Does Quality of Life and Symptom Severity Correlate with Celiac Disease Serology in Adolescents?

PURPOSE: Adolescents with a new diagnosis of celiac disease (CeD) face challenges navigating social relationships while also managing symptoms and the gluten-free diet. The purpose of this study is to evaluate the relationship between quality of life (QoL), symptoms, and CeD serology in adolescents with CeD. METHODS: Cross-sectional survey study of adolescent patients (13-18 years old) within one year of biopsy-proven diagnosis of symptomatic CeD. Participants completed the PedsQL questionnaire, a health-related QoL assessment, and the Celiac Symptom Index (CSI), a measure of CeD-related symptoms. Tissue transglutaminase IgA (tTG-IgA) was used as a measure of disease activity. Means, mean difference, t test, and point biserial correlations were computed to assess the association of tTG-IgA with CSI and PedsQL scores. RESULTS: Fifty-four adolescents and parents/guardians were surveyed. Thirty-seven had abnormal tTG-IgA and were compared to those with normal tTG-IgA. There were significant differences in overall PedsQL scores (84.75 vs 77.03, r = -0.28, p = 0.05), social subscores (95.42 vs 88.59, r = 0.24, p = 0.02), emotional subscores (80.83 vs 66.62, r =- 0.31, p = 0.03), and school functioning subscores (81.25 vs 68.89, r =- 0.36, p = 0.01). There was no significant relationship between tTG-IgA and the physical subscore or CSI score. Females report higher CSI scores and lower PedsQL scores. Older age at diagnosis was associated with lower PedsQL scores. DISCUSSION: Adolescents with abnormal tTG-IgA serology had lower QoL scores that were unrelated to measures of physical symptoms (CSI and physical subscore of PedsQL). This suggests more complex drivers of QoL that are not related to physical symptoms but are still associated with persistently elevated serology.