Recurrent aphthous stomatitis as the only clinical sign of celiac disease in obese adolescent - case report and literature review

Introduction. Recurrent aphthous stomatitis (RAS) is a relatively common oral mucosal lesion of unclear etiology. It occurs in otherwise healthy people, but also in various infectious and non-infectious diseases, including celiac disease (CD). We present an obese adolescent with RAS as the only clinical sign of CD. Case outline. An adolescent aged 15 2/12 years come with very pronounced RAS in previous five months. He had no other difficulties. The patient was obese from the age of 12. Other data were without peculiarities. On admission he was 165 cm tall (P25), obese (BMI 27 kg/m2), in the final stage of puberty, with stretch marks in the distal areas of the abdomen, thighs and gluteus and very pronounced pain-sensitive aphthae in the buccal and labial mucosa accompanied by swelling of the lips and perioral region. Except for lower serum iron levels (8 ?mol/l), routine laboratory blood tests were within the reference range. The serological test for CD was positive (antibodies to tissue transglutaminase IgA 78.5 U/ml, anti-endomysial antibodies IgA positive). Endoscopy revealed reflux esophagitis, without any other pathological findings. Stereomicroscopic and pathohistological analysis of the duodenal mucosa samples showed mild destructive enteropathy (Marsh IIIa). Pathohistological examination of the gastric mucosa revealed grade I-II lymphocytic gastritis. The urease test for Helicobacter pylori was negative. A gluten-free diet resulted in the withdrawal of aphthous stomatitis and no recurrence later. Conclusion. Within the differential diagnostic analysis of the RAS causes, CD should also be considered. Additionally, obesity does not exclude the presence of CD.

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Serological screening for celiac disease using IgA‐tissue transglutaminase antibody in patients with recurrent aphthous stomatitis

International Journal of Dermatology ◽

10.1111/ijd.15271 ◽

2020 ◽

Author(s):

Luiz F. Morgado de Abreu ◽

Marilda A. M. Morgado de Abreu ◽

Vera L. Sdepanian ◽

Cleonice H. W. Hirata ◽

Dalva R. N. Pimentel ◽

...

Keyword(s):

Celiac Disease ◽

Tissue Transglutaminase ◽

Recurrent Aphthous Stomatitis ◽

Aphthous Stomatitis ◽

Serological Screening

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Eradication of Helicobacter pylori in patients without gastric symptoms suffering from recurrent aphthous stomatitis: A pilot study

Vojnosanitetski pregled ◽

10.2298/vsp151014113l ◽

2017 ◽

Vol 74 (7) ◽

pp. 672-675 ◽

Cited By ~ 1

Author(s):

Marina Latkovic ◽

Lazar Ranin ◽

Nevenka Teodorovic ◽

Marko Andjelkovic

Keyword(s):

Eradication Therapy ◽

Recurrent Aphthous Stomatitis ◽

Aphthous Stomatitis ◽

Diffusion Method ◽

Gastric Disease ◽

Warning Sign ◽

Rapid Urease Test ◽

Sensitivity Testing ◽

Urease Test ◽

H Pylori

Background/Aim. Helicobacter (H.) pylori is a widespread bacterium and its involvement in pathogenesis of gastric diseases is well-known. However, H. pylori role in etiology of other histologically similar conditions, especially recurrent aphthous stomatitis (RAS) is still controversial. Research regarding H. pylori and its association with RAS, as well as the treatment options were always conducted on patients with diagnosed gastric problems. The aim of this study was to determine whether H. pylori is present in the oral cavity of patients suffering from RAS but without any symptoms or medical history of gastric disease. Methods. A total of 15 patients with RAS participated in the study. None of the participants suffered from any gastrointestinal disorders. Two dental plaque samples from each participant were collected. The first was analyzed using rapid urease test and the second one was put in transport medium and sent for cultivation. The sensitivity of H. pylori to antibiotics was established using disk diffusion method of sensitivity testing for every patient individually and adequate therapy was prescribed. Results. Before the treatment the mean annual recurrence rate of RAS was 8.1 ? 2.1, with the average number of lesions being 3.9 ? 1.9. During the 12-month observation period after the eradication therapy, none of the patients reported recurrence of aphthous lesions. The treatment was successful in all cases. Conclusion. This study shows that RAS can be effectively treated by successful eradication of oral H. pylori, and that RAS could be possibly considered as an early warning sign of potential gastric infection by H. pilory.

