Functional Dyspepsia Symptoms Are Strongly Associated With Coeliac Disease: Results From a Population-Based Study

Abstract

Introduction: Coeliac disease (CD) is estimated to affect up to 1 in 100 Australians. Although CD has a wide range of clinical manifestations, patients frequently present with gastrointestinal (GI) symptoms which overlap with functional GI disorders such as irritable bowel syndrome (IBS) or functional dyspepsia (FD).Patients with CD have been shown to experience persistent GI symptoms despite long term treatment with a gluten free diet. Methods: The aim of this study was to define GI symptoms reported in an Australian cohort with a doctor diagnosis of CD and compare with those not reporting CD. A total of 3825 people (mean age 58.4 years, age range 18-100 years and 47.5% males) randomly selected from the Australian population returned a mail survey (Digestive Health & Wellbeing Survey, response rate=45%) which contained questions on whether the participant had ever been told by a physician that they had CD, and GI symptom questions to establish whether they had co-existent functional GI disorders. Adherence to a gluten free diet was not assessed. Prevalence of CD, FD and IBS are reported with 95% exact confidence intervals. The difference between symptoms in CD compared with the unaffected population was tested for significance using a Pearson chi-square test. Results: The prevalence of doctor diagnosed CD was 1.17% in this cohort. Subjects with CD reported significantly higher levels of GI symptoms than unaffected individuals, including abdominal pain associated with abnormal bowel habit, diarrhoea, bloating, distention, epigastric burning and early satiety (see Table 1). There was no significant difference observed in symptoms of post-prandial fullness, nausea, constipation, abnormal stool consistency, or straining with defecation. The prevalence of FD as defined by Rome III criteria in the CD cohort was 37.5% (95% CI 22.7-54.2) compared to 13.9% (95% CI 12.8- 15.1) in the non-affected population (OR 3.7, 95% CI 1.9-7.1, p < 0.001). There was no significant difference in the prevalence of IBS in the affected compared with the non- affected cohort (30.8% versus 22.2%, p=0.2).Table: Table. Gastrointestinal symptoms reported in patients with and without coeliac disease (CD). Items reported as greater than one day per week (*) or greater than or equal to “often” (**)Conclusion: The prevalence of gastrointestinal symptoms and a diagnosis of functional dyspepsia are significantly higher in patients with a doctor diagnosis of CD than in the unaffected population.