One of the symptoms many people experience frequently and most people have
had sometime in their adult life is heartburn. The medical term for this
is pyrosis, from the Greek word pyro meaning fire or heat. Heartburn is
the classic symptom of gastroesophageal reflux (GER) or reflux. Most
people have heard of these terms now because you can’t sit through an hour
of television these days without seeing at least one commercial if not
several advertising antacids like tums or acid blockers like Pepcid AC and
Nexium. Most people are not aware that heartburn is a common symptom of
gluten intolerance or sensitivity.
Celiac disease, which is a severe intolerance to gluten (the major
storage protein in wheat and similar proteins in barley and rye resulting
in intestinal damage) is estimated to affect 1 in 133 people in the U.S.
and approximately 1/100 worldwide. Most of these people are undiagnosed.
Many are being treated for reflux, irritable bowel syndrome, gas-bloat
dyspepsia, lactose intolerance, or just suffering ill health unaware that
a gluten free diet (GFD) might relieve their symptoms if not improve them
Dyspepsia is a medical term for stomach upset, indigestion or gas-bloat
abdominal discomfort. This commonly occurs in celiac disease. Stomach
contractions have been shown to be impaired in celiac disease contributing
to the bloating sensation. This is confirmed by diagnostic studies
revealing poor stomach emptying. Delayed stomach emptying is frequently
accompanied by low pressures in the lower esophageal sphincter (LES) of
the esophagus or swallowing tube. The LES is supposed to be a barrier to
regurgitation of stomach contents up into the esophagus. When stomach
juice that is acidic refluxes into the esophagus a burning pain is
typically felt in the chest that is described by most people as heartburn.
When acid frequently regurgitates up into the esophagus a burn of the
lining occurs that is termed esophagitis or reflux esophagitis and defines
gastroesophageal reflux disease (GERD). Celiac disease patients have been
shown to have a high prevalence of GERD and reflux esophagitis. Treatment
with a gluten free diet has been shown to decrease the rate of relapse of
GERD symptoms. In clinical practice, many of us have observed that a
gluten free diet results in marked improvement of heartburn symptoms in
not just celiac disease but in many people.
As a practicing gastroenterologist, (www.thefooddoc.com) I have had
patients referred to me for reflux symptoms including several who were
being considered for possible surgery for GERD. Upon discovery of celiac
disease or non-celiac gluten sensitivity and institution of GFD they have
had improvement or resolution of symptoms. Personally, I experienced
frequent enough heartburn that I was taking a daily acid blocker. When I
discovered that though I had symptoms of gluten sensitivity and was DQ2
positive I had negative blood tests but elevated fecal gliadin IgA and
tissue transglutaminase IgA antibodies, I initiated a GFD. My heartburn
went away and I stopped taking a daily acid blocker. Now I only have
heartburn rarely, usually with obvious dietary indiscretions like too much
coffee, chocolate or wine.
My friend and colleague, Dr. Rodney Ford, who practices pediatric
gastroenterology in New Zealand, has communicated to me his similar
experience with children. Since expanding gluten free diet to those
children he suspects of gluten sensitivity, not just those in whom celiac
disease is confirmed by traditional or classic strict diagnostic criteria,
he has noted a marked decrease in the number of children with GER. He
states it has been many years since he has had to refer a child for
surgery for reflux.
There have been concerns about clinical significance of known acid
suppressive therapy impairment of digestion though so far the worries
about the increased risk for cancer seen in lab rats have been unfounded.
Recently, an increase risk of community-acquired pneumonia attributed to
loss of acid reduction of bacteria in the stomach was found in patients
with chronic lung disease or with other risk factors. There also is the on
going debate about the high costs of the newer, more effective acid
blocking drugs as well as their potential side effects. Some also raise
concerns of an increased risk of food intolerance or allergy while on acid
suppression. These issues and the risks of undiagnosed celiac disease not
withstanding should give one pause to the idea of chronic acid suppressive
therapy without investigating the possibility of undiagnosed celiac or
gluten sensitivity with a trial of GFD.
Copyright 2006 The Food Doc, LLC
ABOUT THE AUTHOR
Scot Lewey is a physician who is specialty trained and board certified in
the field of gastroenterology (diseases of the digestive system) who
practices his specialty in Colorado. He is the physician advisor to the
local Celiac Sprue support group and is a published author and researcher.
He offers online consultation through a secure website linked to his
http://www.thefooddoc.com The website will be offering much more
within the next 6-8 weeks when it is launched in it's final form with such
web applications as a symptom assessment tool, symptom finder, an online
symptom diet diary and much more.