Abstract
BackgroundCeliac disease (CD) is a global health problem and its prevalence is underestimated, especially in Latin American populations. Our aim was to evaluate the clinical features, psychological factors, and health-related quality of life (QoL), before and after diagnosis, in a representative sample of adult Mexican Mestizo patients presenting with CD.MethodsA cross-sectional analysis was conducted on patients seen at two tertiary referral centers in Mexico. QoL before and after CD diagnosis was evaluated using the EuroQoL 5D, the Hospital Anxiety and Depression Scale (HADS), and the disease-specific Celiac Symptom Index (CSI) questionnaires.ResultsWe included 80 patients (80% were women, with a mean age of 48.6 ± 14.1 years). The most common symptoms were diarrhea (86%), bloating (77.5%), and abdominal pain (71.3%). Mean symptom duration was 10.33 ± 6.3 years. Fifty-one patients (63.8%) had a previous diagnosis of irritable bowel syndrome (IBS) and 23 (28.8%) had one of functional dyspepsia. Questionnaire respondents rated their health status at 50% before diagnosis (0 = worst imaginable state, 100 = best imaginable state) and there was a significant improvement of 26% after diagnosis. Thirty-nine percent of the patients had a CSI score > 45 and they were the ones that had been previously diagnosed most often with IBS (p = 0.13) or dyspepsia (p = .036).ConclusionsAt the time of diagnosis, Mexican Mestizo patients with CD had poor QoL. Long-standing symptoms and a previous diagnosis of functional disorders were associated with worse QoL. As in other populations, our results support the need for a detailed examination of cost-effective strategies for increasing CD awareness in clinical practice.
Highlights
Celiac disease (CD) is a global health problem and its prevalence is underestimated, especially in Latin American populations
It has recently been reported that seroprevalence for CD using both anti-transglutaminase and anti-endomysial antibodies (EMA) is 0.59% (0.27%-1.29%) in the Mexican Mestizo population [15]
The Mexican Mestizos in this study were defined as individuals that came from two generations, including their own, of persons born in Mexico, descendants of the original autochthonous inhabitants of the region, as well as of white, mainly Spanish, or black African individuals that came to America in the 16th century [18]
Summary
Celiac disease (CD) is a global health problem and its prevalence is underestimated, especially in Latin American populations. Its typical clinical presentation is characterized by signs or symptoms of malabsorption (anemia, abdominal pain, chronic diarrhea, or malnutrition) as a consequence of chronic inflammation and villous atrophy of the small bowel mucosa [1,2]. This clinical picture has changed over time and, at present, a considerable number of patients do not have gastrointestinal symptoms, but Ramírez-Cervantes et al BMC Gastroenterology (2015) 15:4. Sotelo et al found HLA DQ2/DQ8 haplotypes in 11 out of 15 children with CD in Northern Mexico [16] and Cerda et al found a more frequent expression of DQ8 haplotypes in adults with CD [17]
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