Celiac.com 08/23/2023 - Distal gastrectomy has been a common treatment for peptic ulcers and gastroesophageal reflux disease. However, questions have arisen about its impact on gastric mucosa. 

A team of researchers recently looked into the connection between distal gastrectomy and Helicobacter pylori infection, as well as celiac disease. The research team included Kubilay Issever, Ersin Kuloglu, Demet Sengul, Ali Muhtaroglu, and Ahmet Cumhur Dulger. They are variously affiliated with the departments of Internal Medicine, Pathology, and General Surgery at Giresun University Medical Faculty in Giresun, Turkey.

Observational Retrospective Study Focused on Two Groups of Dyspepsia Patients

Conducted at Giresun University Faculty of Medicine, the observational retrospective study focused on two groups of patients with dyspepsia. The first group, termed the antrectomy group, consisted of 35 individuals who had undergone distal gastrectomy for benign causes. The second, the control group, included 50 dyspepsia patients who had not undergone gastrectomy.

Results showed that the antrectomy group had a higher proportion of older male patients. Lab parameters revealed significant differences: platelets, lymphocytes, and albumin levels were lower in the antrectomy group, while urea, creatinine, and antibodies like anti-Endomisium Ig A (anti-EMA) and anti-tissue transglutaminase IgA (anti-tTGA) were higher. Gastric biopsy results unveiled greater instances of Helicobacter pylori infection, tissue atrophy, neutrophil, and lymphocyte infiltration in the antrectomy group compared to the control group.

Further analysis showed correlations of note. An inverse relationship was found between albumin levels and the presence of anti-EMA antibodies or tissue atrophy. Conversely, a positive correlation existed between anti-EMA antibody presence and both Helicobacter pylori infection and tissue atrophy.

Distal Gastrectomy for Dyspepsia Patients More Likely to Have Helicobacter Pylori Infection and Celiac Disease

The study's implications are significant. People who have undergone distal gastrectomy for dyspepsia may be more susceptible to complications tied to Helicobacter pylori infection and celiac disease. The potential for Helicobacter pylori infections to progress into malignancies raises concerns. As a result, routine screening and interventions to eliminate Helicobacter pylori infections are paramount to prevent malignant transformations in the remaining gastric tissue.

This study underscores the potential risks stemming from distal gastrectomy, especially its association with Helicobacter pylori infection and celiac disease. This knowledge will help medical practitioners to better navigate post-gastrectomy care, more effectively manage potential complications, and better plan preventive measures.

This study does not indicate whether the increased celiac disease risk was a result of the distal gastrectomy, or whether the patients who underwent a distal gastrectomy may have had undiagnosed celiac disease before this treatment. Logically the results of this study might indicate that routine screenings for celiac disease should be done before any distal gastrectomy surgery to rule it out. 

Read more at Cureus.com
 

Celiac.com 12/05/2022 - Helicobacter pylori (H. pylori) is one possible cause for dyspepsia. However, dyspeptic symptoms are also common in H. pylori negative gastritis. Understanding the underlying causes could help improve treatment strategies for dyspepsia and chronic gastritis. 

A team of researchers recently set out to assess rates of dyspeptic symptoms in patients with H. pylori negative chronic gastritis, and explore any potential role played by autoimmunity.

The research team included Noémi Zádori, Dávid Németh, Levente Frim, Nóra Vörhendi, Lajos Szakó, Szilárd Váncsa, Péter Hegyi, and József Czimmer.

They are variously affiliated with the Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary; the János Szentágothai Research Centre, University of Pécs, Pécs, Hungary; the Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; the Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary

For their retrospective study, the team included data from patients with H. pylori negative chronic gastritis. They excluded: patients with acute gastritis; reactive gastropathy; subjects without serology test results; H. pylori positivity; presence of atrophy, intestinal metaplasia (IM), gastroesophageal reflux disease (GERD), ulcer, or cancer. 

The researchers assessed the following endpoints:

1. the rate of dyspepsia-like symptoms;
2. links between dyspepsia and autoimmune disease-related seromarker positivity (AISP);
3. frequency of other symptoms in chronic gastritis and its association with AISP; and
4. location of the inflammation and its association with AISP.

