Quality of life of Moroccan patients with celiac disease: Arabic translation, cross-cultural adaptation, and validation of the celiac disease questionnaire

The ingestion of gluten proteins found in wheat, rye, and barley induces gluten intolerance in certain predisposed individuals. This is known as celiac disease (CD) [1]. CD destroys the villi of the small intestines, crypt hyperplasia, and increased intraepithelial lymphocytes. Its prevalence is increasing considerably worldwide [2]. According to a review and meta-analysis conducted by Singh et al. [3], this prevalence has been estimated at 0.7%–1.4% worldwide. CD management is based on a ban on all gluten-containing foods, i.e., a lifelong gluten-free diet (GFD) [4]. The efficacy of GFD has been clinically, serologically, and histologically approved [5]. Changing dietary habits influences the lifestyle and quality of life (QoL) of patients with CD. QoL, as defined by the World Health Organization, is “an individual’s perception of their position in life in the context of the culture and value systems in which they live, and in relation to their goals, expectations, standards and concerns” [6]. Health is one of the pillars of the health-related QoL (HRQoL). To assess HRQoL in patients with CD, several generic methods have been used [7]. In children, QoL was assessed by several generic methods, such as the Pediatric Quality of Life Inventory [8], DUX 25 [9], or KIDSCREEN-52 questionnaire [10], and in adults by the 36-Item Short Form Survey (SF-36) [11], Euro-QoL [12], or Gastrointestinal Quality of Life Index [13]. Recently, disease-specific methods have been developed for children, adolescents, and adults [14]. CD-DUX was the first disease-specific instrument for children and adolescents, which was developed in Netherlands in 2008 [15], followed by the CD-Specific Pediatric QoL in the USA in 2013 [16]. For the > 18-year-old category, three instruments have been developed. In Germany, Winfried Häuser and coworkers developed the CD-Questionnaire (CD-Q) method, which includes 28 items [17]. In the USA, Dorn et al. [18] developed the CD-QoL instrument based on 20 items subdivided into four subscales. Recently, the third method called Coeliac Disease Assessment Questionnaire was developed by Crocker et al. [19], which includes 32 items. In Denmark, Skjerning et al. [20] conceived a CD-specific instrument for children, adolescents, and adults alike. These tools have been translated, cross-culturally adapted, and validated in several countries [14], including the CD-Q, which has been adapted in Italy [21], France [22], Turkey [23], Brazil [24], Poland [25], and Iran [26]. In Morocco, despite the considerably increasing incidence of CD [27], no specific methods for adults with CD have been adapted so far. The objective of this study as part of this framework was first to translate, cross-culturally adapt, and validate the items of the CD-Q [17] and eventually evaluate the QoL among adults with CD in Morocco.

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