Fatigue as a Determinant of Health in Patients With Celiac Disease

Background: Symptoms of uncontrolled celiac disease impair patients' health-related quality of life, which improves with the exclusion of gluten from the diet. A symptom frequently reported, but difficult to make objective, is fatigue. The Daily Fatigue Impact Scale (D-FIS) questionnaire consisting of 8 items, each scored on a 0 to 4 point scale, with lower scores reflecting greater fatigue, was employed to measure fatigue in celiac patients. Goals: To assess the influence of fatigue on perception of health in celiac disease patients determined as their quality of life. Study: Prospective, cross-sectional study in celiac disease patients diagnosed by serology and histology. Instruments used were the D-FIS to measure fatigue and the generic EuroQol5D to measure quality of life. An additional question on the frequency of problems due to fatigue, scored on a 7-point Likert scale, was used to evaluate the importance of fatigue. Results (in medians): In all, 51 patients were included (13 untreated and 38 treated with a gluten-free diet). D-FIS score was significantly worse in untreated celiacs (16.0 vs. 3.0, P < 0.001). Scores on the frequency scale of fatigue-related problems were also worse in untreated celiacs (2.0 vs. 6.0, P < 0.001). Fatigue and quality-of-life scores were inversely correlated (r = -0.6, P < 0.001). Fatigue severity was also greater in patients with worse quality of life (13.0 vs. 2.0, P < 0.01). Multiple regression analysis showed fatigue to be an independent determinant of quality of life. Conclusions: Fatigue is a major concern in untreated celiac disease patients, which impacts their quality of life.