For their study, the team included 175 from a total of 285 patients. A total of ninety-five of these 175 patients, nearly 55%, experienced dyspeptic symptoms.

Overall, AISP was more common in these dyspeptic patients, especially celiac seropositivity, anti-neutrophil cytoplasmic antibody (ANCA) and anti-Saccharomyces cerevisiae antibodies (ASCA) positivity. The team found no significant connections with other tested autoimmune (AI)-related antibody positivity.

Having positive seromarkers for autoimmune diseases in chronic gastritis may make people susceptible to dyspeptic symptoms, and may be the cause of many cases of dyspepsia. 

According to their findings: "From a total of 285 patients, 175 were included in this study. Among these patients, 95 experienced dyspeptic symptoms (54.29%) and were associated more with AISP (p = 0.012), especially with celiac seropositivity (p = 0.045), anti-neutrophil cytoplasmic antibody (ANCA) and anti-Saccharomyces cerevisiae antibodies (ASCA) positivity (p = 0.043). A significant association was not found with other tested autoimmune (AI)-related antibody positivity."

The data suggest that additional studies will help to clarify whether antibody screening in patients with dyspepsia will help shrink the time for autoimmune disease diagnoses, and whether screening is economically and medically beneficial.

Read more at dovepress.com

Celiac.com 03/23/2022 - There's not much solid data, and no clear consensus, on the connection between eosinophilic esophagitis and celiac disease. There seems to be no clear pattern to the conditions in which they occur together in patients. 

A team of researchers recently set out to investigate rates of esophageal eosinophilia and eosinophilic esophagitis in a large group of children with celiac disease, and to prospectively follow the group over an eleven year period.

The research team included Fernanda Cristofori; Fulvio Salvatore D’Abramo; Vincenzo Rutigliano; Vanessa Nadia Dargenio; Stefania Castellaneta; Domenico Piscitelli; Davide De Benedittis; Flavia Indrio; Lidia Celeste Raguseo; Michele Barone; and Ruggiero Francavilla.

They are variously affiliated with the Interdisciplinary Department of Medicine, Pediatric Section “B. Trambusti”, University of Bari “Aldo Moro” in Bari, Italy; the Department of Emergency and Organ Transplantation, Section of Gastroenterology, University of Bari “Aldo Moro” in Bari, Italy; the Department of Emergency and Organ Transplantation, Section of Pathology, University of Bari “Aldo Moro” in Bari, Italy; the Department of Information Engineering, University of Pisa, Largo L. Lazzarino in Pisa, Italy; and the Department of Medical and Surgical Science, University of Foggia, Viale L. Pinto, 71122 Foggia, Italy.

The team used data from a prospective observational study performed between 2008 and 2019. They used ESPGHAN criteria to make celiac disease diagnosis. They sampled at least four esophageal biopsies in patients who underwent endoscopy. The team defined esophageal eosinophilia as at least 15 eosinophils/HPF seen on esophageal biopsy. They diagnosed eosinophilic esophagitis using the International Consensus Diagnostic Criteria for Eosinophilic Esophagitis. 

The team diagnosed a total of 465 children with celiac disease. A total of three hundred and seventy patients underwent endoscopy, while the team found esophageal biopsies for 313 of those. 

The rate of esophageal eosinophilia in children with celiac disease was 1.6%. Just a single child was diagnosed with eosinophilic esophagitis, for which the team calculated a prevalence rate of 0.3%. Overall, the team saw eosinophilic esophagitis in celiac patients at a rate at least 6.5 times higher than in the general population. 

According to the team, eosinophils over 15/HPF do not have a clinical implication or warrant intervention in celiac patients, so they do not recommend esophageal biopsies beyond what may be clinically indicated.

This is one of the first studies to put some hard numbers on the connection between eosinophilic esophagitis and celiac disease. The idea that people with celiac disease don't generally need to worry about eosinophilic esophagitis is one less thing to deal with in the often confusing world of living with celiac disease. 

Read more:  Nutrients 2021, 13(11), 3755

Celiac.com 07/09/2020 - Refractory functional dyspepsia (RFD) is a condition marked by ongoing symptoms even with medical treatment or H. pylori eradication. A team of researchers recently set out to investigate the presence of gluten-dependent RFD as a clinical presentation of Non-Celiac Gluten Sensitivity (NCGS). 

