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A Gluten Free Diet May Alleviate Gastroesophageal Reflux Symptoms in People with Celiac Disease

Celiac.com 12/16/2011 - To date, symptoms of gastroesophageal reflux disease (GERD) - heartburn and acid regurgitation - have been among the only GI symptoms absent from the list of common manifestations of celiac disease. They are usually definitive indicators of gastric acid reflux. But a report from Julio César Bai's group in Buenos Aires notes that at the time of diagnosis, patients with celiac disease were more likely to complain of GERD symptoms than healthy controls. Moreover, maintaining a gluten free diet alleviated these symptoms. Photo: CC - JudeanPeoplesFront.jpgTheir results are reported in Clinical Gastroenterology and Hepatology. GERD is a chronic condition usually resulting from the reflux of acidic stomach contents up into the esophagus. It is commonly treated with proton pump inhibitors, but some cases are refractory to this treatment. There has been conflicting data as to whether GERD symptoms are more common in people with celiac, and whether a gluten free diet might help. Dr. Bai's group designed a two pronged study to answer these questions: They undertook a cross sectional analysis of 133 people upon their diagnosis with celiac over the course of 2005, and a longitudinal assessment of 53 of them as they maintained a gluten free diet over the next four years.

At the time of their diagnosis, the proportion of celiac with reflux was six-fold higher than that in the the 70 healthy controls included in the study. Interestingly, more severe reflux symptoms were associated with the classical, rather than the silent, presentation of celiac disease. However, it should be noted that this was somewhat of a selected population; these data were obtained from patients coming to a malabsorption clinic, where the classic presentation of celiac is more prevalent than the silent type. Moreover, for whatever reason, these healthy volunteers had less GERD symptoms than is usually reported. After three months on a gluten free diet symptoms were comparable to those seen in healthy controls. Interestingly, though, this was the case for patients who reported only partially complying to a gluten free diet as well as those who adhered to it strictly.

Because these symptoms are alleviated upon assumption of a gluten free diet, the authors hypothesize that they might be caused by a nontraditional mechanism in celiac patients rather than by actual reflux. One suggestion they posit is reduced upper gastrointestinal motility, and another is a permeability defect in the stratified esophageal epithelium. In an editorial accompanying the paper, delayed gastric emptying and disturbed neuroendocrine control of upper GI function are floated potentially contributing to GERD symptoms in untreated celiac. Further research would have to be done to bear out these and other ideas.

Nachman F, Vázquez H, González A, Andrenacci P, Compagni L, Reyes H, Sugai E, Moreno ML, Smecuol E, Hwang HJ, Sánchez IP, Mauriño E, Bai JC. Gastroesophageal reflux symptoms in patients with celiac disease and the effects of a gluten-free diet. Clin Gastroenterol Hepatol. 2011 Mar;9(3):214-9. Epub 2010 Jun 30.

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3 Responses:

 
Joan Williams
Rating: ratingfullratingfullratingemptyratingemptyratingempty Unrated
said this on
19 Dec 2011 11:19:01 AM PST
I was diagnosed with celiac disease almost 33 years ago. I didn't have problems with GERD until 16 or 17 years ago. Have tried to go off med but in couple days dealing with GERD again.

 
Lori Muir
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said this on
19 Dec 2011 6:16:23 PM PST
Well, I can say for sure that yes, gluten caused my constant acid and/or constant belching. I have been through it all.

First they said it was depression, (fibromyalgia, chronic fatigue, IBS, insomnia, migraines, hot flashes, nueralgia, lyme disease, ovaries need to come out, ... back to its all in my head and I now need bipolar drugs, basically they never believed how sick I really was...felt like I was dying or wanted to be dead!)

