Reflux and irritable bowel syndrome are negative predictors of quality of life in coeliac disease and inflammatory bowel disease Stephen M. Barratt a , John S. Leeds a , Kerry Robinson a , Premal J. Shah b , Alan J. Lobo a , Mark E. McAlindon a and David S. Sanders a 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 r 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 r 0.001; IBD odds ratio = 2.2, 95% confidence interval = 1.6–3.2, P r 0.0001. Stepwise reductions in SF-36 scores in association with increasing reflux severity were found (P r 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 r 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. Eur J Gastroenterol Hepatol 23:159–165  c 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. European Journal of Gastroenterology & Hepatology 2011, 23:159–165 Keywords: coeliac disease, inflammatory bowel disease, irritable bowel syndrome, quality of life, reflux, Short-Form 36 a The Gastroenterology and Liver Unit, The Royal Hallamshire Hospital, Sheffield, South Yorkshire and b The 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: mdd06sb@sheffield.ac.uk Received 30 September 2010 Accepted 14 November 2010 Introduction A subjective assessment of quality of life (QoL) is based on needs [1] and expectations [2]. Health-related QoL concerns the satisfaction of subjective needs and expecta- tions insofar as they are affected by health, disease and illness [3], levels of functioning [4], the experience of symptoms [5] and within the wider context of social norms and values [6]. In an aging population that has ever- increasing needs and expectations, QoL occupies the centre ground in planning and resource allocation and is emerging as a critical outcome measure in healthcare [7]. The cause and nature of QoL disturbances in coeliac disease and inflammatory bowel disease (IBD) are spe- cific to each disorder. Despite considerable discussion surrounding the psychological and social consequences of adhering to a gluten-free diet (GFD) [8] and the long- term QoL of the coeliac individual as a result [9,10], it is generally accepted that the GFD is a key determinant of QoL in coeliac disease [11–13]. In IBD the experience of symptoms and the impact these have on work life, financial affairs and psychological well-being dominates [14–16]. Reductions in QoL are particularly acute during relapses [17] and continue, albeit to a lesser extent, during remissive periods when symptoms fade [18]. Similarities between coeliac disease and IBD arise, firstly, as both conditions are chronic inflammatory disorders of the gastrointestinal (GI) tract, and secondly, as they both present challenges to patients on a day-to-day basis from psychological and social perspectives. Parallels can also be drawn with regard to the increased prevalence of GI motor disturbances in both disorders. Earlier studies have reported increased levels of irritable bowel syndrome (IBS) symptoms in coeliac disease [19] and IBD [20,21]. Coeliac patients are also more likely to experience reflux symptoms [22], and CD is associated with foregut dysmotility [23] and delayed gastric emptying [24]. Coeliac disease and IBD share a common ground but retain distinct features in terms of the challenges they present to individuals and the toll these challenges take Original article 159 0954-691X  c 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins DOI: 10.1097/MEG.0b013e328342a547 Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.