Reflux oesophagitis in adult coeliac disease: beneficial effect of a gluten free diet

• Published in: Gut Vol. 52; no. 4; pp. 514 - 517
• Main Authors: Cuomo, A, Romano, M, Rocco, A, Budillon, G, Del Vecchio Blanco, C, Nardone, G
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 01.04.2003; BMJ; BMJ Publishing Group Ltd; BMJ Publishing Group LTD; Copyright 2003 by Gut
• Subjects: Adolescent; Adult; Aged; Anemia; Biological and medical sciences; Cardiovascular disease; Celiac disease; Celiac Disease - complications; Celiac Disease - diet therapy; coeliac disease; Complications and side effects; Drugs; Dysphagia; EMA; endomysium antibodies; Endoscopy; Esophagitis, Peptic - diagnosis; Esophagitis, Peptic - etiology; Esophagoscopy; Evaluation; Female; Follow-Up Studies; gastro-oesophageal reflux disease; Gastroenterology. Liver. Pancreas. Abdomen; Gastroesophageal reflux; Gluten; Gluten-free diet; Glutens - administration & dosage; GORD; Hiatal hernias; Histology; Humans; Hydrogen-Ion Concentration; LOS; lower oesophageal sphincter; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Patients; Recurrence; reflux oesophagitis; Retrospective Studies; Risk factors; Serology; Small Intestine; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Human; Gastroesophageal reflux; Immunopathology; Deficient diet; Nutrition; Esophageal disease; Coeliac disease; Statistical study; Biological activity; Incidence; Intestinal malabsorption; Digestive diseases; Intestinal disease; Complication; Gluten
• ISSN: 0017-5749; 1468-3288; 1458-3288
• DOI: 10.1136/gut.52.4.514

Background: Coeliac disease patients show a number of gastrointestinal motor abnormalities, including a decrease in lower oesophageal sphincter pressure. The prevalence of endoscopic oesophagitis in these subjects however is unknown. Aim: To evaluate whether untreated adult coeliac patients had an increased prevalence of reflux oesophagitis and, if so, to assess whether a gluten free diet exerted any beneficial effect on gastro-oesophageal reflux disease (GORD) symptoms. Patients and methods: We retrospectively studied 205 coeliac patients (females/males 153/52, median age 32 years) who underwent endoscopy for duodenal biopsy and 400 non-coeliac subjects (females/males 244/156, median age 37 years) referred for endoscopy for upper gastrointestinal symptoms. Each patient was given a questionnaire for evaluation of GORD symptoms prior to and 4–12 months after endoscopy. Coeliac patients were given a gluten free diet. Oesophagitis patients of both groups, following an eight week course of omeprazole, were re-evaluated for GORD symptoms at four month intervals up to one year. Significance of differences was assessed by Fisher’s exact test. Results: Oesophagitis was present in 39/205 (19%, 95% confidence interval (CI) 13.8–25.0%) coeliac patients and in 32/400 (8%, 95% CI 5.5–11.1%) dyspeptic subjects. At the one year follow up, GORD symptoms relapsed in 10/39 (25.6%, 95% CI 13–42.1%) coeliacs with oesophagitis and in 23/32 (71.8%, 95% CI 53.2–86.2%) non-coeliac subjects with oesophagitis. Conclusion: Coeliac patients have a high prevalence of reflux oesophagitis. That a gluten free diet significantly decreased the relapse rate of GORD symptoms suggests that coeliac disease may represent a risk factor for development of reflux oesophagitis.