Long term health and quality of life

Untreated coeliac disease is associated with long term health complications including osteoporosis, anaemia, delayed puberty and growth impairment.  A prospective 10 year follow up study investigated whether detection of childhood coeliac disease by mass screening improves long term health status and quality of life.

Method

After mass screening of 12,672 children aged 2-4 years at a child health centre in Holland, 32 children were diagnosed with coeliac disease. The 32 children identified were followed up in a prospective study from 1998-2007. The children were followed up for their general health, coeliac disease related symptoms and health related quality of life.

Symptom improvement

At the time of diagnosis, 19 of the 32 children started a gluten-free diet and 13 continued their normal gluten-containing diet.  After 10 years, 26 of the children were following the gluten-free diet.

At diagnosis 13 of the children had symptoms of diarrhoea, abdominal pain, constipation, chronic fatigue, irritability and mouth ulcers. After following the diet for 1 year, all the children showed improvement in their symptoms.  A further 8 of the children developed symptoms after diagnosis as a result of including gluten in their diet. Symptoms cleared after gluten was removed from the diet.

Also, 7 of the children had an improvement of symptoms including failure to thrive and osteoporosis after starting the gluten-free diet.  However, these children developed other health problems including constipation.  This could be due to factors unrelated to their coeliac disease or due to reduced fibre in the gluten-free diet.  The overall health status improved as the other health problems were less severe.

Long term follow up studies are required to assess possible long term consequences in people with untreated coeliac disease with no symptoms.

Quality of Life

Using the DUX-25, the health related quality of life of the children with symptoms was found to be lower than the general Dutch population at diagnosis.  However, their quality of life improved significantly after diagnosis.

Screening for coeliac disease

Mass screening resulted in health improvements in 21 of the 32 children in this study. 

Van Koppen E, Schweizer J, Csizmadia C, et al (2009) Long-term health and quality of life consequences of mass screening for childhood celiac disease: a 10year follow-up study. Paediatrics 123, e582- e588