The team included Bijan Shahbazkhani, Mohammad M. Fanaeian, Mohammad J. Farahvash, Najmeh Aletaha, Foroogh Alborzi, Luca Elli, Amirhossein Shahbazkhani, Jayran Zebardast, and Mohammad Rostami-Nejad.

They are variously associated with Division of Gastroenterology and Liver Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran; the Division of Gastroenterology and Liver Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran; the Center for Prevention and Diagnosis of Celiac Disease, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; the Cognitive Science Special Linguistics, Institute of Cognitive Sciences, Tehran, Iran; and the Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

For six weeks, the team followed the progress of RFD patients on a gluten-free diet. All patients had been checked and ruled out for celiac disease, wheat allergy and H. pylori infection. 

The team used visual analogue scales to gauge symptoms. Patients who reported a 30% or better improvement, in at least one symptom after a gluten-free diet, then faced a double-blind placebo controlled gluten challenge. 

For the study, the research team divided the participants randomly into two groups. They assessed symptoms after the gluten/placebo challenge. They also followed those who responded to a gluten-free diet for another 3 months, to assess the relationship between patient symptoms and gluten consumption. 

Out the seventy-seven patients with RFD, fifty patients, or 65%, failed to respond to a gluten-free diet. Twenty-seven patients, more than one-third, reported that a gluten-free diet improved their gastrointestinal symptoms. Five patients with RFD, and 14 patients who responded to gluten-free diet, experienced a recurrence of symptoms after blind gluten ingestion, which indicates Non-Celiac Gluten Sensitivity. 

Symptoms that improved in Non-Celiac Gluten Sensitivity patients on a gluten-free diet include extra-intestinal symptoms, fatigue and weakness, musculo-skeletal pain, and headache. 

Because of the high rates of Non-Celiac Gluten Sensitivity among RFD patients, the research team advocates the use of a diagnostic/therapeutic roadmap to evaluate the effect of gluten-free diet in patients with RFD.

Read more at Sci Rep. 2020; 10: 2401

Celiac.com 06/14/2017 - Some data have suggested a connection between celiac disease and eosinophilic oesophagitis (EoE)/oesophageal eosinophilia (EE). Any potential relationship has implications for treatment. Should the two conditions be treated together, or separately?

To better understand any possible connection, and the implications for treatment, a team of researchers recently set out to characterize children with celiac disease+EE in-depth and assess the contribution of each condition to the clinical presentation and treatment response.

The research team included Anne Ari, Sara Morgenstern, Gabriel Chodick, Manar Matar, Ari Silbermintz, Amit Assa, Yael Mozer-Glassberg, Firas Rinawi, Vered Nachmias-Friedler, Raanan Shamir, and Noam Zevit. They are variously affiliated with the Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children’s Medical Center of Israel, Petach Tikvah, Israel, the Pediatrics Center at Schneider Children’s Medical Center of Israel, Petach Tikvah, Israel, the department of Pathology at Rabin Medical Center in Petach Tikvah, Israel, and the Sackler Faculty of Medicine at Tel Aviv University in Tel Aviv, Israel.

The research team conducted a retrospective review of medical records of children with both celiac disease+EE, or isolated EoE diagnosed between 2000 and 2014. They then compared these records with those of patients with isolated celiac disease or epigastric pain. To calculate the frequency of EE, they used endoscopy results of patients with suspected celiac disease or epigastric pain between 2011 and 2014. They used a telephone questionnaire to gather missing data.

At a single large, tertiary pediatric center, the team assessed 17 patients with celiac disease+EE, 46 with EoE, 302 with isolated celiac disease, and 247 with epigastric pain. The patients with celiac disease+EE shared characteristics of both individual conditions. While age at diagnosis, family history of autoimmunity/celiac disease and anaemia were similar to most celiac patients, other characteristics such as male gender, personal/family history of atopy, peripheral eosinophilia and oesophageal white papules more closely resembled those of patients with EoE.

