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    Geographic Tongue (Glossitis) and its Relationship with Celiac Disease


    Dr. Ron Hoggan, Ed.D.

    Celiac.com 01/27/2011 - In response to a post on the celiac listserv stating that both a pediatrician and a dermatologist dismissed the possibility of a connection between previously diagnosed celiac disease and geographic tongue, I wrote the following:


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    One of several early mentions of geographic tongue (glossitis) in association with celiac disease may be found in the medical textbook "Coeliac Disease" by Cooke and Holmes, Churchill Livingstone, 1984, on pages 84 and 85 under the heading "glossitis". They say that it occurs, to a greater or lesser extent, "in a majority of celiac patients" (1). 

    Another very informative article on glossitis can be found at:
    http://www.nejm.org/doi/full/10.1056/NEJMc070200

    In this recent article from the New England Journal of Medicine (2007)  the authors also state that the connection between celiac disease and glossitis is very common. They go on to say: "Our report should alert physicians and dental practitioners to consider celiac disease in managing cases of idiopathic atrophic glossitis." In other words, they want physicians and dentists to be aware that there may be underlying celiac disease when they encounter glossitis. This information is neither controversial nor difficult to locate. Celiac disease is not the only cause of glossitis, or geographic tongue, but it is a common and long acknowledged symptom of celiac disease, with mention of this connection in the medical literature at least as early as 1974.  
       
    My own experience with glossitis is that most of my problems went away when I began a gluten-free diet. The remainder of my glossitis resolved after getting IgG food allergy testing from Immuno Labs in Ft. Lauderdale, and removing all identified allergenic foods from my diet. (I have since re-introduced some of these foods but I avoided them for about 5 years. ( 12 years later, I still have to avoid some of the foods identified by that testing.)

    My questions/concerns are:

    1. Is your daughter eating gluten? Is it possible that there is gluten contamination in her diet?
    2. Is she eating oats? A significant portion of celiac patients do react to oats, yet oat consumption is now widely advocated. 
    3. Has she had testing for common food allergies? If she is strictly gluten-free and avoiding oats, then food allergy testing may provide her with the the information she needs to eliminate this source of her discomfort.  
    I am distressed that neither the pediatrician nor the dermatologist took just a few minutes to run a Medline search that would have informed them about the connection between celiac disease and glossitis and some possible treatments for her problem.  Accidental or intentional gluten consumption, oats consumption, and food allergy testing are all relatively easy for either of these physicians to address. There may, of course, be some other explanation for your daughter's affliction, but these physicians' ignorance of the connection with celiac disease and their failure to run a quick Medline search does not inspire confidence in their opinions.  You might want to pursue a third opinion on this issue, especially since the topical drug she was prescribed falls well short of solving such autoimmune/allergic problems, which almost assuredly is the underlying cause of your daughter's difficulties with her tongue.

    Sources:

    1. Cooke WT, Holmes GKT. Coeliac Disease. Churchill Livingstone, NY, 1984
    2. Pastore L &  Lo Muzio L. Atrophic Glossitis Leading to the Diagnosis of Celiac DiseaseN Engl J Med 2007; 356:2547June 14, 2007
    3. Lampert F, Harms K, Bidlingmaier F, Kiefhaber P, Meister P.Pernicious anemia with dermatologic and neurologic involvement in a 10-year-old boy. Monatsschr Kinderheilkd. 1974 May;122(5):217-20.
    4. Barry RE, Baker P, Read AE.Coeliac disease. The clinical presentation. Clin Gastroenterol. 1974 Jan;3(1):55-69

    I hope this helps.
    Best Wishes,
    Ron

    Ron Hoggan, Ed. D.

    Royal Roads University, Continuing Studies

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    I suffered from geographical tongue long before I was diagnosed with celiac disease. I visited my general physician, dentist and ENT specialist. Not one doctor suggested a test for celiac disease. Thank you for this valuable information.

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    Guest Christine Toms

    Posted

    Thank you, this is very much appreciated. The glossitis problem has been with me for over 20 years. I thought it was part of my diagnosed coeliac disease-related difficulty, but you've now confirmed it.

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    Guest Georgia Hartley

    Posted

    Glossitis is an indication of absorption of vitamin B12, which is very common with celiac disease. Taking liquid B12 is one of the best ways to counteract this and help with healing. It is a very inexpensive treatment.

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    Guest Elizabeth

    Posted

    As a child, my pediatrician diagnosed me with glossitis. However, I went YEARS without knowing I had celiac disease, suffering from various illnesses. It has only been in the last 2 years that I have been healthy. I attribute this to my Gluten-free lifestyle. This info you have provided is so helpful and appreciated. Thanks for sharing this valuable information!

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    Guest Betty J. Owen

    Posted

    Note: This is the first article that I have seen on this subject. After much concern regarding this condition and the potential harmfulness of it I now learn that having celiac disease has fostered yet one more site of discomfort. Thank you sincerely for these published findings. It is a true blessing to us who struggle with celiac disease.

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    Guest Rachael

    Posted

    I have had geographic tongue as long as I can remember and have recently been diagnosed with fibromyalgia. This article was so helpful, I went to get tested for celiac today. It seems consistent with many of my symptoms. Thank you.

