<0.001). CONCLUSION: Despite being on a gluten-free diet German coeliac disease patients suffer from a high burden of general and extra-intestinal symptoms and a reduced HRQOL.

Quality of life in screen-detected and typical coeliac disease and the effect of excluding dietary gluten.

OBJECTIVE: It is widely recognized that 'asymptomatic' patients with coeliac disease often feel better after commencing a gluten-free diet. The aim of this study was to determine a measure of the quality of life in patients diagnosed as having coeliac disease detected both by screening and those with typical clinical symptoms. METHODS: Quality of life (QoL) was measured using the SF36 questionnaire. This was completed prospectively by all subjects who agreed to undergo duodenal biopsy as a follow-up to a serological screening programme. Seventeen typical coeliac patients who presented clinically also completed the QoL assessment at diagnosis. Both coeliac groups were compared to healthy controls. SF36 questionnaires and coeliac serology were repeated in coeliac patients after 1 year on a gluten-free diet. RESULTS: There were no significant differences between the eight SF36 parameters when the screen-detected coeliac patients were compared to controls, and at 1 year follow-up compared to their baseline data. Two QoL parameters (general health, vitality) improved significantly in the typical coeliac patients at 1 year follow-up compared to their baseline data. General health with reference to 1 year previously significantly improved in typical coeliac patients (3.8 vs 2.2; P = 0.0004) but not screen-detected coeliac patients (2.9 vs 2.4; P = 0.08). CONCLUSIONS: Quality of life in screen-detected coeliac patients did not differ significantly compared to controls. Two of eight QoL parameters improved significantly in typical coeliac patients compared to baseline data. Dietary gluten exclusion in typical coeliac patients led to a significant improvement in health at 1 year follow-up, in contrast to screen-detected coeliac patients.

Affective disorders and quality of life in adult coeliac disease patients on a gluten-free diet.

BACKGROUND: Psychiatric symptoms, common in untreated coeliac disease patients, may improve after gluten withdrawal. AIMS: To estimate the incidence of psychiatric disorders in coeliac disease patients on gluten withdrawal and to evaluate: (1) the psychological weight of a chronic disease that involves a restrictive diet and a limited life style; (2) the acceptance of the disease; (3) the effects of both disease and diet on behaviour and quality of life. PATIENTS AND METHODS: Three groups of 100 patients (coeliac disease patients, diabetic patients and healthy controls, respectively) were assessed by means of a professional semi-structured diagnostic interview based on DSM-IV criteria. This interview, together with specific psychiatric questionnaires, ruled out axis I or II psychopathological disturbances. RESULTS: The modified Self-rating Depression Scale and State and Trait Anxiety Inventory Y2 scores were significantly higher in both coeliac and diabetic patients than in healthy controls. The duration of gluten restriction was related to significantly higher modified Self-rating Depression Scale scores in patients with a more recent diagnosis. Quality of life was poorer in both coeliac and diabetic patients than in healthy controls and significantly correlated with anxiety. The Illness Behaviour Questionnaire showed a high psychological and somatic perception of illness in both coeliac and diabetic patients. Its subscale scores correlated significantly with anxiety and depression symptoms. CONCLUSIONS: In coeliac disease, affective disorders should be ascribed to difficulties in adjusting to the chronic nature of the disease rather than directly to the disease itself, thus giving an indication for preventive liaison psychiatric interventions.

[Living with celiac disease].

Celiac disease (CD) is caused by ingestion of gluten-containing foods by gluten-sensitive individuals. The gluten causes malabsorption by damaging their intestinal mucosa. Adherence to a gluten-free diet is not simple, because the composition of foods stocked on store shelves is often not known, Patients with CD, particularly when adolescent, often refuse to comply with the diet; and parents are occasionally unable, or unwilling, to prepare gluten-free food. Furthermore, school teachers are usually ignorant of the specific dietary requirements of these patients. We examined physical, scholastic, and social aspects of CD patients in comparison with their siblings in the same age groups (10-18 years) to determine whether CD and the need to keep a diet influence these parameters. 25 CD patients and 14 of their siblings were interviewed at home where they filled a questionnaire. The mean adherence to a gluten-free diet was 96.6%; the heights of the patients were comparable to those of their siblings. We did not find significant differences in scholastic achievement and social adjustment between patients and siblings. It appears that children and adolescents with CD can live with their disease and keep a gluten-free diet while performing satisfactorily in school. However, some complained of difficulties, such as feeling uneasy at social gatherings, wanting to discuss their disability with friends, and feeling unhappy. Some were angry at society for pitying them and considering them as having a disease, while the patients considered themselves as having a food sensitivity.

[The catamnesis of children with celiac disease]. / Katamnez detei s tseliakiei.

A prospective follow-up was conducted of 29 patients with celiac disease 3 to 10 years in duration. Of these, 8 were on a spare agluten diet, in whom the time-related course of clinical manifestations of the illness was characterized by stabilization of the primary symptoms of disturbed intestinal absorption, improvement in the psychoemotional state at year of their prophylactic management. The glucose tolerance test had gotten normalized after two years of being on a spare diet, lactose tolerance test remaining below the normal range in 37.5 percent of cases at year 3 of the observation, with the content of IgG antibodies to gliadine exceeding the threshold values in 33.3% on an average three times as much as the norm. In those patients having not been on a spare diet, retardation in physical development was recordable together with bone abnormalities manifested by pathologic fractures of the tubular bones. The level of anti-gliadine antibodies of both classes was found to be augmented in 71.4 percent of cases, their values having been fifty times as much as the norm. Glucose tolerance test suggested to us a steady decline in the absorption that was still to be seen at year 10 of the prospective follow-up. Lactase intolerance was somewhat less, remaining at lower values in the half of the patient population.