Long-term Health Outcomes of Screen Detected and Potential Celiac Disease Patients

Symptoms are measured with Gastrointestinal symptom rating scale (GSRS) questionnaire. The scoring consists of 15 items, which are scored with a 7-grade Likert scale in which 1 point indicates no symptoms and 7 points the most severe gastrointestinal symptoms. Items cover five different symptoms (indigestion, diarrhea, abdominal pain, constipation and reflux) and values for each sub-dimension are calculated as a mean of the relevant items. The total GSRS score is described as a mean value of all 15 items (from 1 to 7 points). Scores of the participants are compared with the result of earlier study when possible.

Quality of life is measured with Psychological General Well-Being (PGWB) questionnaire. The survey consists of 22 separate items covering six different sub-dimensions: anxiety, depression, well-being, self-control, general health and vitality. The scoring is based on a 6-grade Likert scale in which higher scores indicate better quality of life. The value of the total PGWB score may range from a minimum of 22 to maximum 132. The sub-scores are calculated as a sum of the items in each sub-dimensio. The PGWB results are compared with the result of earlier study when possible.

How many have received celiac disease diagnosis after previous study?

Adherence to the dietary treatment, when initiated is assessed by food diaries and Celiac Disease Adherence Test (CDAT) questionnaire. CDAT questionnaire is a 7-item questionnaire. Scoring is from 7 to 35, in which lower scores indicate good adherence and higher scores point towards poor adherence to gluten-free diet.

Interview and Dermatology Life Quality Index (DLQI) questionnaire. The DLQI is dermatology-spesific index with 10 questonnaire considering the impact of skin disease to quality of life during the last week. Each question is scored with a 4-point Likert scale (0-3), giving the total DLQI score from 0 to 30, a higher score indicating worse quality of life

Weight (kilograms) and height (centimeters) will be combined as body mass index, kg/m2

Interview and blood tests

Bone mineral density is assessed with Duel-energy WX-ray Absorptiometry (DXA). In DXA, T-score compares bone mineral density to values of young, healthy adult. T-score -2.5 or lower indicates osteoporosis and score between -1.0 and -2.4 indicates osteopenia.

Duodenal histology is evaluated with morphological description and Modified Marsh-Oberhuber classification. In this classification Marsh 0 means entirely normal mucosa, Marsh 1 indicates normal villi and crypts with increased intraepithelial lymphocytes (IEL), Marsh 2 for increased IELs and crypt hyperplasia. Marsh 3 a-c villus atrophy is combined to increased IELs and cryp hyperplasia: Class 3a partial villus atrophy, 3b for subtotal villus atrophy and 3c for total villus atrophy.

Vh/CrD is a morphometric method to assess duodenal histology in addition to classifications like Marsh-Oberhuber. From several well-oriented duodenal samples, villous hight and crypt depth are measured. Ratio <2.0 indicates active celiac disease.