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    Guest Rachel

    Posted

    I have had geographic tongue as long as I can remember and have recently been diagnosed with fibromyalgia. This article was so helpful, I went to get tested for celiac today. It seems consistent with many of my symptoms. Thank you.

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    Guest vivienne harris

    Posted

    I always wondered about my tongue. I just learned something new. Thank you.

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    Guest Soeren Rasmussen

    Posted

    I've been diagnosed with multiple sclerosis some years ago and I've had geographic tongue for several years. My daughter has celiac disease but I've not checked her for geographic tongue. Wonder if there are a connection between autoimmune diseases as f.ex. multiple sclerosis, geographic tongue and celiac disease. It could be a very interesting research subject.

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    I liked the article its very interesting and informative. Keep up the great work.

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    Finally informative article! I've been looking for info for almost 2 years! thank you so much! I guess my next step should be getting my daughter tested for celiac..

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    This is the first I've ever heard of a name for this condition. I had the fissure type for decades, and recently tested high for tTG antibodies. Dad is a celiac so there's a good chance I am as well.

     

    Very interesting stuff!

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    Guest margaret

    Posted

    OMG. I have had a burning tongue for 4 horrible years. I went to 3 doctors about it. One was even an oral pathologist! All they did was give me a mouth rinse to numb my tongue. Now, my abdomen is hurting and I have an appointment with a gastroenterologist. I will ask him to test for celiac disease. My mom's sister developed celiac in her late 70s. I am 60. Hope I can get answers soon. Thanks for all your research.

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    Your article caught my eye, but it would have been helpful if you had given the symptoms of this affliction. I went to a link within your article that did this, but your article never said specifically what it was. I still am not sure, but it sounds like a possibility. I have had celiac disease diagnosed in 1999 with an endoscopy, and was just diagnosed in October 2013 with Type 1 Diabetes. Shortly before this latter diagnosis, I started having a swollen, coated sore tongue with round red spots, and it will lessen or go away, but keeps returning. I don't know if this is the condition you have described, but my oral surgeon and dentist didn't seem concerned or seem to know what it was. Very frustrating.

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    To Soeren Rasmussen,

     

    Please experiment on a true gluten-free diet. Meaning no grains at all including corn and corn derived ingredients, milk because it contains casein protein, soy. I cannot eat eggs as well.

    My symptoms were very like MS. I have read stories of people with MS, after gluten-free diet symptoms diminished.

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    Guest Cherry

    Posted

    I, too, have geographic tongue, chronic vitamin B12 deficiency, fibromyalgia, peripheral neuropathy, ataxia, bloating and daily diarrhea - but am hoping to be tested for celiac or non-celiac sensitivity, when I get an appointment with a gastroenterologist at the local govt. hospital. It could take up to 6 months to get the appointment. In the meantime, I'm suffering and eating food containing gluten in case the test is a false negative. Sometimes, the stomach cramps are so severe that I faint.

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    Sources:
    1. Toft M, Dietrichs E. Aggravated stuttering following subthalamic deep brain stimulation in Parkinson’s disease--two cases. BMC Neurol. 2011 Apr 8;11:44.
    2. Tani T, Sakai Y. Stuttering after right cerebellar infarction: a case study. J Fluency Disord. 2010 Jun;35(2):141-5. Epub 2010 Mar 15.
    3. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    4. Jäncke L, Hänggi J, Steinmetz H. Morphological brain differences between adult stutterers and non-stutterers. BMC Neurol. 2004 Dec 10;4(1):23.
    5. Kell CA, Neumann K, von Kriegstein K, Posenenske C, von Gudenberg AW, Euler H, Giraud AL. How the brain repairs stuttering. Brain. 2009 Oct;132(Pt 10):2747-60. Epub 2009 Aug 26.
    6. Galantucci S, Tartaglia MC, Wilson SM, Henry ML, Filippi M, Agosta F, Dronkers NF, Henry RG, Ogar JM, Miller BL, Gorno-Tempini ML. White matter damage in primary progressive aphasias: a diffusion tensor tractography study. Brain. 2011 Jun 11.
    7. Lundgren K, Helm-Estabrooks N, Klein R. Stuttering Following Acquired Brain Damage: A Review of the Literature. J Neurolinguistics. 2010 Sep 1;23(5):447-454.
    8. [No authors listed] Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 43-1988. A 52-year-old man with persistent watery diarrhea and aphasia. N Engl J Med. 1988 Oct 27;319(17):1139-48
    9. Molteni N, Bardella MT, Baldassarri AR, Bianchi PA. Celiac disease associated with epilepsy and intracranial calcifications: report of two patients. Am J Gastroenterol. 1988 Sep;83(9):992-4.
    10. http://ezinearticles.com/?Food-Allergy-and-Stuttering-Link&id=1235725 
    11. http://www.craig.copperleife.com/health/stuttering_allergies.htm 
    12. https://www.celiac.com/forums/topic/73362-any-help-is-appreciated/
    13. Ford RP. The gluten syndrome: a neurological disease. Med Hypotheses. 2009 Sep;73(3):438-40. Epub 2009 Apr 29.
    14. Hadjivassiliou M, Gibson A, Davies-Jones GA, Lobo AJ, Stephenson TJ, Milford-Ward A. Does cryptic gluten sensitivity play a part in neurological illness? Lancet. 1996 Feb 10;347(8998):369-71.

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