.....and the meds made it (reflux, gerd, belching all of it) worse, (everytime)... so they put me on acid blockers, I was eating tums, and gas X daily... it still got worse; then a coating grew on my tongue...doc says they dont know what causes that exactly, for years they told me this, and I had to figure it out on my own!... ;

It was the prescription acid blockers; After 12 years of being misdiagnosed with every syndrome under the sun; I was suffering from chronic malabsorbtion... this over stimulated or under-stimulated all of my endocrine glands, thyroid slowed down; had nodules all over it; I got fat and sick, and in even more excruciating joint (bone) pain (yea, they called that arthritis at 34!)... the parathyroid kept pumping out PTH like no tomorrow, (and they never checked that until I INSISTED ON IT) which pulled calcium right out of my bones...causing a parathyroid adenoma.

By this time, the high PTH made my calcium way too high (10.2-10.8) plenty high for me; and my Vitamin D hit the floor at only 7-11! this also caused my BP to be high near the end, but it was low for years and I was not an athelete;, as well as high cholesterol; the good cholesterol was really good, the bad was really bad...

I was belching 24-7, even laying in the bed in the morning upon waking, belch belch belch, all the way to the coffee pot; ... my stomach felt so bloated like I was 9 mos. prego all the time.

I had the parathyroid ademoma removed with the minimally invasive radioguided technique; (don't get any other kind in my opinion MIRP or bust!) this immediately stopped the bone pain from leaching calcium; this also stopped the belching for the most part, but not completely..

None of it was completely cured until I figured out that it was not only gluten I had intolerence to...it is also some forms of fructose..the double sugars in particular, like garlic, onions, mushrooms, cabbage family veggies; apples, pears, raisins, honey, etc.

I am now following a LOW FODMAP food list and it is working wonderfully, when I remember to read ALL labels to ensure, no honey, no sugar free ingredients, no Xanthan gum, or any gluten dirivitive...and there are so many.

FODMAP is an acronym for different food groups and how they break down into sugars. Seems I lack a certain enzyme to break down "double sugar" foods, like wheat and corn gluten; while regular sugar is fine...but the doubles will start the belching, bloating, arms and legs going numb, insomnia, and just feel puffy, tired, achy and depressed!

For me, Its all about the VILLI..if damaged from food intolerences, you cant uptake nutrients from food, and digestiion does not work right at all... and you cant process what you have eaten; there is NO PILL TO FIX ANY OF THIS: diet changes are KEY; Good article, yes, its definitely related to food intolerance!! Read Dr. James Norman's new study on GERD and the parathryoid, (I participated in this one, may not be published yet)..

I have gone a step further and linked the reason my (2 out of 4) parathyroids were bad...its all about the villi, chronic malabsorbtion will ruin your endrocrine system after years of eating all the wrong things (and pills make it even worse because they have cellulose and gluten fillers!! - MIRP surgery 4-27-11; only the bone pain and most (not all) of the belching/acid cured; went gluten free in July 2011; symptoms changed as my diet did, still had IBS but it was now different, and definatly related to fruits, as I was now aware of everything I was eating by going gluten free;

I went low fodmap in September... this is heaven now, I am me again, what a journey! I feel light, never bloated, mind feels sharp, memory has improved greatly, along with energy, outlook, good sleep, and a bonus of a negative 40lbs! oh, yea,.....and no more IBS or migranes or high blood pressure, or high cholesterol, and I eat very well, anything I can dream up, as long as the ingredients are low in double sugars!!

This was the easiest trade off in my life compaired to the hell the doctors and surgeons put me though! FOOD< who knew? Veneers for my teeth are the next step and the last to truly feel like myself again! I now feel like I did in high school, never thought it possible.

Thank you all at Celiac.com... all the articles here are wonderful, such a life saver!

 
Kris
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said this on
05 Feb 2012 1:48:19 PM PST
Lori,
You are my kindred spirit. I went through all those diagnoses as well. It's quite frustrating, since I my records carry the words "mental illness", depression, etc., due to their misdiagnosis. I wonder how much better my life would have been, if only they had found the gluten intolerance and 20+ food allergies a long time ago. My health has severely suffered due to 20+ years of vitamin malabsorption.
Thank you for sharing!




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