Most patients with celiac disease+EE tended to present with celiac-associated symptoms, and 63% went on to develop typical EoE symptoms. In celiac disease+EE patients, only 21% saw their EE resolve after a gluten-free diet; another 21% saw their EE normalize after proton pump inhibitor treatment. The rest required EoE-specific treatment.

Patients with celiac disease found to have EE share characteristics similar to both isolated celiac disease and EoE.

This study indicates that celiac patients with concurrent EE are actually suffering from two separate conditions, rather than celiac-associated eosinophilia. Therefore, in such patients, doctors should consider treating each condition separately.

Source:

• Archives of Disease in Childhood Published Online First: 12 April 2017. doi: 10.1136/archdischild-2016-311944

Celiac.com 04/20/2016 - People with celiac disease very often have reflux symptoms. A team of researchers recently set out to evaluate mucosal integrity and motility of the lower esophagus as possible contributors to reflux symptoms in patients with celiac disease.

The research team included María Inés Pinto-Sánchez, Fabio D. Nachman, Claudia Fuxman, Guido Iantorno, Hui Jer Hwang, Andrés Ditaranto, Florencia Costa, Gabriela Longarini, Xuan Yu Wang, Xianxi Huang, Horacio Vázquez, María L. Moreno, Sonia Niveloni, Premysl Bercik, Edgardo Smecuol, Roberto Mazure, Claudio Bilder, Eduardo C. Mauriño, Elena F. Verdu, and Julio C. Bai.

They are variously affiliated with the Farncombe Family Digestive Health Research Institute at McMaster University, in Hamilton, Ontario, Canada, the Department of Medicine, "Dr. Carlos Bonorino Udaondo" Gastroenterology Hospital in Buenos Aires, Argentina, Favaloro University Hospital in Buenos Aires, Argentina, Consejo de Investigación en Salud, MSAL, Gobierno de la Ciudad Autónoma de Buenos Aires, Argentina, and with the Gastroenterology Chair, Universidad del Salvador in Buenos Aires, Argentina.

For their study, they enrolled newly diagnosed celiac disease patients with and without reflux symptoms, non-celiac patients with classical reflux disease (GERD), and control subjects, who had no reflux symptoms.

Using both light microscopy and electron microscopy, they assessed endoscopic biopsies from the distal esophagus for dilated intercellular space (DIS). They used qRT-PC to determine tight junction (TJ) mRNA proteins expression for zonula occludens-1 (ZO-1) and claudin-2 and claudin-3 (CLDN-2; CLDN-3).

Overall, patients with active celiac disease showed higher DIS scores than controls, and similar to GERD patients. They found altered DIS even in celiac disease patients without reflux symptoms, who had normalized after one year of a gluten-free diet.

Celiac disease patients with and without reflux symptoms had lower expression of ZO-1 than controls. Celiac disease and GERD patients showed similar expression of CLDN-2 and CLDN-3.

This study shows that patients with active celiac disease have altered esophageal mucosal integrity, independent of any reflux symptoms.

Loss of TJ integrity in the esophageal mucosa may result from altered expression of ZO-1, which may contribute to the development of reflux symptoms.

Source:

• Open Original Shared Link

Celiac.com 05/21/2015 - Some studies have indicated higher rates of reflux in patients with celiac disease, but there hasn't really been any clear data on the risk for celiac disease in patients presenting with reflux.

A team of researchers recently set out to determine rates of celiac disease in patients with GORD, and to better understand the nature of reflux symptoms in newly diagnosed celiac disease patients.

The research team included P.D. Mooney, K.E. Evans, M. Kurien, A.D. Hopper, and D.S. Sanders. They are affiliated with the Regional GI and Liver Unit, Royal Hallamshire Hospital, Sheffield, South Yorks, UK.

The team divided the patients into groups as follows:

Group A included 3368 patients who had undergone routine duodenal biopsy, and prospectively recruited between 2004 and 2014. Researchers compared these results with those of a screening control group.

Group B included 32 patients with newly diagnosed celiac disease who had undergone esophageal manometry and 24-h pH studies, prospectively recruited.

The results showed the following:

Of the 3368 patients in Group A who received routine duodenal biopsy, 850 (25.2%) presented with GORD.

Rates of celiac disease among GORD patients was just 1.3% (0.7-2.4%), about the same as in the general population (P=0.53).

