Abstract and Introduction
Background and Aim: In Celiac Disease (CD) the role of a gluten-free diet (GFD) on gastroesophageal reflux disease-related symptoms (GERD-rs) is unclear. The aim of this study was to establish the recurrence of GERD-rs, in CD patients with nonerosive reflux disease (NERD).
Methods: From a total of 105 adult CD patients observed, 29 who presented with the NERD form were enrolled in the study. Thirty non-CD patients with NERD were studied as controls. Recurrence of GERD-rs was clinically assessed at 6, 12, 18, and 24 months follow-up (FU) after withdrawal of initial proton-pump inhibitor (PPI) treatment for 8 weeks.
Results: GERD-rs were resolved in 25 (86.2%) CD patients and in 20 (66.7%) controls after 8 weeks of PPI treatment. In the CD group, recurrence of GERD-rs was found in five cases (20%) at 6 months but in none at 12, 18, and 24 months while in the control group recurrence was found in six of 20 controls (30%), in another six (12/20, 60%), in another three (15/20, 75%), and in another two (17/20, 85%) at 6, 12, 18, and 24 months FU respectively.
Conclusions: The present study is the first to have evaluated the effect of a GFD in the nonerosive form of GERD in CD patients, by means of clinical long-term follow-up, suggesting that GFD could be a useful approach in reducing GERD symptoms and in the prevention of recurrence.
Celiac disease (CD) is a gluten-related disorder causing inflammation of small-bowel mucosa, villous atrophy, and crypt hyperplasia, which may display protean clinical manifestations including dyspeptic symptoms, such as pyrosis or epigastric pain, early satiety, postprandial epigastric fullness, and gastroesophageal reflux disease (GERD)-related symptoms.
GERD is a chronic condition showing a trend to recurrence with a 4-week symptomatic response rate to proton-pump inhibitor (PPI) treatment of 56% in those with erosive esophagitis (EE) and 37% in those with nonerosive reflux disease (NERD). Furthermore, if long-term treatment is administered, by the disease's natural history itself, as it is not important whether it is erosive or nonerosive: once the successful initial treatment is withdrawn, only 10-25% of the patients with previous esophagitis and 25-45% of those with the nonerosive form, remain in remission after 6 months. Cuomo etal. were the first to describe a high prevalence of EE in adult CD patients, and to propose, after a short-term follow-up (FU), that gluten withdrawal could decrease the relapse rate of GERD-related symptoms, despite withdrawal of PPI treatment. However, there is a lack of long-term FU data on the clinical and endoscopic outcome of GERD-related symptoms in adult CD patients on a gluten-free diet (GFD).
The aim of the present study was, therefore, to establish, by means of a clinical and endoscopic long-term FU of 2 years the effectiveness of a GFD in resolving and preventing the recurrence of GERD-related symptoms, the need for PPI treatment, and to assess the progression to EE in adult CD patients with NERD.
J Gastroenterol Hepatol. 2008;23(9):1368-1372. © 2008 Blackwell Publishing
Cite this: Effect of Gluten-free Diet on Preventing Recurrence of Gastroesophageal Reflux Disease-related Symptoms in Adult Celiac Patients With Nonerosive Reflux Disease - Medscape - Sep 01, 2008.