Otorhinolaryngological Manifestations and Esophageal Disorders in Celiac Disease: A Narrative Review

Abstract

Celiac disease (CeD) is a chronic gluten-sensitive immune-mediated enteropathy characterized by numerous intestinal and extra-intestinal signs and symptoms. Among extra-intestinal manifestations, otorhinolaryngological (ORL) complaints in CeD are relatively rare and their relation to CeD is frequently overlooked by physicians. Recent studies underlined that the prevalence of recurrent aphthous stomatitis, aphthous ulcers, geographic tongue, and xerostomia was significantly increased in CeD patients compared with healthy individuals. However, data about the other oral manifestations of CeD, such as atrophic glossitis, glossodynia, angular cheilitis, and salivary abnormalities, are scanty. Further ORL conditions associated with CeD include sensorineural hearing loss, nasal abnormalities, and obstructive sleep apnea. Moreover, several esophageal disorders such as gastroesophageal reflux disease and eosinophilic esophagitis have been associated with CeD. The pathophysiological link between both ORL and esophageal manifestations and CeD might be further investigated. In addition, also the role of gluten-free diet in improving these conditions is largely unclear. Certainly, otorhinolaryngologists can play an important role in identifying people with unrecognized CeD and may help prevent its long-term complications. The aim of this narrative review is to analyze the latest evidence on the association between CeD and ORL and esophageal manifestations.

Associations between Celiac Disease, Extra-Gastrointestinal Manifestations, and Gluten-Free Diet: A Narrative Overview

“…Otorhinolaryngological (ORL) manifestations in CeD, occurring in both children and adults, are relatively rare, and their association with CeD is mostly overlooked by physicians [ 11 ]. It is well known that several disorders, such as recurrent aphthous stomatitis (RAS), dry mouth, atrophic glossitis, angular cheilitis, and burning tongue, affect the soft tissue of the oral cavity in active CeD [ 12 , 13 ].…”

“…A systematic review presented in 2017 summarized results regarding the most frequent CVDs in untreated CeD [61]. The largest number of published documents concerned CeD in conjunction with cardiomyopathy (33 studies), thrombosis (27), cardiovascular risk (17), atherosclerosis (13), stroke (12), and ischemic heart disease (11). Most of them tended to resolve on a GFD, often in conjunction with the healing of small intestinal villous atrophy.…”