Background
At present, the only treatment for coeliac disease is a lifelong gluten-free diet, i.e. exclusion of wheat-, rye- and barley-containing cereals and food products. Upon removal of gluten from the diet clinical symptoms are usually rapidly alleviated, while recovery of the duodenal mucosa may take several months or even years. The treatment may also prevent many coeliac disease-associated complications such as intestinal malignancies. Notwithstanding these benefits, the stigma of a chronic disorder and the need for major dietary restrictions increases the self-perceived burden of illness and may impair patients' quality of life. The symptoms may also remain despite a long-term and strict diet. As a result, in some studies even well-treated coeliac patients have failed to attain well-being similar to that of the population in general, albeit that there are also contradictory results. To improve the situation, knowledge of the factors underlying these persistent health concerns in coeliac patients is required. Thus far, only a limited number of studies have investigated this issue; data are scant, particularly in screen-detected patients and in subjects with extraintestinal presentation.
The aim of this large nationwide study was to find predictors of persistent gastrointestinal symptoms and reduced health-related quality of life in long-term treated adult coeliac patients. Particular attention was devoted to aspects such as duration and severity of symptoms before diagnosis and presence of coeliac disease-associated and other co-morbidities.