This article was written for us by a pediatric gastroenterologist. Good information can also be found at the National Instututes of Health web site on celiac disease http://digestive.niddk.nih.gov/ddiseases/pubs/celiac/
Celiac Disease and GERD
Celiac disease (CD) is characterized by a life long sensitivity to food products that contain wheat, barley or rye. When people who are predisposed to celiac disease ingest any of these products they develop an inflammatory process in their intestines that leads to damage of the lining of the bowel. This in turn leads to malabsorption of nutrients and can cause a host of symptoms. CD is probably one of the most common genetically inherited diseases known to mankind. It occurs throughout the world and, in the USA and many European countries, it is estimated to affect between 1:100-200 people. This means there are probably more than 2 million affected people in the USA. In reality far fewer than this number have been diagnosed and there are a large number of affected individuals who remain undiagnosed. One of the major reasons for this state of affairs is the failure on the part of the health care profession to recognize the highly variable ways in which CD can present.
Although CD causes damage to the intestinal tract, not all people with the condition present with gastrointestinal symptoms. In fact, almost half of newly diagnosed cases have no gastrointestinal symptoms initially and present with a variety of manifestations that are often associated with a number of other common conditions. These include tiredness, anemia, unexplained weight loss, growth failure in children, delayed onset of puberty and osteoporosis (thinning of the bones). Even when the symptoms are of a gastrointestinal nature they can be extremely varied and include diarrhea, abdominal pain, bloating, nausea, vomiting, loss of appetite and even constipation.
Gastroesophageal reflux disease (GERD) is also a very common condition affecting both adults and children in the USA. Some features of GERD include vomiting, abdominal pain and feeding difficulties. The question then is “Should people with GERD be evaluated for CD?”
Because both conditions are so common it is likely that some individuals will have both GERD and CD, and it is also likely that a few individuals with CD have been mistakenly diagnosed as having GERD on the basis of their symptoms. If vomiting is the major symptom, it is the nature of the vomiting that may provide a clue. In GERD the vomiting is largely effortless with the gastric content coming back into the mouth quite freely, and often unexpectedly. When the vomiting is more active or forceful in nature, consideration of other conditions, including CD, is warranted. When vomiting is associated with symptoms that are not typical of GERD, it should raise a red flag. Symptoms of concern include weight loss, abdominal pain that does not respond to treatment for GERD, loss of appetite, anemia or diarrhea. As mentioned, it is quite possible that a person can have both GERD and CD, so if any of the gastrointestinal or non gastrointestinal symptoms listed above are present, and no other obvious explanation is found to account for them, the diagnosis of CD should be considered.
Confirmation of a diagnosis of CD requires an endoscopy and small intestinal biopsy. However this does not mean that every person with one of the many manifestations of CD should immediately undergo this procedure. Fortunately there are good blood tests available that allow us to screen for individuals who are more likely to have CD so they can be specifically targeted for biopsies. Confirmation of the diagnosis mandates treatment by means of life long adherence to a diet that excludes all products containing wheat, rye or barley. Adherence to the diet will result in complete symptom resolution and healing of the damage to the small intestine. However, following the diet is not a simple matter and does involve significant life style changes, therefore it is important to confirm the diagnosis in all cases before embarking on treatment.
Ivor Hill, MD
Professor of Pediatrics & Internal Medicine/Gastroenterology
Chief, Section of Pediatric Gastroenterology and Nutrition
Wake Forest University School of Medicine