Recurrent month ulcers suggest celiac disease

NEW YORK Mon Jun 29, 2009 6:20pm EDT

A man looks at price tags of bread in a discount supermarket in Belgrade April 22, 2009. REUTERS/Marko Djurica

A man looks at price tags of bread in a discount supermarket in Belgrade April 22, 2009.

Credit: Reuters/Marko Djurica

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NEW YORK (Reuters Health) - A minority of patients with recurrent mouth sores (aphthous stomatitis) have gluten-sensitive enteropathy, making evaluation for celiac disease appropriate in this population, according to a new study in BMC Gastroenterology.

Gluten-sensitive enteropathy, or celiac disease, is an inherited, autoimmune disorder in which the lining of the small intestine is damaged from eating gluten and other proteins found in wheat, barley, rye, and possibly oats.

"It has been reported that in 5 percent of celiac disease patients, aphthous stomatitis may be the sole manifestation of the disease," write Dr. Farhad Shahram, of Tehran University of Medical Sciences, Iran, and colleagues.

Aphthous stomatitis is a painful open ulcer, such as a canker sore, in the mouth that is white or yellow and surrounded by a bright red area. They tend to reappear in times of stress and are associated with viral infections, food allergies and other conditions.

The researchers studied 247 aphthous stomatitis patients (average age 33 years) who had at least three aphthous attacks during the year. The team measured antibodies and other immune factors associated with celiac disease, and patients with negative results were excluded.

Those with positive results underwent biopsies of the lining of the small intestine. Gluten-sensitive enteropathy was defined as a positive blood test for immune factors and abnormal biopsy results. A gluten-free diet was recommended for patients with gluten-sensitive enteropathy.

Of the 247 patients, seven patients with positive blood tests underwent upper GI endoscopy and duodenal biopsies. Endoscopic findings were compatible with gluten-sensitive enteropathy in two patients and were normal in five patients. However, biopsy findings were compatible with gluten-sensitive enteropathy in all seven patients.

The patients with gluten-sensitive enteropathy were an average of 27 years old and the average duration of the disease was 4.5 years. The seven celiac disease patients had not responded to conventional mouth ulcer medications, including topical corticosteroids, tetracycline, and colchicine.

Of the seven celiac disease patients, four started a strict gluten-free diet. All showed a significant improvement within 2 to 6 months.

"Gluten-sensitive enteropathy should be considered in aphthous stomatitis patients," the authors conclude. A lack of response to conventional treatment for could be another indicator of celiac disease risk.

SOURCE: BMC Gastroenterology 2009.

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