Routine duodenal biopsy at endoscopy showed that reflux was negatively associated with celiac disease, with an adjusted odds ratio of 0.12 (0.07-0.23), P<0.0001.

In group B, about one third of patients complained of reflux. Manometry showed that just under 10% had a hypotensive lower esophageal sphincter, and 40.6% had esophageal motor abnormalities, with 25% showing significant hypocontraction. Also, pH study did show that one in three did in fact suffer reflux episodes.

The main takeaway from this study is that GORD patients have undiagnosed celiac disease at about the same rate as the general population, and so routine duodenal biopsy cannot be recommended for patients with GORD.

Interestingly, pH/manometry studies showed a fairly high percentage of newly diagnosed celiac patients with reflux and/or esophageal dysmotility; which might explain the high prevalence of reflux symptoms in celiac disease.

Source:

• Open Original Shared Link

Celiac.com 09/11/2014 - What’s the relationship, if any, between eosinophilic esophagitis (EoE) and celiac disease? Research studies have produced variable results.

Researchers A. J. Lucendo, Á. Arias, and J. M. Teniaso recently set out to conduct a systematic review of medical literature to determine if there’s any evidence of a connection between both diseases. They used the MEDLINE, EMBASE and SCOPUS databases to conduct electronic searches with keywords relating to EoE and celiac disease.

Depending on study heterogeneity, they used random-effects models as needed (I2). To assess publication bias, they used funnel plot analysis, along with the Begg–Mazumdar, Harbord and Egger tests.

Their keyword search produced 197 significant study references; 30 were included in the quantitative summary, with most showing serious methodological inconsistencies. The team found significant publication bias in favor of short studies reporting positive connections between the two diseases.

The prevalence of EoE in celiac patients ranged from 0% to 10.7% (I2 = 78.9%). Rates of celiac disease in EoE varied wildly, between 0.16% and 57.1% (I2 = 89%).

One high-quality, prospective, randomly selected, population-based study showed a celiac disease rate of 1.1%, with no cases of EoE. Numerous quantitative summaries of celiac prevalence suffer from clinical and methodological differences. That is, they are are not similar enough to draw good conclusions.

A gluten-free diet produced histological remission of EoE in 32.1% of celiac patients (95% confidence interval, 14.9–52.2%; I2 = 52.2%), which was similar to that expected for wheat elimination in EoE patients.

There are not really enough valid studies to completely rule in or out a true association between EoE and celiac disease, currently available evidence does not support any such connection. In fact, the only epidemiologically valid study indicates that these diseases are not connected.

Source:

• Open Original Shared LinkOpen Original Shared LinkOpen Original Shared LinkOpen Original Shared Link

The research team included Jonas F. Ludvigsson, Pertti Aro, Marjorie M. Walker, Michael Vieth, Lars Agréus, Nicholas J. Talley, Joseph A. Murray, and Jukka Ronkainen. They are variously affiliated with the Department of Medicine at Karolinska University Hospital and Karolinska Institutet, Clinical Epidemiology Unit, in Stockholm, Sweden, the Department of Pediatrics at Örebro University Hospital in Örebro, Sweden, the Departments of Medicine and Immunology in the Division of Gastroenterology and Hepatology at the Mayo Clinic College of Medicine in Rochester, USA, the Department of NVS, Center for Family and Community Medicine, Karolinska Institutet, Stockholm, Sweden, the Faculty of Health at the University of Newcastle in Newcastle, Australia, the Institute of Pathology in Bayreuth, Germany, the Primary Health Care Center of Tornio, Finland, and the Institute of Health Sciences at the University of Oulu in Oulu, Finland.

For their study, the team conducted endoscopes on a thousand randomly selected adults from the general population.

They defined celiac disease as positive serology together with mucosal abnormalities of the small intestine. They defined any eosinophil infiltration of the esophageal epithelium as esophageal eosinophilia and EoE was defined as having at least 15 eosinophils/high-power field in biopsies from the distal esophagus.

They used Fisher's exact test to compare the prevalence of GORD, esophageal eosinophilia, and EoE in subjects with celiac disease, and to compare the realists with those of the control group.

