E0635 - Gluten-Associated Disorders and Overlap Irritable Bowel Syndrome: The UCLA Celiac Collective

Introduction: Treating gluten-associated disorders (GAD) requires knowledge of both pathophysiology and comorbid psychosocial factors. While a gluten-free diet (GFD) results in disease improvement or remission, adherence to treatment often proves to be challenging. Irritable bowel syndrome (IBS)-like symptoms are commonly reported in GAD, and account for up to 20% of non-responsive celiac disease (NRCD). Our study aims to characterize patients with GAD and comorbid IBS and explore the role of non-adherence in this group.

Methods: We conducted a cross-sectional study involving patients with GAD from the UCLA Celiac Collective registry, who were invited to complete online IBS surveys in 2022. Surveys captured demographics, medical history, and responses to the Rome IV Criteria, IBS Symptom Severity Scale (IBS-SSS), Celiac Dietary Adherence Test (CDAT), Celiac Symptom Index (CSI), Patient Reported Outcomes Measurement Information System (PROMIS) domains of depression, anxiety, sleep disturbance, fatigue, pain, and social satisfaction. Chi-square, Fisher’s exact and Wilcoxon rank-sum tests were used to identify parameters associated with presence of IBS, our primary outcome.

Results: Our preliminary results show that a third of GAD patients had overlap IBS (Table 1). These patients had worse anxiety, depression, fatigue, pain, and satisfaction with social interactions compared to the general population. Patient-provider relationships were better for those with overlap IBS compared to patients with only GAD. Subjects with GAD and IBS had only a trend of having more anxiety, depression, fatigue, and pain than those without IBS. Non-adherence to GFD was not more common in patients with overlap IBS.

Discussion: Patients with GAD and overlap IBS have more psychological distress than the general population, and likely more than GAD patients without IBS. More interestingly, GAD patients share the same prevalence of non-adherence, regardless of the presence of IBS, which suggests that overlap IBS is not the result of advertent nor inadvertent exposure to gluten. Treatment of GAD with IBS overlap should prioritize and assess for the presence of psychosocial comorbidities. Providers may appropriately be monitoring these patients closely, as evidenced by stronger patient-physician relationships reported in the overlap IBS group.