Fatigue as a Determinant of Health in Patients With Celiac Disease

Abstract

Symptoms of uncontrolled celiac disease impair patients' health-related quality of life, which improves with the exclusion of gluten from the diet. A symptom frequently reported, but difficult to make objective, is fatigue. The Daily Fatigue Impact Scale (D-FIS) questionnaire consisting of 8 items, each scored on a 0 to 4 point scale, with lower scores reflecting greater fatigue, was employed to measure fatigue in celiac patients. To assess the influence of fatigue on perception of health in celiac disease patients determined as their quality of life. Prospective, cross-sectional study in celiac disease patients diagnosed by serology and histology. Instruments used were the D-FIS to measure fatigue and the generic EuroQol5D to measure quality of life. An additional question on the frequency of problems due to fatigue, scored on a 7-point Likert scale, was used to evaluate the importance of fatigue. RESULTS (IN MEDIANS): In all, 51 patients were included (13 untreated and 38 treated with a gluten-free diet). D-FIS score was significantly worse in untreated celiacs (16.0 vs. 3.0, P<0.001). Scores on the frequency scale of fatigue-related problems were also worse in untreated celiacs (2.0 vs. 6.0, P<0.001). Fatigue and quality-of-life scores were inversely correlated (r=-0.6, P<0.001). Fatigue severity was also greater in patients with worse quality of life (13.0 vs. 2.0, P<0.01). Multiple regression analysis showed fatigue to be an independent determinant of quality of life. Fatigue is a major concern in untreated celiac disease patients, which impacts their quality of life.