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Celiac.com 06/28/2013 - Celiac disease has been linked to gastroesophageal reflux disease (GORD) and eosinophilic esophagitis (EoE), but there is very little data from population-based studies on the rates of shared disease among these groups. To get a better picture of the issue, a team of researchers recently set out to conduct a population-based study on rates of celiac disease in people with gastroesophageal reflux disease (GORD) and eosinophilic esophagitis (EoE). 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: Informa Healthcare. doi:10.3109/00365521.2013.792389
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: Leffler DA, Kelly CP. Celiac disease and gastroesophageal reflux disease: yet another presentation for a clinical chameleon. Clin Gastroenterol Hepatol. 2011 Mar;9(3):192-3. Epub 2010 Dec 8.
Celiac.com 11/21/2008 - Not much is known about what effects, if any, a gluten-free diet might have upon gastroesophageal reflux disease-related symptoms (GERD-rs) in people with celiac disease. A team of researchers recently set out to assess the recurrence of GERD-rs, in celiac patients with nonerosive reflux disease (NERD). 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.