Effect of Gluten-free Diet on Preventing Recurrence of Gastroesophageal Reflux Disease-related Symptoms in Adult Celiac Patients With Nonerosive Reflux Disease

Paolo Usai; Roberto Manca; Rosario Cuomo; Maria Antonia Lai; Luigi Russo; Maria Francesca Boi


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

In This Article

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,[1] and gastroesophageal reflux disease (GERD)-related symptoms.[2]

GERD is a chronic condition showing a trend to recurrence[3] 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).[4] 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.[5] Cuomo etal.[6] 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.


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