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Reflux and irritable bowel syndrome are negative predictors of quality of life in coeliac disease and inflammatory bowel disease

Barratt, Stephen M.a; Leeds, John S.a; Robinson, Kerrya; Shah, Premal J.b; Lobo, Alan J.a; McAlindon, Mark E.a; Sanders, David S.a

European Journal of Gastroenterology & Hepatology: February 2011 - Volume 23 - Issue 2 - p 159–165
doi: 10.1097/MEG.0b013e328342a547
Original Articles: Intestinal Inflammation

Background and aim An increased prevalence of reflux and irritable bowel syndrome (IBS) symptoms is associated with coeliac disease and inflammatory bowel disease (IBD). We aimed to determine the prevalence of reflux and IBS symptoms in a cohort of patients with coeliac disease and IBD and their relationship with quality of life (QoL) and psychological distress.

Methods Histologically proven coeliac disease (n=225), ulcerative colitis (UC) (n=228), Crohn's disease (CD) (n=230) patients and age/sex-matched controls (n=348) completed the Short-Form 36 (SF-36)-Item Health Survey, Hospital Anxiety and Depression Scale (HADS), reflux screen and Rome II criteria.

Results UC patients report higher SF-36 (QoL) scores than coeliac disease; CD fairing worse overall (P 0.0001). Reflux prevalence: coeliac disease 66%; UC 62%; CD 72%; controls 50%. Patients report reflux of a greater severity: coeliac disease odds ratio=6.8, 95% confidence interval=3.6–12.7, P 0.001; IBD odds ratio=2.2, 95% confidence interval=1.6–3.2, P 0.0001. Stepwise reductions in SF-36 scores in association with increasing reflux severity were found (P 0.0001). IBS prevalence: coeliac disease 22%; UC 16%; CD 24%; controls 6%. Concomitant IBS was associated with reduced SF-36 scores in patients (P 0.0001).

Conclusion Reflux and IBS are more prevalent in coeliac disease and IBD in comparison with age-matched and sex-matched controls. These additional symptoms are associated with reduced QoL and increasing likelihood of anxiety and depression. QoL may be improved if coeliac disease and IBD patients were assessed for reflux and IBS.

aThe Gastroenterology and Liver Unit, The Royal Hallamshire Hospital, Sheffield, South Yorkshire

bThe Royal Edinburgh Hospital, Edinburgh, UK

Correspondence to Stephen M. Barratt, BA (Hons), BMedSci (Hons), The Gastroenterology and Liver Unit, Room P39, The Royal Hallamshire Hospital Glossop Road, Sheffield S10 2JF, South Yorkshire, UK Tel: + 44 114 2261179; fax: + 44 114 2712692; e-mail:

Received September 30, 2010

Accepted November 14, 2010

© 2011 Lippincott Williams & Wilkins, Inc.