Coeliac: A Gut Feeling. An Investigation Into What Factors Influence Patterns Of Clinical Presentation In Adult Onset Coeliac Disease

Aims Anxiety and depression are common in coeliac disease (CD) patients, and many psycho-social explanations have been considered. However, as the gut-brain axis is becoming increasingly understood, biological mechanisms have been proposed, including vitamin or mineral deficiencies and gut inflammation. The aim of this study was to investigate associations between anxiety/depression and symptom severity, vitamin status, and gut inflammation in untreated adult patients presenting with a serologic indication of coeliac disease.

Methods The Hospital Anxiety and Depression Scale, Coeliac Symptom Index and Perceived Stress Scale questionnaires were administered to 17 patients over a 14-month period. Duodenal biopsies were obtained to determine histological Marsh score. Iron, B12, folate, vitamin D and thyroid function tests were reviewed.

Results HADS-A scores correlated with symptom severity (rs=0.62, p=0.008) but not with any hematological investigations or degree of intestinal inflammation. No patients scored highly for depression. Iron deficiency was the most common deficiency observed (n = 6). Greater symptomatology was associated with female sex (females vs males, average CSI scores 32.1 vs 23.6; t17= 2.1, p<0.05), younger age at presentation (rs= -0.55, P = 0.02), and lower Marsh score (Marsh 0 vs Marsh 3C, mean scores 36 vs 24.5; t5= 6.2, p=0.009).

Conclusions Anxiety experienced by CD patients at presentation is likely a reactive form due to gastrointestinal symptoms rather than a biologic process specific to CD. Older patients tend to present less symptomatically, highlighting the need for screening of at-risk individuals. The degree of villous atrophy does not correlate well with clinical presentation. Highly symptomatic patients should be screened for anxiety at presentation to allow for early intervention and ultimately, improved gluten-free diet adherence.

Citation O’Shaughnessy K, Jackson L, Stack W et al. eP110 COELIAC: A GUT FEELING. AN INVESTIGATION INTO WHAT FACTORS INFLUENCE PATTERNS OF CLINICAL PRESENTATION IN ADULT ONSET COELIAC DISEASE. Endoscopy 2021; 53: S132.

Publication History

Article published online:
19 March 2021