Introduction There are limited data assessing the relationship between coeliac disease and GORD. We aimed to establish the prevalence and nature of GORD symptoms in patients with coeliac disease, and the prevalence of undetected coeliac disease in those presenting to endoscopy with GORD symptoms.
Methods Group A were histologically proven patients with coeliac disease (n=225) who were asked to complete a validated reflux questionnaire and then compared to age/sex-matched controls (n=348). Group B were consecutive GORD patients undergoing endoscopy who had duodenal biopsies and coeliac serology taken. (n=851) Furthermore, patients with newly diagnosed coeliac disease underwent manometry and pH studies prior to commencing gluten free diet (n=33).
Results In Group A the prevalence of GORD was greater in coeliac disease (66%) than in healthy controls (50%) p=0.0001. Coeliac patients also report reflux of greater severity: coeliac disease OR=6.8, 95% CI=3.6 to 12.7, p≤0.001. In Group B at endoscopy the prevalence of undetected coeliac disease was 1.66% (14/851). In Group C 31/33 were able to tolerate manometry and complete testing (2 had partial investigation before the catheter was removed) At manometry 30/33 (91%) had a normal lower oesophageal sphincter (LOS). 2/33 had a hypotensive LOS. 21/33 (64%) had normal oesophageal motility. However, 10/33 had a hypocontractile oesophagus, 1 was hypertensive and 1 showed functional oesophagogastric junction obstruction. During manometry 6/31 (19%) demonstrated significant reflux, 6/31 (19%) had some reflux and the final 19/31 (61%) had no reflux episodes. In these coeliac patients neither the presence of symptoms nor abnormal oesophageal study findings was related to histological grade of coeliac disease, (villous atrophy) or serology findings.
Conclusion Up to two thirds of patients with coeliac disease report reflux symptoms and one third have demonstrable abnormalities of oesophageal motility and reflux. However, in an unselected population at endoscopy, reflux symptoms are not predictive of coeliac disease.
Competing interests None declared.
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