Celiac Disease Clinical Trial
Official title:
Mechanisms Underlying Development of Barrett's Esophagus in Patients With Gluten Related Disorders
In a small group of people gluten, a storage protein commonly in wheat and other grains, can
cause gut inflammation and symptoms like diarrhea and abdominal pain. Gluten-related
disorders include celiac disease (CD) and non-celiac gluten sensitivity (NCGS) and are
treated by starting a gluten free diet (GFD). Patients with CD and NCGS also more commonly
experience esophageal reflux and damage to the lining of the esophagus. A potential
consequence of long-standing heartburn is Barrett's esophagus (BE), a major risk factor for
cancer of the esophagus.
This study aims to investigate the mechanism that leads to reflux and BE in those with gluten
related disorders, and to assess if a GFD is beneficial. We will study the upper gut function
and reflux activity in patients with BE both with and without a GRD disorder. Testing will
occur before and after a gluten free diet is instituted. The results will help inform health
care providers and patients about the connection between gluten-related disorders, reflux,
BE, and the role of GFD.
Perhaps patient's with gluten related disorders develop Barrett's esophagus due to non-acid
reflux precipitated by upper gastrointestinal motility changes that respond to a gluten free
diet; whereas patients without gluten related disorders develop Barrett's due to the accepted
mechanism of acid reflux.
The primary objectives are to explore if patients with gluten-related disorders (CD and GS)
may have an altered mechanism of developing Barrett's esophagus typified by increased alkali
reflux compared to those without gluten-related disorders; and to determine if this mechanism
(altered motility and increased non-acid reflux) responds to a gluten free diet.
Specific objectives include assessing whether patients with GRD and Barrett's esophagus have
altered esophageal reflux extent, frequency, and type (assessed by pH-impedance); altered
symptom profiles; differential esophageal body and sphincter pressures (assessed by
manometry); aberrant gastroduodenal motility (assessed by videofluoroscopy) in comparison to
patients with BE and no GRD. Finally a gluten free diet will be instituted to assess whether
a gluten-free diet alters esophageal reflux extent, frequency, and type or symptom profiles
in those with BE with and without a GRD.
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