From Detecting Celiac Disease in Your Patients by Harold T. Pruessner, MD
"Angular cheilitis (Figure 6) and recurrent aphthous ulcers (Figure 7) are frequent in children and adults with celiac disease.13 These clinical findings should prompt the physician to consider the diagnosis of celiac disease."
Coeliac disease is an immune-mediated chronic inflammatory disorder of the small bowel caused by irritant gluten and, possibly, other environmental cofactors, in genetically prone people. Coeliac disease is characterized by no (or elusive or varied) symptoms. Oral clinical settings include aphthous stomatitis and dental enamel defects. Association with other signs in the oral mucosa (such as, for example, soreness, a burning sensation, erythema or atrophy) is much less common and, often, not considered by clinicians. We report on a 72-year-old woman with a four months history of oral burning sensation as a single clinical manifestation of coeliac disease. Clinical presentation and symptomatology are discussed in relation to the differential diagnosis of oral glossodynia. This case history highlights the importance of considering coeliac disease in managing cases of idiopathic glossodynia.
Glossodynia and coeliac disease.
PMID: 22268634 April 2012
Oral manifestations of celiac disease: a clinical guide for dentists.
PMID:21507289 April 2011
RESULTS: The levels of serum antigliadin IgA and IgG antibodies were not significantly higher in patients with RAU in comparison with the controls (P = 0.937 and P = 0.1854 respectively). The levels of serum anti-CMP IgA, IgG and IgE antibodies were significantly higher in patients with RAU in comparison with the controls (P < 0.005, P < 0.002 and P < 0.001 respectively). In general, the increased humoral (IgA or IgG) immunoreactivity to CMP was found in 32 of 50 patients, while 17 of them showed the increased levels of both IgA and IgG immunoreactivity to CMP. At the same time, 16 out of 50 patients had IgA, IgG and IgE immunoreactivity to CMP. CONCLUSION: These results indicate the strong association between high levels of serum anti-CMP IgA, IgG and IgE antibodies and clinical manifestations of recurrent aphthous ulcers.
Humoral immunity to cow's milk proteins and gliadin within the etiology of recurrent aphthous ulcers?
PMID: 19563417 Nov 2009
CONCLUSIONS: This study supports that CD is highly associated with dental enamel defects in childhood, most likely because of the onset of CD during enamel formation; no such association was found in adults. Our study also supports the association between CD and aphthous ulcer. All physicians should examine the mouth, including the teeth, which may provide an opportunity to diagnose CD. In addition, CD should be added to the differential diagnosis of dental enamel defects and aphthous ulcers.
The Association Between Celiac Disease, Dental Enamel Defects, and Aphthous Ulcers in a United States Cohort.
PMID: 19687752 Aug 2009
Gluten sensitivity enteropathy in patients with recurrent aphthous stomatitis.
PMID: 19534771 June 2009
PMID: 18758399 Sept 2008
Forty-six out of 197 coeliac disease patients (23%) were found to have enamel defects vs. 9% in controls (P < 0.0001). Clinical delayed eruption was observed in 26% of the pediatric coeliac disease patients vs. 7% of the controls (P < 0.0001). The prevalence of oral soft tissues lesions was 42% in the coeliac disease patients and 2% in controls (P < 0.0001). Recurrent aphthous stomatitis disappeared in 89% of the patients after 1 year of gluten-free diet.
Oral pathology in untreated coeliac disease.
PMID: 17919276 Dec 2007
Celiac disease presenting with chilblains in an adolescent girl.
PMID: 17014640 Sep 2006
Frequency and prognostic value of IgA and IgG endomysial antibodies in recurrent aphthous stomatitis.
PMID: 16874419 2006
Long-standing oral aphthae - a clue to the diagnosis of coeliac disease. PMID: 10894972 2000
Oral mucosal changes in coeliac patients on a gluten-free diet.
PMID: 9786318 Oct 1998
Gliadin antibodies identify gluten-sensitive oral ulceration in the absence of villous atrophy.
PMID: 1753350 Nov 1991
Twenty selected patients with recurrent aphthous stomatitis in whom celiac disease had been specifically excluded were placed on a gluten-free diet. Five patients (25%) showed a favorable response to gluten withdrawal and a positive gluten challenge. Jejunal morphology was normal in all patients indicating gluten sensitivity without enteropathy.
Gluten-sensitive recurrent aphthous stomatitis.
PMID: 7261838 Aug 1981
In the group, two patients were found to have coeliac disease and their recurrent aphthae cleared soon after starting a gluten free diet. This study confirms the presence of an increased prevalence of nutritional deficiency and of coeliac disease in aphthous patients.
Coeliac disease associated with recurrent aphthae.
PMID: 7399324 Mar 1980
All remitted completely on a gluten-free diet, both clinically and haematologically, and the aphthous ulceration did not recur.
Jejunal mucosal abnormalities in patients with recurrent aphthous ulceration.
PMID:1247715 Jan 1976
We suggest that the high incidence of deficiencies found in this series and the good response to replacement therapy shows the need for haematological screening of such patients.
Recurrent aphthae: treatment with vitamin B12, folic acid, and iron.
PMID: 1148667 May 1975