Gastro-oesophageal reflux symptoms and coeliac disease: no role for routine duodenal biopsy.
BACKGROUND
Coeliac disease (CD) has been linked to gastro-oesophageal reflux disease (GORD). Previous studies have demonstrated an increased prevalence of reflux in patients with CD. However data on the risk for CD in patients presenting with reflux are conflicting.


OBJECTIVE
The aim of this study was to establish the prevalence of CD in patients with GORD and to elucidate the mechanisms for reflux symptoms in newly diagnosed CD patients.


METHODS
Group A: patients who had undergone routine duodenal biopsy were prospectively recruited between 2004 and 2014. Diagnostic yield was compared with that of a screening cohort. Group B: 32 patients with newly diagnosed CD who had undergone oesophageal manometry and 24-h pH studies were prospectively recruited.


RESULTS
Group A: 3368 patients (58.7% female, mean age 53.4 years) underwent routine duodenal biopsy. Of these patients, 850 (25.2%) presented with GORD. The prevalence of CD among GORD patients was 1.3% (0.7-2.4%), which was not significantly higher than that in the general population (P=0.53). Within the context of routine duodenal biopsy at endoscopy (when corrected for concurrent symptoms, age and sex), reflux was found to be negatively associated with CD [adjusted odds ratio 0.12 (0.07-0.23), P<0.0001]. In group B, 34% of patients complained of reflux. On manometry, 9% had a hypotensive lower oesophageal sphincter and 40.6% had oesophageal motor abnormalities, with 25% significantly hypocontractile. On pH studies, 33% demonstrated reflux episodes.


CONCLUSIONS
The prevalence of undiagnosed CD among GORD patients is similar to that in the general population, and routine duodenal biopsy cannot be recommended. A significant number of patients with newly diagnosed CD were found to have reflux and/or oesophageal dysmotility on pH/manometry studies; this may explain the high prevalence of reflux symptoms in CD.
Regional GI and Liver Unit, Royal Hallamshire Hospital, Sheffield, South Yorks, UK.
Peter D
PD
Mooney
Kate E
KE
Evans
Matthew
M
Kurien
Andrew D
AD
Hopper
David S
DS
Sanders
D001706:Biopsy; D002446:Celiac Disease / Q000150:complications / Q000453:epidemiology* / Q000473:pathology*; D004386:Duodenum / Q000473:pathology*; D015154:Esophageal Motility Disorders / Q000453:epidemiology; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology; D050782:Esophageal pH Monitoring; D005260:Female; D005764:Gastroesophageal Reflux / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D006113:United Kingdom / Q000453:epidemiology