Celiac disease: a biopsychosocial condition. A systematic review Section: Revisión Authors1 Alicia Montes Orts, 2 Elena García Cuevas, 3 María Isabel Mármol López Position 1 Enfermera. Home Care Nurse in Norway.2 Enfermera. “La Fe” Escuela de Enfermería. Universidad de Valencia. GREIACC Research Group. La Fe Health Research Institute. Valencia (España). 3 Enfermera. “La Fe” Escuela de Enfermería. Universidad de Valencia. GREIACC Research Group. La Fe Health Research Institute. Valencia (España). ORCID: https://orcid.org/0000-0002-6859-6133 Contact email: maribelmrlp@gmail.com Abstract Objective: to summarize the evidence available on the association between adherence to the treatment for celiac disease and the quality of life of the adult person. Method: a systematic review during February and March 2022, in the following databases: Pubmed, Embase, Web of Science and Nursing & Allied Health Database. Articles published in Spanish or English were included, up to five years old, and with a sample that presented celiac disease in the adult stage. Results: fifteen (15) studies were selected, showing that a gluten-free diet improved the symptomatology of persons with celiac disease, even though persistent symptoms were frequent. The gluten-free diet caused psychological problems and plenty of negative emotions. Leisure time, travels, or the high cost of gluten-free products, were some of the barriers highlighted by adults regarding their daily life and social outings. Conclusions: the adherence to treatment for celiac disease does not have a normalising impact on the quality of life of persons, because the difficulties associated to a gluten-free diet affect the physical as well as the psychological and social settings. Keywords: celiac disease; quality of life; treatment compliance and adherencegluten-free diet Versión en Español Título: La celiaquía: una enfermedad biopsicosocial. Revisión sistemática Artículo completo no disponible en este idioma / Full article is not available in this language Bibliography 1. Husby S, Koletzko S, Korponay-Szabó IR, Mearin ML, Phillips A, Shamir R, et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr. 2012; 54(1):136-60. doi: http://dx.doi.org/10.1097/MPG.0b013e31821a23d0 2. Martín I, van der Hofstadt M, Campos A, Fernández A, De Abreu C, Brieva VD, et al. Manual de la enfermedad celiaca. Celiacos.org [internet] 2021 [citado 20 may 2024]. Disponible en: https://celiacos.org/wp-content/uploads/2021/05/Manual-de-la-EC-1.3-SEEC.pdf 3. Zamora CM. Enfermedad celiaca: una revisión de sus aspectos más relevantes. Rev Med Cos Cen [internet]. 2017 [citado 20 may 2024]; 84(622):35-43. Disponible en: https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=101660 4. Bai JC, Ciacci C, Corazza GR, Fried M, Olano C, Rostami-Nejad M, et al. Guías Muldiales de la Organización Mundial de Gastroenterología. Enfermedad Celiaca. J Clin Gastroenterol. 2013; 47(2):121-6. doi: https://doi.org/10.1097/mcg.0b013e31827a6f83 5. De la Calle I, Ros G, Peñalver Miras R, Nieto G. Celiac disease: causes, pathology, and nutritional assessment of gluten-free diet. A review. Nutr Hosp. 2020; 37(5):1043-51. doi: http://dx.doi.org/10.20960/nh.02913 6. Naranjo Hernández Y, Concepción Pacheco JA, Rodríguez Larreynaga M. La teoría Déficit de autocuidado: Dorothea Elizabeth Orem. Gac méd espirit [internet]. 2017 [citado 20 may 2024]; 19(3). Disponible en: http://www.revgmespirituana.sld.cu/index.php/gme/article/view/1129 7. Al-Sunaid FF, Al-Homidi MM, Al-Qahtani RM, Al-Ashwal RA, Mudhish GA, Hanbazaza MA, et al. The influence of a gluten-free diet on health-related quality of life in individuals with celiac disease. BMC Gastroenterol. 2021; 21(1):330. doi: http://dx.doi.org/10.1186/s12876-021-01908-0 8. Real-Delor RE, Centurión-Medina IC. Calidad de vida en adultos del Paraguay con enfermedad celiaca. Duazary 2018; 15(1):61. doi: http://dx.doi.org/10.21676/2389783x.2026 9. MeSHDatabase [sede web]. Los Ángeles: National Library of Medicine (US); 2022. [citado 20 may 2024]. Disponible en: http://www.ncbi.nlm.nih.gov/mesh 10. Cartes-Velasquez R, Moraga J. Pautas de chequeo, parte III: STROBE y ARRIVE. Rev chil cir. 2016; 68(5):394-9. doi: http://dx.doi.org/10.1016/j.rchic.2015.12.003 11. Cano Arana A, González Gil T, Cabello López JB. Plantilla para ayudarte a entender un estudio cualitativo. Guías CASPe de Lectura Crítica de la Literatura Médica [internet]. Alicante: CASPe; 2010. [citado 20 may 2024]. Disponible en: https://studylib.es/doc/4907309/10-preguntas-para-ayudarte-a-entender-un-estudio-cualitativo 12. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. Declaración PRISMA 2020: una guía actualizada para la publicación de revisiones sistemáticas. Rev Esp Cardiol 2021; 74(9):790-9. doi: http://dx.doi.org/10.1016/j.recesp.2021.06.01613. The Joana Briggs Institute [sede web]. New JBI Grades of Recommendation. 2013. [citado 20 may 2024]. Disponible en: https://ebevidencia.com/wp-content/uploads/2015/06/Grados-de-recomendacion-JBI.pdf 14. The Joana Briggs Institute [sede web]. New JBI Levels of Evidence. 2013. [citado 20 may 2024]. Disponible en: https://ebevidencia.com/wp-content/uploads/2015/06/Niveles-de-evidencia-JBI.pdf 15. Van Megen F, Skodje GI, Stendahl M, Veierød MB, Lundin KEA, Henriksen C. High disease burden in treated celiac patients - a web-based survey. Scand J Gastroenterol. 2021; 56(8):882-8. doi: http://dx.doi.org/10.1080/00365521.2021.1930146 16. Silvester JA, Graff LA, Rigaux L, Bernstein CN, Leffler DA, Kelly CP, et al. Symptoms of functional intestinal disorders are common in patients with celiac disease following transition to a gluten-free diet. Dig Dis Sci 2017; 62(9):2449-54. doi: http://dx.doi.org/10.1007/s10620-017-4666-z 17. Sansotta N, Amirikian K, Guandalini S, Jericho H. Celiac disease symptom resolution: Effectiveness of the gluten-free diet. J Pediatr Gastroenterol Nutr 2018; 66(1):48-52. doi: http://dx.doi.org/10.1097/MPG.0000000000001634 18. Parker S, Palsson O, Sanders DS, Simren M, Sperber AD, Törnblom H, et al. Functional gastrointestinal disorders and associated health impairment in individuals with celiac disease. Clin Gastroenterol Hepatol 2022; 20(6):1315-1325.e4. doi: http://dx.doi.org/10.1016/j.cgh.2021.07.026 19. Deepak C, Berry N, Vaiphei K, Dhaka N, Sinha SK, Kochhar R. Quality of life in celiac disease and the effect of gluten-free diet: Quality of life in celiac disease. JGH Open 2018; 2(4):124-8. doi: http://dx.doi.org/10.1002/jgh3.12056 20. Martínez-Martínez MI, Alegre-Martínez A, García-Ibánez J, Cauli O. Quality of life in people with coeliac disease: Psychological and Socio- economic aspects. Endocr Metab Immune Disord Drug Targets 2019; 19(2):116-20. doi: http://dx.doi.org/10.2174/1871530318666180723100003 21. Crocker H, Jenkinson C, Peters M. Quality of life in coeliac disease: qualitative interviews to develop candidate items for the Coeliac Disease Assessment