Hearburn and Celiac Disease: Gluten Sensitivity as a Reversible Cause of Gastroesophageal Reflux

Dr. Scot Lewey
 


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One of the symptoms many people experience frequently and most people have had sometime in their adult life is heartburn. The medical term for this is pyrosis, from the Greek word pyro meaning fire or heat. Heartburn is the classic symptom of gastroesophageal reflux (GER) or reflux. Most people have heard of these terms now because you can’t sit through an hour of television these days without seeing at least one commercial if not several advertising antacids like tums or acid blockers like Pepcid AC and nexium.

Most people are not aware that heartburn is a common symptom of gluten intolerance or sensitivity. Celiac disease, a severe intolerance to gluten, the major storage protein in wheat (and similar proteins in barley and rye) resulting in intestinal damage is estimated to affect 1 in 133 people in the U. S. and approximately 1/100 worldwide. Most of these people are undiagnosed. Many are being treated for reflux, irritable bowel syndrome, gas-bloat dyspepsia, lactose intolerance, or just suffering ill health unaware that gluten free diet (GFD) might relieve their symptoms if not improve them significantly.

Dyspepsia is a medical term for stomach upset, indigestion or gas-bloat abdominal discomfort that commonly occurs in celiac disease. Stomach contractions have been shown to be impaired in celiac contributing to the bloating sensation and confirmed by diagnostic studies revealing poor stomach emptying. Delayed stomach emptying is frequently accompanied by low pressures in the lower esophageal sphincter (LES) of the esophagus or swallowing tube. The LES is supposed to be a barrier to regurgitation of stomach contents up into the esophagus. When stomach juice that is acidic refluxs into the esophagus a burning pain is typically felt in the chest that is described by most people as heartburn.

When acid regurgitates frequently up into the esophagus a burn of the lining occurs that is termed esophagitis or reflux esophagitis and defines gastroesophageal reflux disease (GERD). Celiac disease patients have been shown to have a high prevalence of GERD and reflux esophagitis. Treatment with gluten free diet has been shown to decrease the rate of relapse of GERD symptoms. In clinical practice, many of us have observed gluten free diet results in marked improvement of heartburn symptoms in not just celiac disease but in many people.

As a practicing gastroenterologist, (www.thefooddoc.com) I have had patients referred to me for refractory reflux symptoms including several who were being considered for possible surgery for GERD who upon discovery of celiac disease or non-celiac gluten sensitivity and institution of GFD have had improvement or resolution of symptoms. Personally, I experienced frequent enough heartburn that I was taking a daily acid blocker before starting a GFD. When I discovered I that though I had symptoms of gluten sensitivity and was DQ2 positive I had negative blood tests but elevated fecal gliadin IgA and tissue transglutaminase IgA antibodies, I initiated a GFD. My heartburn went away and I stopped taking a daily acid blocker. Now I only have heartburn rarely, usually with obvious dietary indiscretions like too much coffee, chocolate and wine in combination.

My friend and colleague, Dr. Rodney Ford, who practices pediatric gastroenterology in New Zealand, has communicated to me his similar experience with children. Since expanding gluten free diet to those children he suspects of gluten sensitivity, not just those in whom celiac disease is confirmed by traditional or classic strict diagnostic criteria, he has noted a marked decrease in number of children with GER. He states it has been many years since he has had to refer a child for surgery for reflux.

There have been concerns about clinical significance of known acid suppressive therapy impairment of digestion though so far the worries about the increased risk for cancer seen in lab rats have been unfounded. Recently, an increase risk of community-acquired pneumonia attributed to loss of acid reduction of bacteria in the stomach was found in patients with chronic lung disease or with other risk factors. There also is the on going debates about the high costs of the newer more effective acid blocking drugs as well as their potential side effects. Some also raise concerns of increase risk of food intolerance or allergy while on acid suppression. These issues and the risks of undiagnosed celiac disease not withstanding should give one pause pause to the idea of chronic acid suppressive therapy without investigating the possibility of undiagnosed celiac or gluten sensitivity with a trial of GFD.

Copyright 2006 The Food Doc, LLC. www.thefooddoc.com

Dr. Scot Lewey is a physician who is specialty trained and board certified in the field of gastroenterology (diseases of the digestive system) who practices his specialty in Colorado. He is the physician advisor to the local Celiac Sprue support group and is a published author and researcher. He offers online consultation through a secure website linked to his website http://www.thefooddoc.com The website will be offering much more within the next 6-8 weeks when it is launched in it's final form with such web applications as a symptom assessment tool, symptom finder, an online symptom diet diary and much more.

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