Patients with gastro-oesophageal reflux disease might benefit from coeliac disease screening as the two conditions are strongly linked, Australian researchers say.
A Newcastle University team including Professor Nick Talley conducted a meta-analysis and systematic review that identified a statistically significant three-to-four fold increased risk of gastro-oesophageal reflux disease (GORD) in patients with coeliac disease. The study also highlighting that a gluten free diet appeared to improve GORD symptoms.
The review, which drew from the findings of 31 studies, showed that prevalence of GORD in coeliac disease was 19%, with prevalence higher in paediatric coeliac disease patients compared to the adult patient group.
In a pooled analysis of 12 case–control studies with 105,051 patients, coeliac disease was strongly associated with GORD compared to controls (OR: 3.37).
This was also the case when compared with healthy volunteers (OR: 3.54), non-coeliac disease patients presenting with GI symptoms or iron deficiency (OR: 1.68), and those with coeliac disease on a gluten free diet (OR: 10.20), subgroup analyses showed.
Endoscopic oesophagitis was also significantly associated with coeliac disease.
One year of a gluten free diet in coeliac disease and GORD was more efficacious in preventing GORD symptom relapse than treatment with eight weeks of standard dose proton pump inhibitors in non-coeliac disease GORD patients (OR: 0.18), said the researchers, led by Dr Mudar Zand Irani of the NHMRC Centre of Research Excellence in Digestive Health, NewCastle.
“Subgroup analyses demonstrated an independent relationship between coeliac disease and GORD in reflux oesophagitis, GORD symptoms and manometric abnormalities. The most convincing evidence of an association between GORD and coeliac disease was GORD symptom relapse at one year was over five times less likely in coeliac disease treated with gluten free diet compared to controls with no heterogeneity,” the authors wrote in eClinicalMedicine [link here].
They said several possible mechanisms might explain the link, including duodenal inflammation in coeliac disease leading to GORD “through mechanisms such as eosinophilic neural induced damage in the duodenum altering entero-gastric reflex responses, impairing fundic accommodation and promoting reflux events”.
“Another possible pathway may be the presence of a common mucosal immunogenic response to gluten affecting both the duodenum and oesophagus.”
The researchers concluded the strong association between coeliac disease and GORD suggested the need for screening for coeliac disease in GORD patients.
“As coeliac disease and GORD are linked, the benefits of a gluten free diet should be assessed in coeliac disease and coexistent GORD, and the need for PPI therapy should regularly be reviewed after a gluten free diet is commenced.”