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Could that Canker Sore Mean Celiac Disease? 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.

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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 welcomes your comments below (registration is NOT required).

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18 Responses:

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said this on
16 Jul 2009 3:14:40 PM PST
hmm, negative blood tests only, huh?

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said this on
28 Jul 2009 10:18:54 AM PST
This info needs to get out more! Canker sores and throat ulcers were my main symptom of Celiacs disease AND Crohn's. Gluten causes my mouth cankers and bakers yeast causes my severe throat ulcers. I had not had GI issues since childhood, which I seemed to outgrow, but suffered with severe cankers, as many as 9 at a time in my mouth. I would have never been diagnosed if it were not for trying a gluten free diet (the SCD) for my child's autism, my doctor thought I should give it a try myself when I mentioned it to him. The cankers went away! I was 41 years old and had spent years suffering, not to mention numerous doctor visits. I can always tell when I get a trace of gluten or yeast extract, I'll get a canker sore.

alan frank
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said this on
02 Aug 2009 6:31:36 AM PST
As a dentist (retired after 30+ years) and a sufferer of cancer sores for many years, I tried many remedies to no avail. I had numerous patients that had outbreaks much worse than mine.
Most had to "suck it up" and bear the pain. I researched out cures but never found anything in the literature (both medical and dental- I had full access to both the AMA and ADA web sites). I had been told they were from "stress". I was a long distance runner and noticed that after long workouts and hard training that they were more frequent. As I remember what foods that I was consuming after these workouts, I now realize that it was the huge quantities of gluten that caused the outbreaks.
My epithany came in July'05 when I was diagnosed with Celiac disease (age 62) and started my new gluten free diet. To date, I have not had a full blown outbreak, only small localized ulcers that heal within 1-2 days. (probably from contamination)
In the past, if I had bitten my lip, the ensuing ulcers would last at least 1 week, but now, they're gone by the next day.
Since I have retired, I no longer have access to these dental/medical sites and wonder if any articles have been written about the gluten intolerance/Celiac link to canker sores?? My dentist had no idea about the relationship after asking him at a recent visit.
Anyone that gets these sores in clumps, can be in so much pain that it is debilitating - unable to eat or drink.

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said this on
23 Jan 2012 7:38:20 PM PST
Thank you Dr. Frank. I am a dental asst who has suffered from these sores for almost ten years. I am in my late 30's. I think I have celiac disease. The dentist I used to work for laughed when I would have really bad sores. Like you clumps. I wanted to die. He never had an answer. He would say I was just a freak. He thought it was all in my head. I have been taking a Zinc supplement for over a year now and it helps. They are no where near as bad as they used to be. Some of them used to take weeks to heal. Sometimes even months! Now they last about a week on the Zinc. I will give a gluten free diet a try. Thanks again for posting. You changed my life tonight.

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said this on
10 Aug 2013 2:35:41 PM PST
Oh girl, we're in the same situation. My doctor diagnosed that I have celiac disease and I'm two days on the gluten-free diet.


said this on
15 Jul 2014 11:54:26 AM PST
I too suffered from age 11 - 30 with cankers all over mouth and throat. unable to eat or swallow. I had NO cankers for 1 or 2 days per month. AGONY! Loss time at school and missed dentist apt due to pain. If I ate something that gave me cankers, I wouldn't eat that food again. Cankers are totally food related. I went gluten free ( tested neg for celiac per biopsy and blood test) I still had no cankers UNTIL I started eating snickerdoodle cookies from Enjoy Life. Gluten free, non gmo..etc.... those darn cookies give me cankers!

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said this on
03 Aug 2009 9:49:18 PM PST
I can add the missing (formerly common) canker sores to the laundry list of untreated symptoms that have cleared up magically on a gluten free diet. Biting my cheek at night clears in days not weeks. Some of mine were laterally symmetrical and other symptoms indicated Niacin deficiency in spite of eating adequate Niacin: poor absorption, can do that.

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said this on
28 Aug 2009 2:11:45 PM PST
After being diagnosed with celiac disease by endoscopy three years ago, I have followed a gluten-free diet. I no longer suffer from the following: canker sores, cold sores, charlie horse leg cramps, rice krispie noises in my neck when I move my head side to side, constipation, bloating, and anemia. I have also helped three friends get diagnosed by describing my symptoms before I was diagnosed.

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said this on
22 Jan 2012 8:27:42 AM PST
Just a clarification. Almost all cold sores are caused by HSV1 (herpes simplex 1 virus) and could not/ would not go away due to a chande in diet. Cold sores and Canker sores are NOT the same thing.

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said this on
01 Oct 2012 8:07:12 PM PST
Thank you - that is exactly what happens to me!

Emery C
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said this on
16 Jun 2010 4:48:11 PM PST
This is a great article, It's well written and quite informative. It's known that there are no cures for canker sores. Over the counter products speed recovery and offer pain relief to make our lives less miserable. Canker sores can run in families and seem to follow certain age groups. Further studies in diets and personal hygiene may offer a good prevention program if certain individuals are prone to these sores.
Thanks for a great article.

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said this on
10 Nov 2010 9:52:53 AM PST
I've had canker sores all my life and just found out that I probably have Celiac disease and this is my only obvious symptom. I've found that avoiding toothpastes that contain sodium laurel sulfate really helps avoid outbreaks and the product Ulcer Ease helps with the pain when they do occur.

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said this on
29 Jun 2011 12:08:52 AM PST
My mom is 83 and started having canker sores (did not respond to treatment), anemia, vitamin D deficiency, terrible edema in legs, distended abdomen, hypoparathyroid with no known cause. They did a celiac panel (after I begged) and said she was negative. I just found out I have one celiac gene. I'm going to demand they test mom's...thanks for making this connection.

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said this on
07 May 2012 12:04:34 PM PST
I found out I have celiac disease and was diagnosed after having multiple mouth sore breakouts. Most of them were canker sores, but I also have the herpes virus. For me, eating gluten seemed to also depress my immune system. And then that can cause the herpes virus to come out of the nerves. Also, I would get ulcers from exposure to gluten inside of my mouth and severe bloating, stomach pain, and diarrhea. I thought the stomach pain was dairy for years, but I was not eating it and still had symptoms. I wish I had seen this article years ago. I am just so glad we were able to figure it out. I am gluten free, healthy, and happy today.

Gluten Freek
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said this on
06 Nov 2012 4:19:19 PM PST
I have been gluten-free for 10 years, and I still get canker sores just as bad.

Bye Bye Gluten
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said this on
22 Apr 2013 12:32:40 PM PST
I've been searching for a solution for my mouth ulcers for over 40 years. Recently, my daughter was diagnosed with a sensitivity to gluten, so I stopped eating it out of solidarity. Voila, the ulcers are gone for several months now: something I don't remember in my entire adult life. Who'd have thought?

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said this on
15 Jul 2013 6:46:44 PM PST
I stopped eating gluten for a period of 8 months and had no canker sores. After I began eating gluten again I didn't notice their appearance immediately, rather it has taken a little while, but they are back in full swing. I agree that gluten suppresses the immune system in some people and causes a myriad of other problems. Whether or not gluten is the direct or indirect cause of no canker sores I cannot say but it is definitely worth a try!

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said this on
10 Aug 2013 2:44:35 PM PST
I'm very thankful that I now know what causes my canker sores not to heal, instead just staying in my mouth every month and when the one heals comes the other... I don't like when my sores will be at my tongue its very painful and I can barely talk. But two days ago, my test was positive of celiac disease. I was so happy that now I know what triggers my canker sores, and on Tuesday i will go to my gastroenterologist doctor to have an endoscopy test. I have been to the hospital twice because I can't eat at all, my mouth and my throat was full of canker sores. I like to die in that time... but thank God there's always a way to find the cause of the problem. I'm still adjusting to what I eat and looking for gluten-free products in the shop. It's not so easy, but for my own good I will stick to my diet.

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