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  • Jefferson Adams
    Jefferson Adams

    Remission of Severe Aphthous Stomatitis of Celiac Disease with Etanercept

    Reviewed and edited by a celiac disease expert.
    Remission of Severe Aphthous Stomatitis of Celiac Disease with Etanercept - Photo: CC--clr_flickr
    Caption: Photo: CC--clr_flickr

    Celiac.com 01/27/2014 - A team of physicians presents the case of a patient who experienced remission of severe aphthous stomatitis of celiac disease with etanercept.

    Photo: CC--clr_flickrThe team included Adey Hasan, Hiren Patel, Hana Saleh, George Youngberg, John Litchfield, and Guha Krishnaswamy. They are variously affiliated with the The Department of Internal Medicine, the Division of Allergy, Asthma and Immunology, and the James H. Quillen VA Medical Center at East Tennessee State University in Johnson City, TN, and with the Departments of Medicine and Pathology at Quillen College of Medicine in Johnson City, TN.



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    The team presents a patient with celiac disease complicated by severe aphthous stomatitis that impairs swallowing, chewing and speaking, which have triggered weight loss, psychosocial problems, and impaired her work performance.

    The woman tried a variety of topical and systemic medications symptoms, but saw little or no improvement in her symptoms.

    She consented to treatment with etanercept, and experienced complete remission of aphthous stomatitis, decrease in arthralgia and fatigue and considerable improvement in her quality of life.

    The team points out that newer biological agents, such as etanercept, might be useful in treating certain celiac disease complications, and may even help to improve patient morbidity.

    They are calling for further study to determine long-term efficacy and safety of these drugs in the mucosal and/or systemic complications of this disease.

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  • About Me

    Jefferson Adams

    Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,500 articles on celiac disease. His coursework includes studies in science, scientific methodology, biology, anatomy, medicine, logic, and advanced research. He previously served as SF Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.


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  • Related Articles

    Jefferson Adams
    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


    Jefferson Adams
    Celiac.com 07/31/2014 - Although the adverse mucosal reaction in celiac disease occurs mainly in the small intestine, other mucosal surfaces in the gastrointestinal tract and the gut-associated lymphoid tissue are also affected. To better understand the impact, a research team recently set out to examine histopathological findings in the oral mucosa of celiac disease patients.
    Specifically, based on the assumption that the oral mucosa could reflect the histopathological intestinal inflammation seen in celiac disease patients, they wanted to determine the pattern of T-cell subsets in the oral mucosa of young adults with celiac disease. The research team included E. Bardellini, F. Amadori, A. Ravelli, M. Salemme, S. Lonardi, V. Villanacci, and A. Majorana.
    For their study, they enrolled a group of 37 patients with celiac disease, ranging in age from 20-38 years. Twenty-eight were female, nine male. The team broke the 37 subjects into two groups. The nineteen patients of group A were following a gluten free diet (GFD); two patients for less than one year; 6 patients between 1 and 5 years; 11 patients more than 5 years. The 18 patients (group remained untreated.
    Meanwhile, fifteen healthy volunteers (age range 18-35 years, 11 females and 4 males served as controls. Because the study involved observing untreated celiac patients, the team sought and received ethical approval for the research from the Ethics Committee.
    The team took biopsy specimens from normal looking oral mucosa. They conducted immunohistochemical investigation with monoclonal antibodies to CD3, CD4, CD8, and gamma/delta-chains T cell receptor (TCR).
    They found T-lymphocytic inflammatory infiltrate significantly higher in group B (p < 0.0001); as compared with group A and with the control group.
    Their results confirm that the oral cavity is involved with adverse reactions to celiac disease triggers, and might offer potential for celiac diagnosis.
    Source:
    Rev Esp Enferm Dig. 2014 Feb;106(2):86-91.


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