Mucosal healing in coeliac disease may occur at expense of increased mood disorders
Anxiety and depression appear to be more common in coeliac disease patients who have achieved mucosal healing than in those with persistent villous atrophy, both before and after follow‐up biopsy, a study has found. This association is potentially mediated by vigilant compliance with a gluten-free diet (GFD).
Researchers looked at two groups of coeliac disease patients: those with persistent villous atrophy (n=3,317) and those with mucosal healing (n=4,331). Incidence rates of anxiety (123 vs 94 patients; 2.8 vs 2.1 per 1,000 person-years) and depression (167 vs 148 patients; 3.8 vs 3.3 per 1,000 person-years) during follow-up were higher in the latter vs former group.
Cox regression analysis revealed mucosal healing to be significantly associated with about a 50-percent increased risk of future anxiety (hazard ratio [HR], 1.49; 95 percent CI, 1.12–1.96) and a 25-percent higher risk of depression (HR, 1.25; 0.99–1.59).
Mucosal healing notably occurred with greater frequency in patients with prior diagnoses of anxiety or depression, according to pre-follow-up biopsy data. Anxiety diagnosed between diagnostic and follow‐up biopsy for coeliac disease was associated with an almost ninefold greater likelihood of achieving mucosal healing (odds ratio, 8.94; 2.03–39.27).
According to researchers, the increased frequency of anxiety and depression in the present population may be explained by patients being more careful with GFD, although it may also represent proof of the burden of treatment in coeliac disease.
GFD is said to influence psychological wellbeing and, ultimately, the risk of psychiatric disease through increased costs, poor palatability, lack of available gluten‐free foods, difficulties when eating out or travelling abroad, distrust of gluten-free menu designations, and the social restriction of having another diet, among others. [J Hum Nutr Diet 2016;29:593‐606]
In some reports, the burden of treatment of coeliac disease, including the social restrictions of GFD, can be so severe as to affect even the wellbeing of caregivers of coeliac disease patients. [Dig Liver Dis 2017;49:273‐279]