Gluten-free diet improves quality of life in both nonclassical, classical coeliac disease

Patients with either classical or nonclassical coeliac disease (CD) show improvement in quality of life (QOL) and achieve a comparable QOL following adherence to a gluten-free diet (GFD) despite the latter showing better QOL at diagnosis, reports a study.

The authors identified patients with biopsy-proven classical and nonclassical CD at a tertiary care centre, who completed a Talley Bowel Disease Questionnaire and the Short Form-36 at diagnosis and who had been on a GFD for at least 1 year.

Participants were further surveyed to examine gastrointestinal symptoms, QOL, Somatization Symptom Checklist (SSC), and adherence to a GFD. The authors then compared the results between patients with classical versus nonclassical presentation of CD.

A total of 122 patients were included in this study, of whom 62 had classical CD and 60 had nonclassical CD. Health-related QOL at diagnosis was poorer among patients in the classical CD group than those in the nonclassical CD group.

Adherence to a GFD resulted in improved QOL and substantially increased body mass index in both CD groups. In addition, most subscales of QOL, SSC scores, and adherence to the GFD were similar between the two groups, except for the Short-Form-36 Mental Component summary scores that remained lower in the classical CD group (48.4 vs 52.6; p=0.03).

“CD often presents with symptoms of diarrhoea and malabsorption, termed classical CD, [but] it can also present as nonclassical CD, which is commonly associated with nongastrointestinal symptoms,” the authors explained, noting that nonclassical CD tends to have less severe symptoms than classical CD, which may affect both adherence to a GFD and psychological stress, as suggested by some studies.