Are those with Celiac Disease more likely to have GERD?

The symptoms of Celiac Disease can range from none at all to diarrhea, stomach pain and bloating, and even acid reflux and other symptoms of gastroesophageal reflux disease (GERD). As you know, the only treatment for Celiac Disease is a gluten-free diet. Not long ago a group of researchers in Naples published a study that looked at whether a gluten-free diet would resolve the GERD-related symptoms in those with Celiac Disease (J Gastr and Hep 2008;23(9):1368-1372).

The researchers recruited 29 men and women with newly-diagnosed, biopsy-proven Celiac Disease who had also experienced reflux symptoms, including heartburn or acid regurgitation, which had recurred at least three times per week for six months or more. They also recruited 30 men and women without Celiac Disease who also had experienced the same symptoms to serve as a control group.

Often those with gastroesophageal reflux disease (GERD) are treated with a type of medication called a proton-pump inhibitor, or PPI. (Brand names of these drugs include Prilosec®, Nexium® and Prevacid®.) For the first 8 weeks of the study, the group with Celiac Disease followed a gluten-free diet and were also given a standard dosage of a PPI. The control group continued their usual diets and were also given a standard dosage of a PPI.

Other research has shown that if PPI treatment is successful at resolving the symptoms of GERD and then the patient stops taking the medication, as many as 75% of patients have their symptoms recur within 6 months. Accordingly, the Italian researchers had the participants stop taking the medication after the initial 8 weeks of the study. Those with Celiac Disease continued their gluten-free diet, while the control group continued their usual diet without the medication. Those people whose symptoms were not resolved by the first 8 weeks of medication were removed from the study (and continued the medication).

Every six months thereafter, the researchers followed up with the participants to see if their GERD symptoms had come back. If a patient had relapsed at any point, they were again treated with the medication, but withdrawn from the study.

After 6 months, 20% of those with Celiac Disease had begun to re-experience GERD symptoms, while 30% of the control group had had their symptoms recur. Those who experienced symptoms were withdrawn from the study.

After 12 months, the Celiac Disease patients had no more recurrence of GERD symptoms, while recurrence of those in the control group had reached 60%. After two years, 85% of the control group had returned to taking medication for their GERD, while those with Celiac Disease still had no symptoms of GERD.

What this means for you

The Celiac patients were not perfect in following their gluten-free diets: 1 in 4 of them consumed gluten once a month throughout the study. Even so, their GERD symptoms did not recur, leading the researchers to conclude that "a sporadic exposition to gluten is not enough to induce a significant GERD recurrence." If you have Celiac Disease and experience GERD symptoms, a short term of treatment with medication may be enough to help you become GERD-free, even if you sometimes slip up and consume foods containing gluten. Talk to your doctor.

First posted: February 16, 2011