Prevalence of gastroesophageal reflux disease in adult coeliac disease at diagnosis and during follow-up: a 20-year retrospective study

Objective Gastroesophageal reflux disease (GORD) is commonly reported in coeliac disease (CD). However, long-term data on GORD in coeliac patients on a gluten-free diet (GFD) are lacking. 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 who underwent follow-up duodenal biopsy were enrolled. Clinical data were retrospectively collected and analysed. Results A total of 197 patients (141 F, mean age at diagnosis 36 ± 13 years) were studied. At diagnosis, 33/197 (16.8%) had reflux symptoms and 12/197 (6.1%) had oesophagitis. Only 7/33 (21.9%) still had reflux symptoms at follow-up duodenal biopsy (median 16 months, interquartile range: 13-20). Conversely, 7/164 (4.3%) patients without GORD at diagnosis developed reflux symptoms after starting a GFD. Overall, GORD was significantly more common at diagnosis of CD than at follow-up duodenal biopsy (P < 0.01), where only five had oesophagitis. GFD adherence was good in 90.4% and duodenal biopsy showed recovery of villous atrophy in 83.8% of patients. Neither GFD adherence (P = 1.00) nor mucosal recovery (P = 0.13) were related to GORD at follow-up biopsy. During follow-up (median 111 months), 41/197 patients (20.8%) reported ongoing reflux symptoms, more commonly in those with GORD at CD diagnosis (42.4% vs. 16.5%, P < 0.001). Conclusion 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.