Reflux, or gastroesophageal reflux disease (GERD), normally isn't considered one of the "classic" celiac disease symptoms — that dubious honor goes to symptoms such as diarrhea, bloating and fatigue.
However, medical research shows that reflux symptoms occur frequently in people with celiac disease, and may even appear after diagnosis, possibly as a sign of ongoing intestinal damage. In both cases, eliminating gluten from your diet seems to improve the reflux symptoms.
They also appear in people with non-celiac gluten sensitivity, and again, eliminating gluten from your diet seems to help relieve them.
Of course, there are many potential causes for GERD, including ulcers, gastritis, Barrett's esophagus and Heliobacter pylori, a type of bacteria that can cause ulcers. If you experience continuing or worsening GERD symptoms, you should see your doctor to rule out any potential causes that are unrelated to celiac disease.
GERD Causes Heartburn, Sore Throat, and Coughing
GERD, also known as acid reflux, is a common medical condition, both in people with celiac disease and without.
It's caused by a reflux of acid from your stomach backing up into your esophagus, most often due to relaxation of your lower esophageal sphincter, the valve in your esophagus that prevents food and acid from going the wrong way in your digestive system.
If you have GERD, you may feel a burning sensation in your chest, possibly traveling up to your throat, at some point between a few minutes and a few hours after eating. This burning sensation is caused by the acid backing up into your esophagus and towards your throat.
You may also feel as though your throat is sore (a result of stomach acid irritation), and you may taste that stomach acid in your mouth. Some people with GERD find they have difficulty swallowing or feel as if they have a lump in their throats, while some also have a chronic cough.
Celiac Disease and Reflux Symptoms Commonly Linked
Celiac disease patients have significantly higher rates of GERD, especially at the time of their celiac disease diagnosis.
In one study, researchers looked at 133 just-diagnosed adult celiac patients, and compared them to 70 non-celiac control subjects. At the time of their diagnosis, more than 30% of the celiacs had moderate to severe GERD, compared with fewer than 6% of controls.
Moderate and severe GERD symptoms occurred most commonly with "classical" celiac disease -- in other words, patients who had GERD also tended to have the classic celiac symptoms of diarrhea, bloating, weight loss and fatigue. Some 35% of celiacs with these "classical" symptoms also had GERD, while 15% of atypical and "silent" (i.e., mainly asymptomatic) celiacs complained of GERD.
Gluten-Free Diet Rapidly Alleviates GERD Symptoms
It's not clear whether gluten ingestion causes GERD in celiacs or if GERD is simply an associated condition. But in that study of just-diagnosed patients, most GERD sufferers saw their symptoms improve rapidly — within three months — once they adopted the gluten-free diet to treat their celiac disease.
Other researchers have reported similar findings. For example, another study looked at 29 adults with celiac disease who also suffered from a form of GERD that doesn't erode your esophagus. It found that the GERD resolved and stayed in remission throughout the two-year study once the patients adopted a gluten-free diet.
New GERD Cases May Suggest Persistent Villous Atrophy in Celiacs
However, some people with celiac disease report experiencing chronic GERD for the first time after their diagnoses. One study suggests that there could be some association between GERD, other "atypical" gastrointestinal symptoms, and persistent villous atrophy, or celiac-related damage to your intestines.
A total of 69 celiacs following a gluten-free diet were divided into two groups: one that included 42 people who still had symptoms, and another that included 27 people without symptoms. Both groups had repeat endoscopies and biopsies.
Persistent intestinal damage was more frequent in the group of patients with symptoms than in the second group: 85% of patients in the symptomatic group had some villous atrophy, compared to 33% in the asymptomatic group.
However, the symptoms the symptomatic group reported in this case were different from the symptoms that had led to their celiac disease diagnoses. Notably, 12 of the 69 complained of GERD, while 24 of them said they had constipation and abdominal pain.
The researchers concluded that persistent intestinal damage in celiac disease is associated with "atypical" gastrointestinal symptoms, including GERD.
Those with Gluten Sensitivity Also Report GERD
Heartburn and GERD may be even more common in undiagnosed people with non-celiac gluten sensitivity than they are in people with celiac disease, according to anecdotal reports.
Dr. Alessio Fasano, a leading gluten sensitivity researcher who heads the Center for Celiac Research at MassGeneral Hospital for Children, tells me that gluten sensitivity symptoms frequently include heartburn and "stomach ache."
Other researchers have noted the same thing. For example, a 2013 study in the American Journal of Gastroenterology listed GERD and heartburn among the top symptoms of people with non-celiac gluten sensitivity.
Still, much more research is needed to determine what percentage of people with GERD or heartburn symptoms might benefit from a gluten-free diet.
Could a Completely Gluten-Free Diet Alleviate GERD Symptoms?
In addition, it's not clear whether adopting a "cleaner" gluten-free diet (i.e., a diet with gluten levels far below the legal definition of "gluten-free") would alleviate GERD and other symptoms in people with celiac or with gluten sensitivity, or potentially clear up the intestinal damage found in celiac disease. Researchers haven't addressed either of those points.
However, other studies and anecdotal evidence from celiacs indicate that it might be possible to alleviate ongoing gluten symptoms, including GERD, if you give up most grain products and processed foods, since those are most likely to have low levels of gluten in them.
It's also possible to treat GERD through medications or even, in very severe cases, surgery. If you have celiac disease and you're suffering from severe, persistent GERD, you may want to consider talking with your doctor about potential treatment options.
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Nachman F. et al. Gastroesophageal Reflux Symptoms in Patients With Celiac Disease and the Effects of a Gluten-Free Diet. Clinical Gastroenterology and Hepatology. 2010 Jun 30 [Epub ahead of print]
Usai P. et al. Effect of gluten-free diet on preventing recurrence of gastroesophageal reflux disease-related symptoms in adult celiac patients with nonerosive reflux disease. Journal of Gastroenterology and Hepatology. 2008 Sep;23(9):1368-72.