Should we screen reflux oesophagitis patients for coeliac disease?
OBJECTIVE
Oesophagitis and gastro-oesophageal reflux have been implicated recently in the manifestations of coeliac disease. The aim was to investigate this association in a primary-care setting.


METHODS
First, the prevalence of coeliac disease was calculated in 1198 adults with oesophagitis, in 2541 adults with reflux symptoms and in 200 adults suffering from dysphagia; 5459 patients with a history consistent with dyspepsia and 709 patients with a suspicion of coeliac disease served as controls. Second, the prevalence of oesophagitis was estimated in 382 untreated and 232 treated coeliac patients; controls here comprised 5404 patients with dyspeptic symptoms and 2525 patients with reflux symptoms. Third, oesophagitis and oesophageal reflux symptoms were investigated before and after a gluten-free diet was followed in 67 adults with coeliac disease. The diagnosis of coeliac disease was based on small-bowel histology; histological exclusion of the disease was unambiguous in all controls. Oesophagitis was identified by endoscopic inspection.


RESULTS
Altogether, 0.9% of patients with oesophagitis and 0.6% of those with oesophageal reflux symptoms had coeliac disease. The corresponding percentages were 1.0% in patients with dyspepsia and 12% with suspicion of coeliac disease. The prevalence of oesophagitis was 5.2% in untreated coeliac disease, 5.6% in treated coeliac disease, 7.0% in patients with dyspepsia, and 27% in symptomatic reflux disease. In coeliac patients, the reflux symptoms were mild but nevertheless were alleviated on a gluten-free diet.


CONCLUSIONS
This study does not support the conception that patients with reflux oesophagitis should be screened vigorously for coeliac disease. The association between these two conditions is, at most, weak, but a gluten-free diet may still bring symptomatic relief for reflux symptoms in coeliac disease.
Collin
Pekka
P
Department of Medicine, Tampere University Hospital, University of Tampere, Finland. pekka.collin@uta.fi
Mustalahti
Kirsi
K
Kyrönpalo
Sinikka
S
Rasmussen
Martin
M
Pehkonen
Eeva
E
Kaukinen
Katri
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002446:Celiac Disease / Q000150:complications* / Q000178:diet therapy / Q000453:epidemiology; D003680:Deglutition Disorders / Q000150:complications / Q000453:epidemiology; D004415:Dyspepsia / Q000150:complications / Q000453:epidemiology; D004942:Esophagitis, Peptic / Q000150:complications* / Q000178:diet therapy / Q000453:epidemiology; D005260:Female; D005387:Finland / Q000453:epidemiology; D005764:Gastroesophageal Reflux / Q000150:complications / Q000178:diet therapy / Q000453:epidemiology; D005983:Glutens / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care / Q000379:methods; D011446:Prospective Studies
D005983:Glutens