الفهرس 
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Abstract
This work provides details about the prevalence of CD in patients presented by gastroesophageal reflux symptoms in Assiut university hospital from October 2017 to October 2018. CD, a gluten-dependent enteropathy occurring in genetically predisposed subjects. The disorder is initiated by the interaction between proteolytic-resistant gluten peptides and the small intestinal mucosa. These mucosal events involve innate immune activation and disruption of the intestinal barrier, with subsequent uptake of immunogenic peptides into the lamina propria that induce an adaptive proinflammatory response. Impairment of mucosal integrity inactive CD is not restricted to the small intestine and has been detected in other columnar digestive epithelia, such as the gastric, intestinal, and colonic mucosa. It is unclear whether patients with active CD also present alterations in the esophageal mucosa. CD patients often complain of GERD symptoms. Moreover in the endoscopic investigation of patients with GERD symptoms has sometimes resulted in the diagnosis of an unexpected CD enteropathy. Clinical experience has shown that this observation is more commonly associated with GERD symptoms refractory to PPI treatment. However, the prevalence of GERD symptoms and the effectiveness of GFD in CD patients still remain to be elucidated. Furthermore the pathogenesis of GERD symptoms in CD remains unknown. Our study included 114 patients with GERD symptoms including 63(63%) male and 37(37%) female with mean age of patients was 36.71 ± 5.98 years. All patients were subjected to: 1- Detailed history regarding compliance to treatment, timing and dose of proton pump inhibitors, history of other medical problems, medication, smoking and dietary history, then thorough clinical examinations were done. 2- Upper endoscopy and duodenal biopsies and classification according to modified Marsh classification of histologic findings in CD. 3- Testing for CD antibodies by using (anti tissue transglutaminase antibody tTG IgA). The patients were divided according presence of CD into two groups, twenty-three patients in group A (celiac), ninety-one in group B (non-coeliac) and then evaluated as regards their patient characteristics, laboratory and histopathological data before and after division in groups. Based on biopsy, MARSH classification and serology; out of those enrolled patients, only 23 (20%) patients had picture of CD. So, GERD symptoms are common in classically symptomatic untreated CD patients. The GFD is associated with a rapid and persistent improvement in reflux symptoms that resembles the healthy population. Conclusion CD represents 20% of the patients represented with reflux symptoms. So we concluded that serological tests using anti-tissue transglutaminase antibodies is the first line of investigation to make diagnosis of CD in patients with reflux symptoms as screening test. Because early diagnosis is important as late diagnosis increase the risk of intestinal lymphoma. Because of major implication of the diagnosis of CD, it is recommended that a positive blood test should be followed by endoscopy/gastroscopy and biopsy.Any case with GERD not responding to treatment should be investigated for CD, especially when associated with abdominal manifestations as diarrhea and abdominal cramps.Early diagnosis of CD prevents the use of unnecessary drugs Both serology and endoscopy are a must for diagnosis of CD Further studies are needed for patients’ follow up after gluten free diet Serological test using anti-tissue transglutaminase antibodies is the first line of investigations to make a diagnosis of CD Because of major implication of the diagnosis of CD, it is recommended that a positive blood test should be followed by endoscopy/gastroscopy and biopsy Early diagnosis of CD is important, because late diagnosis increase the risk of intestinal lymphoma.