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Testing for Gluten-Related Disorders in Clinical Practice: The Role of Serology in Managing the Spectrum of Gluten Sensitivity

Canadian Journal of Gastroenterology ◽

10.1155/2011/642452 ◽

2011 ◽

Vol 25 (4) ◽

pp. 193-197 ◽

Cited By ~ 21

Author(s):

David Armstrong ◽

Andrew C Don-Wauchope ◽

Elena F Verdu

Keyword(s):

Celiac Disease ◽

Serological Test ◽

Tissue Transglutaminase ◽

Immunoglobulin A ◽

Intestinal Damage ◽

Gluten Sensitivity ◽

Serological Testing ◽

Diet Compliance ◽

At Risk Populations ◽

Irritable Bowel

Immunoglobulin A tissue transglutaminase is the single most efficient serological test for the diagnosis of celiac disease. It is well known that immunoglobulin A tissue transglutaminase levels correlate with the degree of intestinal damage, and that values can fluctuate in patients over time. Serological testing can be used to identify symptomatic individuals that need a confirmatory biopsy, to screen at-risk populations or to monitor diet compliance in patients previously diagnosed with celiac disease. Thus, interpretation of serological testing requires consideration of the full clinical scenario. Antigliadin tests are no longer recommended for the diagnosis of classical celiac disease. However, our understanding of the pathogenesis and spectrum of gluten sensitivity has improved, and gluten-sensitive irritable bowel syndrome patients are increasingly being recognized. Studies are needed to determine the clinical utility of antigliadin serology in the diagnosis of gluten sensitivity.

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Cystic fibrosis and celiac disease - multifaceted and similar

Folia Medica ◽

10.2478/folmed-2013-0033 ◽

2013 ◽

Vol 55 (3-4) ◽

pp. 87-89 ◽

Cited By ~ 2

Author(s):

Nelly D. Genkova ◽

Ivan V. Yankov ◽

Miroslava N. Bosheva ◽

Benjamin L. Anavi ◽

Dafina G. Grozeva ◽

...

Keyword(s):

Cystic Fibrosis ◽

Celiac Disease ◽

Chronic Diarrhea ◽

Serological Test ◽

Clinical Manifestations ◽

Duodenal Mucosa ◽

Gluten Free ◽

Immunological Tests ◽

Targeted Screening ◽

Sweat Tests

ABSTRACT Celiac disease and cystic fibrosis share a number of clinical manifestations. The comorbidity rate of these diseases is low: 1:200000. We present a case of a child aged 1 year and 5 months, born to a mixed-marriage parents, with concomitant cystic fibrosis and celiac disease manifesting initially with chronic diarrhea. Diagnosis of cystic fibrosis was made on the basis of changes in pulmonogram and three positive sweat tests with the malabsorption managed. Celiac disease was demonstrated through immunological tests (serological test of anti-transglutaminase antibodies of IgA class), histological tests (altered duodenal mucosa) and the therapeutic effect of a gluten-free diet. This case is the first ever reported case of a child with concomitant cystic fibrosis and celiac disease in Bulgaria. The case suggests the need for targeted screening for celiac disease in children with cystic fibrosis.

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Response to “Recurrent Aphthous Stomatitis As a Marker of Celiac Disease in Children”

Pediatric Dermatology ◽

10.1111/pde.12801 ◽

2016 ◽

Vol 33 (2) ◽

pp. 242-242

Author(s):

Asuman Gürkan ◽

Sare Gülfem Özlü ◽

Pınar Altıaylık Özer ◽

Bengi Ece Kurtul ◽

Can Demir Karacan ◽

...

Keyword(s):

Celiac Disease ◽

Recurrent Aphthous Stomatitis ◽

Aphthous Stomatitis

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High Incidence of Celiac Disease in Patients with Systemic Sclerosis

The Journal of Rheumatology ