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

¹ Dipartimento di Internistica Clinica e Sperimentale-Gastroenterologia and CIRANAD, Seconda Università di Napoli, Napoli, Italy
² Dipartimento di Medicina Clinica e Sperimentale-Gastroenterologia, Università Federico II, Napoli, Italy

Correspondence to:
Correspondence to:
Dr M Romano, Dipartimento di Internistica Clinica e Sperimentale- Gastroenterologia, Seconda Università di Napoli, II Policlinico, Edificio 3, Secondo piano, Via Pansini 5, 80131 Napoli, Italy;
marco.romano{at}unina2.it

ABSTRACT
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.

Keywords: coeliac disease; reflux oesophagitis; gluten free diet

Abbreviations: GORD, gastro-oesophageal reflux disease; LOS, lower oesophageal sphincter; EMA, endomysium antibodies

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