Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Dec 11, 2018
Date Accepted: Feb 11, 2019
Symptoms Prompting Interest in Celiac Disease and the Gluten-Free Diet: Analysis of Internet Search Term Data
ABSTRACT
Background:
Celiac disease, a common immune-based disease triggered by gluten, has diverse clinical manifestations, and the relative distribution of symptoms in the population leading to diagnosis has not been well-characterized.
Objective:
We aimed to use search engine data to identify a set of symptoms and conditions that would identify individuals at elevated likelihood of a subsequent celiac disease diagnosis. We also measured the relative prominence of these search terms before versus after a search related to celiac disease.
Methods:
We extracted English-language queries submitted to the Bing search engine in the United States and identified those who submitted a new celiac-related query during a 1-month period, without any celiac-related queries in the preceding 9 months. We compared the ratio between the number of times that each symptom or condition was asked in the 14 days preceding the first celiac-related query of each person and the number of searches for that same symptom/condition in the 14 days after the celiac-related query.
Results:
We identified 90,142 users who made a celiac-related query, of whom 6,528 (7%) exhibited sustained interest, defined as making a query on >1 day. Though a variety of symptoms and associated conditions were also queried prior to a celiac-related query, the maximum area under the receiver operating characteristic curve was 0.53. The symptom most likely to be queried more before than after a celiac-related query was diarrhea (query ratio [QR] 1.28). Extra-intestinal symptoms queried prior to a celiac disease query included headache (QR 1.26), anxiety (QR 1.10), depression (QR 1.03), and attention deficit hyperactivity disorder (QR 1.64).
Conclusions:
We found an increase in antecedent searches for symptoms known to be associated with celiac disease, but also a rise in searches for depression and anxiety, symptoms that are associated with celiac disease but may not be reported to health care providers. The protean clinical manifestations of celiac disease are reflected in the diffuse nature of antecedent internet queries, underscoring the challenge of effective case-finding strategies.
Citation
