title: Celiac disease and intestinal metaplasia of the esophagus (Barrett's esophagus).
abstract: Previous studies on celiac patients demonstrated that exposure to gliadin alters the motility of the upper gastrointestinal tract, leading to increased acid reflux. No literature is available regarding the possible presence of specialized intestinal metaplasia of the esophagus as a consequence of chronic reflux in adult celiac patients. Our purpose was to evaluate endoscopically and histologically the esophagi of a group of untreated celiac patients. We studied 60 celiac patients, 13 men and 47 women (mean age, 40 +/- 14 [SD] years; range, 18-80 years), at their first endoscopy (following a normal diet). The distal esophagus was evaluated and multiple biopsies were taken. Hematoxylin-eosin and alcian blue stainings were performed. A group of nonceliac, age- and sex-matched patients was used as a control. We found intestinal metaplasia in the distal esophagus of 16 of 60 (26.6%) celiacs (mean age, 45 +/- 13 years; range, 27-75 years), in comparison with a control-group prevalence of 10.9% (OR, 3.9; 95% CI, 1.4-11.2%). Among the celiac group with metaplasia, only one patient had reflux-like symptoms. None had esophagitis. In conclusion, we observed an increased prevalence of esophageal metaplasia in patients with celiac disease. This finding could be the result of motor abnormalities leading to chronic acid reflux, combined with a mucosa which is sensitive to gliadin.
authors.affiliation: Gastroenterology Unit, General Hospital S. M. della Misericordia, Udine, Italy. robertomaieron@tin.it
authors.forename: Roberto
authors.initials: R
authors.lastname: Maieron
authors.forename: Luca
authors.initials: L
authors.lastname: Elli
authors.forename: Marco
authors.initials: M
authors.lastname: Marino
authors.forename: Irene
authors.initials: I
authors.lastname: Floriani
authors.forename: Francesco
authors.initials: F
authors.lastname: Minerva
authors.forename: Claudio
authors.initials: C
authors.lastname: Avellini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Falconieri
authors.forename: Stefano
authors.initials: S
authors.lastname: Pizzolitto
authors.forename: Maurizio
authors.initials: M
authors.lastname: Zilli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000150:complications / Q000453:epidemiology / Q000473:pathology*; D002446:Celiac Disease / Q000150:complications* / Q000473:pathology*; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence