In a recent study published in the journal, BMC Gastroenterology1, Iranian researchers found that recurrent mouth sores (recurrent aphthous stomatitis, or RAS) can be the only symptom of celiac disease. Also known as canker sores, RAS are small ulcers with a red base and a yellow layer that usually appear on the tongue or inside the cheeks or lips. RAS can affect any gender at any age; however, these sores occur more frequently in females, adolescents, and children.

Over a two-year period, data were collected from 247 patients who suffered from RAS. The prevalence of patients with recurrent mouth ulcers and celiac disease (confirmed by biopsy) was 2.83%, which is 3 times higher than the normal rate of diagnosis (0.9%) for celiac disease within the Iranian population. All of the patients who had both mouth ulcers and celiac disease, suffered from recurrent RAS for an average of 4.5 years and were unresponsive to previous treatments with conventional drugs. When a gluten-free diet was introduced for four of the patients studied, all showed significant improvement of RAS within 2-6 months. None of the patients in this study displayed other gastrointestinal symptoms.

It was reported that in 5% of celiac patients, recurrent aphthous stomatitis may be the only symptom present. The researchers concluded that celiac disease should be considered when a patient presents with symptoms of RAS and is unresponsive to conventional medicinal approaches.

First published in the Inside Tract® newsletter issue 173 – 2009
Shakeri R et al. Gluten sensitivity enteropathy in patients with recurrent aphthous stomatitis. BMC Gastroenterology. 2009;9:44.