Article

Digestive Diseases and Sciences

, Volume 50, Issue 1, pp 126-129

First online:

Celiac Disease and Intestinal Metaplasia of the Esophagus (Barrett’s Esophagus)

  • Roberto MaieronAffiliated withGastroenterology Unit, General Hospital S. M. della Misericordia Email author 
  • , Luca ElliAffiliated withGastroenterology Unit, General Hospital S. M. della Misericordia
  • , Marco MarinoAffiliated withGastroenterology Unit, General Hospital S. M. della Misericordia
  • , Irene FlorianiAffiliated withInstitute Mario Negri for Pharmacological Research
  • , Francesco MinervaAffiliated withGastroenterology Unit, General Hospital S. M. della Misericordia
  • , Claudio AvelliniAffiliated withDepartment of Pathology, University of Udine
  • , Giovanni FalconieriAffiliated withPathology Unit, General Hospital S. M. della Misericordia
  • , Stefano PizzolittoAffiliated withPathology Unit, General Hospital S. M. della Misericordia
  • , Maurizio ZilliAffiliated withGastroenterology Unit, General Hospital S. M. della Misericordia

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Previous studies on celiac patients demonstrated that exposure to gliadin alters the motility of the upper gastrointestinal tract, leading to increased acid reflux. No literature is available regarding the possible presence of specialized intestinal metaplasia of the esophagus as a consequence of chronic reflux in adult celiac patients. Our purpose was to evaluate endoscopically and histologically the esophagi of a group of untreated celiac patients. We studied 60 celiac patients, 13 men and 47 women (mean age, 40 ± 14 [SD] years; range, 18–80 years), at their first endoscopy (following a normal diet). The distal esophagus was evaluated and multiple biopsies were taken. Hematoxylin–eosin and alcian blue stainings were performed. A group of nonceliac, age- and sex-matched patients was used as a control. We found intestinal metaplasia in the distal esophagus of 16 of 60 (26.6%) celiacs (mean age, 45 ± 13 years; range, 27–75 years), in comparison with a control-group prevalence of 10.9% (OR, 3.9; 95% CI, 1.4–11.2%). Among the celiac group with metaplasia, only one patient had reflux-like symptoms. None had esophagitis. In conclusion, we observed an increased prevalence of esophageal metaplasia in patients with celiac disease. This finding could be the result of motor abnormalities leading to chronic acid reflux, combined with a mucosa which is sensitive to gliadin.

KEY WORDS:

celiac disease Barrett’s esophagus intestinal metaplasia histology gluten