Almost 70% of patients with celiac disease (CD) develop reflux, with 30% describing their symptoms as moderate to severe. Most celiac patients with reflux aren’t well managed on reflux medication (PPI’s) but show fast improvement after starting a gluten-free diet.
Previous studies have also shown that the majority of CD patients reduce symptoms after starting a gluten-free diet, and don’t require the addition of PPI’s.
Impaired mucosal integrity in CD could explain the development of reflux in some patients. The mucosal barrier, also referred to as the intestinal barrier ensures containment of substances in the intestine, while preserving the ability to absorb nutrients. Mucosal barrier dysfunction has been implicated in numerous health conditions including celiac disease. Loss of mucosal integrity is considered to be a factor in the development of reflux. Mucosal integrity was restored to normal after one year of treatment on a gluten-free diet without PPI therapy. A gluten-free diet reversed symptoms of celiac disease after one year, restoring the gut mucosa to normal levels, since patients didn’t undergo any specific therapeutic interventions other than dietary changes.
Gastroesophageal reflux disease (GERD) is thought to be caused by altered expression of tight junctions (leaky gut). Zonulin, a marker of leaky gut, was increased in patients with celiac and normalised one year after starting a gluten-free diet. This suggests changes in tight junctions are related to celiac disease and are not a result of acid reflux.
Tight junction mRNA expression is altered in CD. MRNA’s are encoded on Chromosome 21, and their overexpression is likely to increase the onset of celiac disease in the Down Syndrome population. Research shows that Resveratrol reduces permeability by down regulating mRNA’s. The first step in reducing reflux associated with Celiac disease is to down-regulate the overexpression of mRNA’s via Resveratrol supplementation. Following this a gluten free diet will restore mucosal integrity and leaky gut associated with high mRNA expression and gluten intolerance.
https://www.ncbi.nlm.nih.gov/pubmed/20601132
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4022605/
https://www.ncbi.nlm.nih.gov/pubmed/27446827