Questionnaire. Patient Relat Outcome Meas 2018; 9:211-20. doi: http://dx.doi.org/10.2147/prom.s149238 22. Fueyo-Díaz R, Montoro M, Magallón-Botaya R, Gascón-Santos S, Asensio-Martínez Á, Palacios-Navarro G, et al. Influence of compliance to diet and self-efficacy expectation on quality of life in patients with celiac disease in Spain. Nutrients 2020; 12(9):2672. doi: http://dx.doi.org/10.3390/nu12092672 23. Rustagi S, Choudhary S, Khan S, Jain T. Consequential effect of gluten-free diet on Health-related quality of life in celiac populace-A meta-analysis. Curr Res Nutr Food Sci J. 2020; 8(3):1025-36. doi: http://dx.doi.org/10.12944/crnfsj.8.3.29 24. Guedes NG, Silva LA da, Bessa CC, Santos JCD, Silva VM da, Lopes MV de O. Anxiety and depression: a study of psychoaffective, family-related, and daily-life factors in celiac individuals. Rev Bras Enferm 2020; 73(1). doi: http://dx.doi.org/10.1590/0034-7167-2020-0086 25. Casellas Jordá F, Argüelles Arias F, Burgos R, van der Hofstadt Rovira M. National survey on the experiences of people with celiac disease in Spain. The CELIAC-SPAIN project. Rev Esp Enferm Dig 2020; 112(5):343-54. doi: http://dx.doi.org/10.17235/reed.2020.6929/2020 26. Garnweidner-Holme L, Sende K, Hellmann M, Henriksen C, Lundin KEA, Myhrstad MCW, et al. Experiences of managing a gluten-free diet on multiple levels of society: a qualitative study. BMC Nutr 2020; 6(1):65. doi: http://dx.doi.org/10.1186/s40795-020-00390-3 27. Arias-Gastelum M, Cabrera-Chávez F, Vergara-Jiménez M de J, Ontiveros N. The gluten-free diet: access and economic aspects and impact on lifestyle. Nutr Diet Suppl 2018; 10:27-34. doi: http://dx.doi.org/10.2147/nds.s143404 28. Leffler DA, Acaster S, Gallop K, Dennis M, Kelly CP, Adelman DC. A novel patient-derived conceptual model of the impact of celiac disease in adults: Implications for patient-reported outcome and health-related quality-of-life instrument development. Value Health. 2017; 20(4):637-43. doi: http://dx.doi.org/10.1016/j.jval.2016.12.016 29. Canova C, Rosato I, Marsilio I, Valiante F, Zorzetto V, Cataudella G, et al. Quality of life and psychological disorders in coeliac disease: A prospective multicentre study. Nutrients 2021; 13(9):3233. doi: http://dx.doi.org/10.3390/nu13093233 30. Castaño P, Pascual A, Vázquez-Díaz C, Vega C, Castaño T, Cernuda JA. Papel de la enfermera de Atención Primaria en pacientes con enfermedad celiaca. RqR Enfermería Comunitaria [internet]. 2017 [citado 20 may 2024]; 5(3):19-29. Disponible en: https://dialnet.unirioja.es/servlet/articulo?codigo=6079378 31. Ring Jacobsson L, Friedrichsen M, Göransson A, Hallert C. Does a Coeliac School increase psychological well-being in women suffering from coeliac disease, living on a gluten-free diet? Patient education for coeliac women. J Clin Nurs 2012; 21(5-6):766-75. doi: http://dx.doi.org/10.1111/j.1365-2702.2011.03953.x 32. Estévez V, Araya M. La dieta sin gluten y Los alimentos libres DE gluten. Rev Chil Nutr 2016; 43(4):14-14. doi: http://dx.doi.org/10.4067/s0717-75182016000400014 33. Defensor del Pueblo. Estudio sobre la situación de las personas con Enfermedad Celiaca en España. [internet] 2017. [citado 20 may 2024]. Disponible en: https://www.defensordelpueblo.es/wp-content/uploads/2017/04/Celiaquia_2017-1.pdf 34. Lopera-Vásquez JP. Calidad de vida relacionada con la salud: exclusión de la subjetividad. Cien Saude Colet 2020; 25(2):693-702. doi: http://dx.doi.org/10.1590/1413-81232020252.16382017