OTH-5 Functional gastrointestinal disorders and associated health impairment in individuals with coeliac disease

<h3>Introduction</h3> Individuals with coeliac disease (CD) can experience persisting gastrointestinal symptoms despite adhering to a gluten-free diet (GFD). This may be due to functional gastrointestinal disorders (FGIDs), although there is little data on its prevalence and associated factors. <h3>Methods</h3> An online health questionnaire was completed by adult members of Coeliac UK in October 2018. The survey included validated questions on Rome IV FGIDs, non-gastrointestinal somatic symptoms, anxiety, depression, quality of life, healthcare use, GFD duration and its adherence using the coeliac dietary adherence test score (with a value ≤ 13 indicating optimal adherence). The prevalence of FGIDs and associated health impairment in the coeliac cohort was compared against an age- and sex- matched population-based control group. <h3>Results</h3> Of the 863 individuals with CD (73% female, mean-age 61 years) all were taking a GFD for at least 1 year, with 96% declaring that they have been on the diet for over 2 years. The adherence to a GFD was deemed optimal in 61% (n=523) with the remaining 39% (n=340) non-adherent. Those adhering to a GFD fulfilled criteria for a FGID in approximately a half of cases, although this was significantly lower than non-adherent subjects (51% vs. 75%, OR 2.0; p&lt;0.001). However, the prevalence of FGIDs in GFD-adherent subjects was significantly higher than in matched population-based controls (35%, OR 2.0; p&lt;0.001). This was accounted for by functional bowel (46% vs. 31%, OR 1.9; P&lt;0.0001) and anorectal disorders (14.5% vs. 9.3%, OR 1.7; p=0.02) but not functional esophageal (7.6% vs. 6.1%, p=0.36) or gastroduodenal disorders (8.7% vs. 7.4%, p=0.47). Finally, GFD-adherent subjects with FGIDs were significantly more likely, than their counterparts without FGIDs, to have abnormal levels of anxiety (5% vs. 2%, OR 2.8; p=0.04), depression (7% vs. 2%, OR 3.6; p=0.01), somatisation (31% vs. 8%, OR 5.1; p&lt;0.0001), increased healthcare use and reduced quality of life (P&lt;0.0001). <h3>Conclusion</h3> One-in-two people with CD, despite having been on a GFD for a number of years and demonstrating optimal adherence, have ongoing symptoms compatible with a Rome IV FGID. This is two-fold the odds of FGIDs seen in age- and sex- matched controls. The presence of FGIDs is associated with significant health impairment, including psychological co-morbidity. Addressing disorders of gut-brain interaction might improve outcomes in this specific group of patients.