Of the 400 subjects (40%) with gastroesophageal reflux symptoms (GORS), 155 (15.5%) had erosive esophagitis, 16 (1.6%) had Barrett's esophagus, 48 (4.8%) had esophageal eosinophilia, and 11 (1.1%) had EoE.

They diagnosed celiac disease in eight (2%) of the 400 individuals with GORS, compared to 10 of 600, or 1.7% for the control group (p = 0.81). They also diagnosed celiac disease in 3 of 155 subjects (1.9%) with erosive esophagitis, compared with 15 of 845 (1.7%) of control subjects (p = 0.75); and 2 cases of celiac disease from the 48 (4.2%) individuals with esophageal eosinophilia (controls were 16 of 952 (1.7%), p = 0.21).

They found no celiac disease, however, in any of the 16 subjects with Barrett's esophagus, while they did find 18 cases among the 984, or 1.8% of control subjects; p = 1.0.

Nor did they find celiac disease in any of the 11 individuals with EoE, compared with 18 cases in the 989, or 1.8% of control subjects; p = 1.0.

Because this population-based showed no increased risk of celiac disease among individuals with GORD, esophageal eosinophilia, or EoE, they conclude that there is no need to conduct celiac screening of individuals with GORD, or EoE screening of individuals with celiac disease.

Source:

• Open Original Shared Link

Celiac.com 01/04/2012 - A number of cases have led researchers to suspect a connection between eosinophilic esophagitis and celiac disease in children.

A research team sought to confirm this association in children, and determine whether it extends into adulthood. To do this, they reviewed data from a group of celiac disease patients to learn the number of patients who also had a diagnoses of eosinophilic esophagitis. 

The team included Jennifer S. Thompson, MD, Benjamin Lebwohl, MD, MS, Norelle Rizkalla Reilly, MD, Nicholas J. Talley, MD, PhD, Govind Bhagat, MD, and Peter HR. Green, MD.

For their study, they reviewed histopathology reports of esophageal biopsies to identify all cases of increased esophageal eosinophilia.

The team defined cases of eosinophilic esophagitis as those where biopsies showed Z15 eosinophils per high power field and, which also included associated symptoms.

Using published US population-derived incidence data as a reference, they formulated age- and sex-adjusted standardized incidence ratios with corresponding 95% confidence intervals (CI).

In all, the team found 4 children and 10 adults with eosinophilic esophagitis, which makes eosinophilic esophagitis more common in people with celiac disease than in the general population.

Standardized incidence ratio was 35.6 (95% CI, 9.3-79.0) for children, and 13.1 (95% CI, 6.2-22.5) for adults. Overall, age-adjusted and sex-adjusted standardized incidence ratio was 16.0 (95% CI, 8.7-25.5).

This study found higher rates of eosinophilic esophagitis in patients with celiac disease than in the general population. The researchers advise doctors to consider the possibility of eosinophilic esophagitis for celiac disease patients who suffer ongoing esophageal problems.

Source:

• Open Original Shared Link

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. Their 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.

Source:

• Open Original Shared Link

Out of a total of 105 adult patients with celiac disease, the team found 29 with celiac disease who presented with the NERD. Those 29 were enrolled in the study, and compared against a control group of thirty non-celiac patients with NERD.

After 8 weeks of PPI treatment the team found that 25 (86.2%) celiac patients saw GERD-rs resolve, compared to just 20 (66.7%) control subjects. The team used clinical means to assess recurrence of GERD-rs at 6, 12, 18, and 24-month intervals after initial proton-pump inhibitor (PPI) treatment were withdrawn for 8 weeks.

In the celiac disease group, just five patients (20%) had a recurrence of GERD-rs at 6 months, but none had recurrence at 12, 18, and 24 months, while the control group showed recurrence in six of 20 controls (30%) at 6 months, in another six (12/20, 60%) at 12 months, in another three (15/20, 75%) at 18 months, and in another two (17/20, 85%) at 24 months.

This is the first study to evaluate the effect of a gluten free diet in the nonerosive form of GERD in patients with celiac disease, via a clinical long-term follow-up, and the results suggest that a gluten free diet could be helpful reducing GERD symptoms and in preventing of their recurrence.

J Gastroenterol Hepatol.  2008;23(9):1368-1372.