Can Gluten Cause Acid Reflex?

Research Suggests a Link Between GERD and Celiac Disease

Terrible pain in his throat
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While gastric reflux, also known as gastroesophageal reflux disease (GERD), isn't considered a classic symptom of celiac disease, research suggests that as many as 30 percent of people with celiac disease will also experience symptoms of GERD, sometimes severe.

Fortunately, there is evidence that switching to a gluten-free diet may help resolve symptoms of both diseases. The same appears to be true for people with GERD and non-celiac gluten sensitivity, suggesting that there is more than just an incidental link between the various illnesses.

Understanding GERD

GERD, commonly referred to as acid reflux, is caused when a valve in separating the esophagus and stomach malfunctions and allows acid to back up (reflux) into the esophagus. There are many possible causes of GERD including ulcers, gastritis, and H. pylori infection, some of which are more treatable than others.

GERD is characterized by a sudden burning sensation in the chest due to the regurgitation of acid which can often extend into the throat. People with severe GERD often have trouble swallowing and may feel a persistent lump in the throat. A chronic, non-productive cough is also common.

Association Between Celiac Disease and GERD

People with celiac disease have a significantly higher rate of GERD than the general population, especially at the time of diagnosis.

In one study conducted in 2011, scientists evaluated 133 newly diagnosed adults with celiac disease alongside 70 non-celiac control subjects.

At the time of their diagnosis, persons with celiac disease had a five-fold increase in the risk of GERD compared to the non-celiac participants. Moreover, individuals with current symptoms of celiac disease (including diarrhea, bloating, weight loss, and fatigue) were more than twice as likely to have GERD than those without.

The biggest differentiator appeared to the adoption of a gluten-free diet. According to the investigators, participants who maintained a gluten-free diet almost universally had a "rapid and persistent improvement in reflux symptoms" compared to those who didn't. However, it is not clear whether gluten consumption caused GERD or if GERD was simply an associated condition.

What we do know for certain is that GERD sufferers in the study experienced a resolution of symptoms within three months of starting a gluten-free diet. The same was seen in a similar study in 2008 in which 29 adults with celiac disease had a two-year remission of GERD symptoms after adopting a gluten-free lifestyle.

Celiac Disease as the Cause of GERD

While a gluten-free diet may resolve symptoms of GERD in newly diagnosed celiacs, the same may not be true for people who experience GERD in later disease.

One study comprised of 69 adults with celiac disease found that those with evidence of villous atrophy (the flattening of the finger-like projections on the lining of the intestines) were more than twice as likely to have GERD than those with healthy villi.

This suggests that a different disease mechanism may be associated with GERD in later-stage celiacs.

Whether the adoption of a gluten-free diet might improve symptoms was not addressed in the study.

What This Tells Us

Whether a person with celiac disease has GERD at the time of diagnosis or later, the adoption of a gluten-free diet may help relieve symptoms of both.

We do, for instance, know that a gluten-free diet has the ability to reverse villous atrophy. It would stand to reason, therefore, that the resolution of intestinal damage may, at the very least, relieve some of the more profound symptoms of GERD.

With that being said, if GERD is caused by an unassociated condition such as H. pylori, it is unclear what, if anything, a gluten-free diet would do.

It is for this reason that any case of GERD needs to be investigated separately in order to establish the underlying cause. Without this, more serious causes may be overlooked or contributing factors (such as smoking, obesity, or aspirin use) may not be properly addressed.

Sources:

Boettcher E. and Crowe, S. "Dietary proteins and functional gastrointestinal disorders." American Journal of Gastroenterology. 2013;108(5):728-36. DOI: 10.1038/ajg.2013.97.

Lebwohl, B.; Blaser, M.; Ludwigsson, J. et al. "Decreased Risk of Celiac Disease in Patients With Helicobacter pylori Colonization." American Journal of Epidemiology. 2013; 178(12):1721-30. DOI: 10.1093/aje/kwt234.

Nachman F.; Vasquez, H.; Gonzalez, A. et al. "Gastroesophageal Reflux Symptoms in Patients With Celiac Disease and the Effects of a Gluten-Free Diet." Clinical Gastroenterology and Hepatology. 2011 Mar;9(3):214-9. DOI: 10.1016/j.cgh.2010.06.017.

Usai P.; Manca, R.; Cuomo, R. 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; 23(9):1368-72. DOI: 10.1111/j.1440-1746.2008.05507.x.