Celiac disease and gastritis are distinct conditions affecting the digestive system, yet a connection exists. While celiac disease primarily impacts the small intestine and gastritis involves the stomach lining, this article explores their potential link and how one might contribute to the other.
Understanding Celiac Disease
Celiac disease is an autoimmune condition triggered by gluten, a protein found in wheat, barley, and rye. When gluten is consumed, the immune system attacks the small intestine lining, damaging the villi. These small, finger-like projections are responsible for nutrient absorption. The destruction of these villi, known as villous atrophy, impairs the body’s ability to absorb nutrients from food.
Understanding Gastritis
Gastritis refers to inflammation of the stomach lining. This inflammation can occur suddenly (acute gastritis) or develop gradually over time (chronic gastritis). Several factors can irritate or damage the stomach lining, leading to gastritis. Common causes include infection with Helicobacter pylori (H. pylori) bacteria, regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, excessive alcohol consumption, and significant stress.
The Link: How Celiac Disease Can Lead to Gastritis
Celiac disease, an autoimmune condition, can extend its inflammatory effects beyond the small intestine to the stomach. Lymphocytic gastritis (LG), a specific type of chronic gastritis characterized by an increase of lymphocytes in the stomach lining, is strongly associated with celiac disease. This association becomes more pronounced with increasing severity of villous atrophy in the small intestine.
Beyond direct autoimmune involvement, malabsorption caused by celiac disease can lead to nutrient deficiencies that indirectly affect stomach health. For instance, iron or vitamin B12 deficiencies, common in unmanaged celiac disease, could make the stomach lining more vulnerable to inflammation or hinder repair. Chronic inflammation from untreated celiac disease might also contribute to broader inflammatory responses, extending to the gastric mucosa. A compromised immune system and digestive tract due to celiac disease could also increase susceptibility to gastritis from other causes, such as H. pylori infection, although lymphocytic gastritis associated with celiac disease is often H. pylori negative.
Recognizing Symptoms and Getting a Diagnosis
When celiac disease contributes to gastritis, individuals may experience digestive and systemic symptoms. Common digestive complaints include abdominal pain, bloating, gas, nausea, vomiting, and indigestion. Beyond digestive issues, celiac disease can cause weight loss, fatigue, iron-deficiency anemia, and skin rashes (dermatitis herpetiformis).
Diagnosis for both conditions involves a combination of tests. For celiac disease, initial screening includes blood tests for specific antibodies, such as tissue transglutaminase (tTG) IgA. If positive, an endoscopy with small intestine biopsies confirms villous atrophy. For gastritis, an endoscopy with stomach lining biopsies is also common, allowing direct visualization of inflammation and collection of tissue samples to identify the type of gastritis and test for H. pylori infection.
Management and Outlook
Managing celiac disease-related gastritis involves treating the underlying celiac disease. The most effective treatment for celiac disease is a strict, lifelong gluten-free diet. Adhering to this diet allows the damaged small intestine to heal, often leading to significant improvement or resolution of associated gastritis, particularly lymphocytic gastritis. For most individuals, symptoms begin to improve within days to weeks of starting the diet, though complete intestinal healing can take months to several years, especially for adults.
While the gluten-free diet addresses the root cause, other treatments for gastritis symptoms, such as antacids or proton pump inhibitors (PPIs) to reduce stomach acid, may be used temporarily. If H. pylori infection is present, antibiotics are prescribed. However, strict gluten avoidance remains the most important step for long-term improvement and prevention of recurrent gastritis. Regular follow-up with a healthcare team, including blood tests to monitor antibody levels and nutritional markers, helps ensure the diet is effective and conditions are well-managed.