Floris van Overveld

Background: Persistent gastrointestinal (GI) symptoms are frequently reported in patients with coeliac disease (CD). Knowledge about the role of disorders of gut‐brain interaction (DGBI) as the cause of these persistent symptoms remains limited. Objective: To assess the prevalence and factors associated with DGBI‐compatible symptom profiles in individuals with CD on a long‐term gluten‐free diet (GFD). Methods: Adult members of the Dutch Coeliac Society completed an online survey, including the Rome IV diagnostic questionnaire and validated questionnaires assessing psychological distress, non‐GI somatic symptom severity, and health‐related quality of life (QOL). Only individuals with CD adhering to a GFD ≥ 1 year were included. A population‐based Dutch cohort served as the reference group. Results: Among 1001 participants with CD (79.3% female; median age 50 years), 64.8% met the criteria for ≥ 1 DGBI‐compatible symptom profile compared with 31.3% in the reference group (for confounders adjusted odds ratio (AOR) 3.2 (95% CI 2.6–3.8)). Irritable bowel syndrome showed the strongest association with CD (AOR 4.5 (95% CI 3.3–6.2)). Having DGBI‐compatible symptom profiles was, like the reference group, associated with higher levels of psychological distress and non‐GI somatic symptom severity and lower health‐related QOL. Conclusions: Rome IV DGBI‐compatible symptom profiles are highly prevalent in individuals with CD on a long‐term GFD and are associated with impaired QOL. While ongoing gluten exposure and other comorbidities could not be excluded, these findings support the consideration of DGBI in the evaluation and treatment of persistent symptoms in patients with CD.

INTRODUCTION: Celiac disease (CD) may affect quality of life (QoL), health care use, and societal costs in various ways both before and after diagnosis. However, detailed evidence remains limited about how costs and QoL change after diagnosis and which patient characteristics (e.g., symptom duration) influence those changes. The aim of this study was to evaluate CD patients' QoL and societal costs before and after diagnosis. METHODS: In this cross-sectional study, 2,691 patient-members of the Dutch Celiac Society completed a questionnaire about their life before and after diagnosis. Data collection included sociodemographic and clinical characteristics, health care use, non–health care costs, and QoL (measured using the EuroQol 5-Dimension 5-Level). Mean QoL and annual health care and societal costs were compared prediagnosis and postdiagnosis. Multivariate regression models were used to identify factors associated with QoL and costs in both periods (and difference between periods). RESULTS: On average, respondents recalled experiencing 4–5 symptoms before diagnosis. QoL improved significantly postdiagnosis, with greater improvements among childhood diagnoses. Annual health care and societal costs decreased by 23% and 36%, respectively, postdiagnosis, except for societal costs in those diagnosed during childhood. Age at diagnosis and the number of prediagnosis symptoms were associated with lower and higher recalled prediagnosis QoL, respectively. Number of symptoms, comorbidities, and nonadherence to a gluten-free diet were associated with lower postdiagnosis QoL. DISCUSSION: After CD diagnosis, QoL significantly improved and health care and societal costs decreased, except for societal costs among childhood diagnoses. These findings enhance the understanding of CD's burden and economic impact, supporting health care and policy efforts for timely CD identification.

Strict adherence to a gluten-free diet (GFD) is the cornerstone of treatment in coeliac disease, yet gluten cross-contamination in household settings poses a persistent challenge. Guidance from dieticians and patient organizations is often not evidence-based. This study quantified gluten contamination risks associated with common kitchen appliances and evaluated the effectiveness of various cleaning methods in typical Dutch households. We performed a two-phase analysis of 417 samples of 275 chopping boards, 34 toasters/sandwich makers, and 108 deep-fat fryers/air fryers. Gluten levels were assessed on appliances and food items under different cleaning protocols, with Bayesian modeling used to estimate contamination probabilities. Plastic chopping boards showed the highest risks, with probabilities up to 0.868 when rinsed with cold water, compared with 0.147 after dishwasher cleaning. Glass and wooden boards cleaned in dishwashers had the lowest probabilities (0.0102 and 0.0194). Toasters and sandwich makers tested positive in 1 of 34 samples; at the 20 ppm threshold, contamination probability was 0.00001. In fryers, probabilities were 0.125 for deep-fat fryers and 0.070 for air fryers at the 5 ppm threshold, decreasing to 0.0405 and 0.0326 at 20 ppm. Across all appliances, gluten levels seldom exceeded the clinically relevant threshold of 20 ppm. This study highlights the importance of dedicated cleaning protocols and appliance-specific recommendations to mitigate gluten exposure. While complete elimination of gluten is challenging, adopting rigorous practices can substantially mitigate exposure for coeliac patients, enhancing safety and quality of life.