Celiac.com 07/16/2009 - A small but significant number of people who suffer from aphthous stomatitis, commonly called canker sores, also suffer from celiac disease, so it makes sense to perform celiac screening these people, according to a recent study that appears in BMC Gastroenterology.

Celiac disease is an inherited, immune system disorder in which the proteins found in wheat, rye and barley cause damage to the lining of the small intestine.

Reports suggest that canker sores might be the sole symptom for about one in twenty people with celiac disease, according to Dr. Farhad Shahram, of Tehran University of Medical Sciences, Iran, and colleagues.

Commonly called canker sores, aphthous stomatitis is a painful, open ulcer in the mouth that is white or yellow and surrounded by a bright red area. The sores often recur in times of stress and are associated with viral infections, food allergies and other complaints.

The research team looked at 247 people with aphthous stomatitis, who had suffered at least three aphthous lesions in the previous year. Subjects had a median age of 33 years.

The team screened blood samples for antibodies and other immune factors connected with celiac disease, and excluded patients with negative results. Subjects with positive blood tests underwent intestinal biopsy. A positive gluten-antibody blood test and abnormal biopsy results constituted gluten-sensitive enteropathy.

Of the 247 patients, seven patients showed positive blood tests and submitted for upper GI endoscopy and duodenal biopsy.

Two of the seven patients showed endoscopy results compatible with gluten-sensitive enteropathy, while five were normal. However, biopsy results for all seven showed gluten-sensitive enteropathy.

Average age for patients with gluten-sensitive enteropathy was 27 years old, and on average suffered from the disease for 4.5 years.

Interestingly, none of the seven celiac disease patients responded to conventional mouth ulcer medications, including topical corticosteroids, tetracycline, and colchicine.

Four of the seven patients with celiac disease adopted a gluten-free diet, and all four showed substantial improvement within 2 to 6 months.

As a result of the study, doctors should consider the possibility of celiac disease/gluten-sensitive enteropathy when treating patients for aphthous stomatitis patients, especially those who show a lack of response to conventional treatment, which may be another indicator of celiac disease risk.

BMC Gastroenterology 2009, 9:44

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