Skjellerudsveen Berit Mære, Omdal Roald, Hetta Anne Kristine, Kvaløy Jan Terje, Aabakken Lars, Skoie Inger Marie, Grimstad Tore
Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway.
Department of Clinical Science, University of Bergen, Bergen, Norway.
Front Med (Lausanne). 2023 Sep 12;10:1242512. doi: 10.3389/fmed.2023.1242512. eCollection 2023.
Fatigue is a frequent complaint in patients with celiac disease. A gluten-free diet is the only established treatment for celiac disease, but how this diet influences fatigue is uncertain. We aimed to investigate fatigue prevalence, severity, and associated factors in patients with celiac disease, at diagnosis and at 1 year after commencing a gluten-free diet.
78 patients with serologically and histologically verified celiac disease, 78 age- and sex-matched healthy subjects. Primary endpoints were Fatigue Visual Analog Scale (fVAS), Fatigue Severity Scale (FSS), and inverted Vitality subscale of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36vs). Clinically relevant fatigue was defined as: FSS score ≥ 4, fVAS score ≥ 50 mm, or inverted SF-36vs score ≥ 65. Higher scores represented more fatigue.
Fatigue was reduced after a 12-month gluten-free diet. Median scores changed from 3.8 (interquartile range [IQR]: 2.2 to 4.8) to 1.9 (IQR: 1.4 to 3.5) for FSS, from 44.5 (IQR: 18.8 to 66.0) to 15.5 (IQR: 7.8 to 43.3) for fVAS, and from 65 (IQR: 40 to 75) to 35 (IQR: 25 to 55) for inverted SF-36vs ( < 0.001 for all). Fatigue prevalence also declined after treatment. However, scores were significantly higher in patients compared to control subjects. Higher fatigue scores were associated with depression and pain, but not with signs of disease activity or nutritional deficiency.
At diagnosis, patients with celiac disease frequently had severe fatigue. Fatigue declined after a gluten-free diet, but it remained higher than that observed in healthy subjects.
ClinicalTrials.gov, Identifier NCT01551563.
疲劳是乳糜泻患者常见的主诉。无谷蛋白饮食是乳糜泻唯一已确立的治疗方法，但这种饮食如何影响疲劳尚不确定。我们旨在调查乳糜泻患者在诊断时以及开始无谷蛋白饮食1年后的疲劳患病率、严重程度及相关因素。
78例血清学和组织学确诊的乳糜泻患者，78例年龄和性别匹配的健康受试者。主要终点为疲劳视觉模拟量表（fVAS）、疲劳严重程度量表（FSS）以及医学结局研究简明健康调查36项量表（SF - 36）中的活力分量表反向得分（SF - 36vs）。临床相关疲劳定义为：FSS评分≥4、fVAS评分≥50mm或SF - 36vs反向评分≥65。分数越高表示疲劳越严重。
经过12个月的无谷蛋白饮食后，疲劳症状减轻。FSS的中位数评分从3.8（四分位间距[IQR]：2.2至4.8）降至1.9（IQR：1.4至3.5），fVAS从44.5（IQR：18.8至66.0）降至15.5（IQR：7.8至43.3），SF - 36vs反向评分从65（IQR：40至75）降至35（IQR：25至55）（所有P均<0.001）。治疗后疲劳患病率也有所下降。然而，患者的评分仍显著高于对照组。较高的疲劳评分与抑郁和疼痛相关，但与疾病活动迹象或营养缺乏无关。
在诊断时，乳糜泻患者经常有严重疲劳。无谷蛋白饮食后疲劳减轻，但仍高于健康受试者。
ClinicalTrials.gov，标识符NCT01551563。
