Two-hundred and twenty-nine patients newly diagnosed adult patients with celiac disease were eligible. A total of 186 (mean age ± SD: 37.6 ± 12.5 years) fulfilling the inclusion criteria were enrolled in the study, and 43 patients were not included because of exclusion criteria. The majority of CD patients were feminine gender (n = 152, 81.7%), with age <40 years (n = 117, 63%). Ninety-six GERD patients were selected as the control group. They were similar for gender (women n = 70, 72.9%, χ2 1.842, p = 0.2) and age (mean age ± SD 36.2 ± 11.8 years, p = 0.4) distribution to the CD group. As for the BMI, as expected, it was higher in GERD than in CD patients (mean BMI ± SD: 24.7 ± 3.1 in GERD patients and 22.3 ± 3.8 in CD patients, p = 0.000), but none of them showed a BMI greater than 30. None of them refused to answer the questionnaires.
CD and control group did not differ in the length of the period with symptoms prior to diagnosis (4.87 ± 5.8 vs. 5.56 ± 3.0 years, p = 0.4). Gastrointestinal symptoms (diarrhea and/or abdominal pain) were present in 43% of CD and 22% of control group patients (χ2 11.402, p < 0.001). Dyspepsia was present in 41% of CD and 62% of control group patients (χ2 9.956, p = 0.002). Weight loss was present in 24% of CD and 12% of control group patients (χ2 5.677, p = 0.017). GERD symptoms were present in 46% of CD and 100% of Control group patients (χ2 77.640, p < 0.001).
CD patients were statistically more likely to have a life event prior to the diagnosis (OR 3.495% CI 1.766–6.606) compared to patients in the GERD group although the severity of the event assessed by the Paykel’s interview was significantly higher in control group patients than CD (). In the comparison between the two diseases, differences were not significant in the time lapse between the date of the event and the date of the diagnosis. Due to the higher prevalence of women in both groups a gender-analysis was performed. A significantly higher prevalence of events was observed in women in the CD group than in the control group (71.1% vs. 34.3%, χ2 16.727, p < 0.001), while men did not differ in the frequency of events between groups (50.0% vs. 46.2%, χ2 0.056, p = 0.8).
Table 1 Reported number of events according to the Paykel’s interview, time lapse from the event to the diagnosis, and normative values (the standardized weight of each event in the scale) in coeliac disease (CD) and control gastroesophageal reflux disease (more ...)
Pregnancies were reported in 79 CD and in 22 control group women. Number of pregnancies/women was 1.03 ± 1.13 for celiac women and 1.00 ± 0.9 for disease control women (p = 0.9). Additional analyses were done to exclude that pregnancy could be a major determinant of the difference in the prevalence of events between CD and control disease. To address this possibility, the comparison between women with CD and women with control disease was repeated after exclusion of events related to pregnancy. However, a significant difference in the prevalence of events between the CD and the control group was confirmed in this additional analysis (67.4% vs. 34.3%, χ2 12.769, p < 0.001). Furthermore, 20.3% of CD women who experienced a pregnancy indicated the pregnancy itself as a stressful event, while no women who experienced a pregnancy in the control disease group did (p = 0.02).
shows the distribution of life events by the 10 categories of the Paykel’s interview. The two most common categories of events in CD patients were somatic health problems and loss (prevalence > 17%). Distribution of events was similar in the Control group. CD patients reported most frequently gastrointestinal symptoms, and diagnosis of severe anemia, osteoporosis, and thyroiditis among somatic health problems.
Distribution of life events among the 10 areas identified by the Paykel Scale in CD and control (GERD) subjects.
Since most of somatic health problems might be considered dependent from the illness under consideration, analyses were repeated with the exclusion of the patients reporting health-related events. CD patients reported more frequently events independent from the disease when compared to the control disease group (86/147 (58.5%) vs. 26/86 (30.2%), χ2 10.655, p = 0.001).
describes the patients’ opinions about the possible relationship between the reported event and the disease development. Findings were not significantly different between the CD group and Control group (χ2 1.132, p = 0.9) and indicated that only a minority of the patients pointed out that the event could have a role in the development of the disease.
Patients’ opinion about the effect of the reported event on the development of the disease Scale in CD and control (GERD) subjects according to the Paykel scale.
Celiac patients were interviewed extensively about the life events that occurred during the year prior to the onset of symptoms. Since symptoms typically precede diagnosis by months or even years in this condition, we aimed to explore specifically whether limiting the time lapse from the diagnosis and the onset of symptoms as much as possible changes the previous findings. Then, the analyses were repeated selecting subgroups of CD and GERD patients in whom symptoms begun not more than 12 months before diagnosis. In this subgroup, CD patients reported a higher prevalence of life events than GERD patients (40/56, 71.4% vs. 18/48, 37.5%, χ2 12.062, p = 0.01). This prevalence became even stronger with the exclusion of patients who experienced a pregnancy and consequently reported events (χ2 8.181, p = 0.006).