Background. Gastroesophageal reflux disease (GORD) is common in coeliac disease (CD), both at diagnosis and during follow-up. However, few data are available on the natural history of GORD in coeliac patients on a long-term gluten-free diet (GFD). We aimed to evaluate the prevalence of GORD and endoscopic lesions in coeliac patients at diagnosis and throughout follow-up. Methods. Adult patients directly diagnosed with CD from January-2000 to October-2021 at our centre who underwent follow-up duodenal biopsy were enrolled in the study. Data on clinical, demographic, endoscopic and histological features of patients were retrospectively collected and analysed. Results. 197 patients (mean age at diagnosis 36±13 years, 141F) were enrolled. At diagnosis, 33/197 (16.8%) had reflux symptoms and 12/197 (6.1%) had oesophagitis. Of the 33 patients with GORD at diagnosis, only 7 (21.9%) still had reflux symptoms at time of follow-up duodenal biopsy (median 16 months, IQR 13-20) on a GFD. Conversely, 7/164 (4.3%) patients without GORD at diagnosis developed reflux symptoms after starting a GFD. Overall, reflux symptoms were significantly more common at diagnosis of CD than at follow-up duodenal biopsy (p<0.01) and only 5 patients (2.5%) had oesophagitis. GFD adherence was good in 90.2% of patients and duodenal biopsy showed recovery of villous atrophy in 83.8% of patients. Neither GFD adherence (p=1.00) nor mucosal recovery were related to GORD at follow-up biopsy (p=0.13). During follow-up (median 111 months, IQR 70-164), 37/197 patients (18.8%) reported ongoing reflux symptoms, more commonly in those with GORD at CD diagnosis (42.4% vs 14.0%, p<0.001). Conclusions. GORD is common in coeliac patients at diagnosis and improves in the large majority of patients after starting a GFD. However, a minority of patients develop GORD after starting a GFD, and ongoing reflux symptoms are common during long-term follow-up in coeliac patients.
Introduzione. La malattia da reflusso gastroesofageo (MRGE) è comune nei pazienti affetti da malattia celiaca (MC), sia alla diagnosi sia durante il follow-up. Tuttavia, sono disponibili pochi dati riguardanti la storia naturale di MRGE in pazienti celiaci in dieta priva di glutine (DPG) a lungo termine. Il nostro scopo è stato di valutare la prevalenza di MRGE e di lesioni endoscopiche in pazienti celiaci alla diagnosi e durante il follow-up. Metodi. Sono stati arruolati nello studio pazienti adulti che hanno ricevuto diagnosi di MC presso il nostro centro da gennaio-2000 a ottobre-2021 e che sono poi stati sottoposti a biopsia duodenale di follow-up. Dati relativi a caratteristiche cliniche, demografiche, endoscopiche e istologiche dei pazienti sono stati retrospettivamente raccolti e analizzati. Risultati. Sono stati arruolati 197 pazienti (età media alla diagnosi 36±13 anni, 141F). Alla diagnosi, 33/197 (16.8%) avevano sintomi da reflusso e 12/197 (6.1%) avevano esofagite. Dei 33 pazienti con MRGE alla diagnosi, solo 7 (21.9%) avevano ancora sintomi da reflusso al momento della biopsia duodenale di follow-up (mediana 16 mesi, IQR 13-20) in DPG. Al contrario, 7/164 (4.3%) pazienti senza MRGE alla diagnosi hanno sviluppato sintomi da reflusso dopo aver iniziato la DPG. Complessivamente i sintomi da reflusso risultavano significativamente più comuni alla diagnosi di MC che alla biopsia duodenale di follow-up (p<0.01), dove solo 5 pazienti (2.5%) avevano esofagite. L’aderenza alla DPG era buona nel 90.2% dei pazienti e la biopsia duodenale mostrava risoluzione dell’atrofia dei villi nell’83.8% dei pazienti. Né l’aderenza alla DPG (p=1.00) né la risposta istologica duodenale (p=0.13) si associavano a MRGE alla biopsia di follow-up. Durante il follow-up (mediana 111 mesi, IQR 70-164), 37/197 pazienti (18.8%) si sono verificati nuovi o ricorrenti sintomi da reflusso, più frequentemente nei pazienti con MRGE al momento della diagnosi di MC (42.4% vs 14.0%, p<0.001). Conclusioni. La MRGE è comune nei pazienti celiaci alla diagnosi di MC e migliora nella maggioranza dei pazienti dopo aver cominciato una DPG. Tuttavia, una minoranza di pazienti sviluppa MRGE dopo aver iniziato una DPG e i sintomi da reflusso sono comuni nel follow-up a lungo termine dei pazienti celiaci.
Malattia da reflusso gastroesofageo in pazienti affetti da malattia celiaca: studio di prevalenza alla diagnosi e dell’evoluzione durante follow-up
MANGILI, LORENZA
2022/2023
Abstract
Background. Gastroesophageal reflux disease (GORD) is common in coeliac disease (CD), both at diagnosis and during follow-up. However, few data are available on the natural history of GORD in coeliac patients on a long-term gluten-free diet (GFD). We aimed to evaluate the prevalence of GORD and endoscopic lesions in coeliac patients at diagnosis and throughout follow-up. Methods. Adult patients directly diagnosed with CD from January-2000 to October-2021 at our centre who underwent follow-up duodenal biopsy were enrolled in the study. Data on clinical, demographic, endoscopic and histological features of patients were retrospectively collected and analysed. Results. 197 patients (mean age at diagnosis 36±13 years, 141F) were enrolled. At diagnosis, 33/197 (16.8%) had reflux symptoms and 12/197 (6.1%) had oesophagitis. Of the 33 patients with GORD at diagnosis, only 7 (21.9%) still had reflux symptoms at time of follow-up duodenal biopsy (median 16 months, IQR 13-20) on a GFD. Conversely, 7/164 (4.3%) patients without GORD at diagnosis developed reflux symptoms after starting a GFD. Overall, reflux symptoms were significantly more common at diagnosis of CD than at follow-up duodenal biopsy (p<0.01) and only 5 patients (2.5%) had oesophagitis. GFD adherence was good in 90.2% of patients and duodenal biopsy showed recovery of villous atrophy in 83.8% of patients. Neither GFD adherence (p=1.00) nor mucosal recovery were related to GORD at follow-up biopsy (p=0.13). During follow-up (median 111 months, IQR 70-164), 37/197 patients (18.8%) reported ongoing reflux symptoms, more commonly in those with GORD at CD diagnosis (42.4% vs 14.0%, p<0.001). Conclusions. GORD is common in coeliac patients at diagnosis and improves in the large majority of patients after starting a GFD. However, a minority of patients develop GORD after starting a GFD, and ongoing reflux symptoms are common during long-term follow-up in coeliac patients.È consentito all'utente scaricare e condividere i documenti disponibili a testo pieno in UNITESI UNIPV nel rispetto della licenza Creative Commons del tipo CC BY NC ND.
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https://hdl.handle.net/20.500.14239/17122