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  • Scott Adams
    Scott Adams

    Recurrent Aphthous Stomatitis Points to Anemia and Celiac Disease

    Reviewed and edited by a celiac disease expert.

    Investigators from the Turkish Republic Health Ministry suggest screening for celiac disease and hematological abnormalities in children with recurrent aphthous stomatitis.

    Recurrent Aphthous Stomatitis Points to Anemia and Celiac Disease - Canker sores can be very painful. Image: CC BY-SA 4.0--https://www.scientificanimations.com
    Caption: Canker sores can be very painful. Image: CC BY-SA 4.0--https://www.scientificanimations.com

    Celiac.com 05/27/2020 - Recurrent aphthous stomatitis (RAS), or canker sores, is one of the most common oral mucosa conditions, and may be related to vitamin deficiencies or immune conditions such as celiac disease. A team of researchers Turkish Republic Health Ministry recently set out to determine rates of hematinic deficiency and celiac disease in children with RAS. 

    The research team included Songül Yılmaz, Ceyda Tuna Kırsaçlıoğlu, and Tülin Revide Şaylı. They are variously affiliated with the Department of Pediatric Gastroenterology, and the Department of Pediatrics at the Turkish Republic Health Ministry, Ankara Child Health Diseases, Hematology and Oncology Training and Research Hospital, Ankara, Turkey.

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    The study included patients from 6 months to 18 years in age, who were diagnosed with RAS at the study institution from 2010–2011, and who had experienced at least three or more episodes of aphthous stomatitis in the prior year. The research team excluded patients with chronic illness, acute infection, or those receiving immunosuppressant drug treatment. The team also included a control group of similarly aged children without RAS, who were being seen in pediatric outpatient clinics.

    The research team reviewed medical records of RAS patients, looking for the evidence of celiac disease, and also hematinic deficiencies, including hemoglobin, mean corpuscular volume, ferritin, vitamin B12, and folic acid.

    In all, the team reviewed records for 108 children with RAS, and nearly 60 healthy children assessed for hematological abnormalities during regular examination. Nearly 35% of the RAS group patients had a family history of RAS, compared with just 7% for the control group. The data showed hematological abnormalities in nearly one-third of the RAS group, compared with 10.5% for the control group, along with significantly higher rates of iron deficiency anaemia for the RAS group. 

    Three patients, about 3% of RAS patients were diagnosed with celiac disease, which is much higher than rates seen in healthy children in Turkey. The children also commonly showed mild malnutrition, iron deficiency and iron deficiency anaemia.

    Based on their data, the researchers are recommending nutritional and hematological assessment for children with RAS. They also recommend the doctors consider celiac disease screening for children with hematological abnormalities and malnutrition.

    Read more in Pediatrics International; 2020 19 January

    Edited by Scott Adams

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    To All,

    Try taking some Lysine and the Fat Soluble form of Thiamine (Benfotiamine) found in the diabetic section...

    Both these nutrients have been shown to be low in those having recurrent mouth ulcers.

    Here is the research on it....for anyone else still suffering from them.


    I used the Lysine (amino acid) regularly before I found out about Thiamine...now I hardly every need Lysine.

    Here is the research on mouth ulcers with a Thiamine deficiency entitled "Recurrent aphthous stomatitis (RAS) and thiamine deficiency"


    They summarized their finding by saying "Our finding suggests an association between thiamine deficiency and recurrent aphthous stomatitis." when 70pct of sufferers of mouth ulcers tested low in Thiamine...

    quoting the research

    "we studied vitamin B1 levels in 70 patients with recurrent aphthous stomatitis and in 50 members of a control group. The vitamin B1 level was determined as thiamine pyrophosphate effect on transketolase activity in red blood cell lysates. Low levels of vitamin B1 were detected in 49 patients but in only two members of the control group"

    I hope this is helpful but it is not medical advise.


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    I had these ulcers in my mouth all the time from early childhood until I was diagnosed at the age of 54.  My dentist was shocked when I went for a check up and did not have any in my mouth.  I explained about the gluten connection.  Sadly, this University of Texas trained dentist had no knowledge of this.  I took him several medical journal articles to review.  He started recommending patients with the ulcers be screened for gluten sensitivity, celiac disease and vitamin deficiencies.

    I am thrilled to say I have not had one since January 2007.  It took about a week after going gluten-free for them to completely go away.

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    I find this fascinating because as a child and young adult, up until about age 27, I had recurring canker sores.  My canker sores always came in groups.  I nearly always had 2 or 3 at a time but during a bad case I would get 8 or 10 and the most I had at once was 16!  They hurt SO BAD!  Talking hurt, eating was near impossible.  They would take about 2 weeks to go dead and then another week to heal.  I remember taking Lysine but with no improvement.  I also always tasted metal in my mouth.  I saw doctors, dentists, dermatologists.  No one had answers.  We thought I might be allergic to tomatoes and oranges or anything acidic.  Then at around age 27 I stopped having outbreaks and the metal taste left.  I'm 51 now and wondering if my canker sores were celiac related?  Hmm... just thinking out loud.  Wow.

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  • About Me

    Scott Adams

    Scott Adams was diagnosed with celiac disease in 1994, and, due to the nearly total lack of information available at that time, was forced to become an expert on the disease in order to recover. In 1995 he launched the site that later became Celiac.com to help as many people as possible with celiac disease get diagnosed so they can begin to live happy, healthy gluten-free lives.  He is co-author of the book Cereal Killers, and founder and publisher of the (formerly paper) newsletter Journal of Gluten Sensitivity. In 1998 he founded The Gluten-Free Mall which he sold in 2014. Celiac.com does not sell any products, and is 100% advertiser supported.

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