Celiac disease is an autoimmune condition where consuming gluten, a protein found in wheat, barley, and rye, triggers an immune response that damages the lining of the small intestine. This damage, known as villous atrophy, impairs the body’s ability to absorb nutrients properly. Acid reflux occurs when stomach acid flows back up into the esophagus, causing a burning sensation often referred to as heartburn. While these two conditions affect different parts of the digestive system, research suggests a notable association between them.
The Connection Between Celiac Disease and Acid Reflux
Untreated celiac disease can contribute to acid reflux symptoms through several mechanisms. The intestinal damage caused by gluten exposure, specifically villous atrophy, disrupts normal digestion and nutrient absorption. This disruption can lead to symptoms like bloating and gas, which may increase abdominal pressure and push stomach acid into the esophagus.
Chronic inflammation throughout the digestive tract can also affect gut motility and the function of the lower esophageal sphincter (LES). The LES is a ring of muscle that acts as a valve between the esophagus and the stomach; if it doesn’t close properly, acid can escape. Some studies suggest that celiac disease patients may have decreased LES pressure and delayed gastric emptying, both of which can lead to reflux.
Changes in the gut microbiota, known as dysbiosis, are also observed in individuals with celiac disease and can play a role in digestive discomfort and reflux. Compromised esophageal tissue due to malabsorption may also make the lining less resilient to stomach acid and slower to heal. Acid reflux is a commonly reported symptom in individuals with undiagnosed or poorly managed celiac disease.
Managing Acid Reflux with Celiac Disease
For individuals experiencing acid reflux who also have celiac disease, managing the underlying celiac disease is the primary step toward alleviating reflux symptoms. Strict adherence to a gluten-free diet (GFD) is the primary treatment for celiac disease. As the small intestine begins to heal on a GFD, many individuals experience significant improvement or even resolution of their reflux symptoms.
Beyond a gluten-free diet, general dietary adjustments also help manage acid reflux. Avoiding common reflux triggers such as fatty foods, spicy foods, caffeine, chocolate, peppermint, and carbonated beverages helps. These foods can relax the LES or increase stomach acid production, exacerbating reflux.
Lifestyle modifications also support reflux management. Eating smaller, more frequent meals reduces pressure on the stomach. Avoid lying down immediately after eating, waiting at least two to three hours. Elevating the head of the bed by six to eight inches helps keep stomach acid down, and maintaining a healthy weight reduces abdominal pressure that contributes to reflux. If symptoms persist or worsen even with strict adherence to a GFD and lifestyle changes, consult a doctor for further evaluation and guidance.