Coeliac disease: oral ulcer prevalence, assessment of risk and association with gluten-free diet in children

Dig Liver Dis. 2008 Feb;40(2):104-7. doi: 10.1016/j.dld.2007.10.009. Epub 2007 Dec 11.

Abstract

Aims: Oral mucosal lesions may be markers of chronic gastrointestinal disorders, such as those causing malabsorption. Our objectives were to assess the prevalence of recurrent oral aphthous-like ulcers in coeliac disease patients living in the Mediterranean area, and to evaluate the impact of a gluten-free diet.

Methods: A test group of 269 patients (age range 3-17 years) with coeliac disease confirmed both serologically and histologically was compared with a control group of 575 otherwise clinically healthy subjects for the presence, or a positive history of aphthous-like ulcers. Coeliac disease patients with aphthous-like ulcers were re-evaluated 1-year after starting a gluten-free diet.

Results: Aphthous-like ulcers were found significantly more frequently in coeliac disease, in 22.7% (61/269) of patients with coeliac disease versus 7.1% (41/575) of controls (p=<0.0001; chi-square=41.687; odds ratio=4.3123; 95% confidence interval=2.7664:6.722). Most coeliac disease patients with aphthous-like ulcers and adhering strictly to gluten-free diet (71.7%; 33/46) reported significant improvement on gluten-free diet, with no or reduced episodes of aphthous-like ulcers (p=0.0003; chi-square=13.101; odds ratio=24.67; 95% confidence interval=2.63:231.441).

Conclusions: The epidemiological association found between coeliac disease and aphthous-like ulcers suggests that recurrent aphthous-like ulcers should be considered a risk indicator for coeliac disease, and that gluten-free diet leads to ulcer amelioration.

MeSH terms

  • Adolescent
  • Case-Control Studies
  • Celiac Disease / diagnosis
  • Celiac Disease / diet therapy*
  • Celiac Disease / epidemiology*
  • Child
  • Child, Preschool
  • Comorbidity
  • Female
  • Glutens / administration & dosage*
  • Humans
  • Italy / epidemiology
  • Male
  • Oral Ulcer / diagnosis
  • Oral Ulcer / epidemiology*
  • Prevalence
  • Recurrence
  • Risk Assessment
  • Treatment Outcome

Substances

  • Glutens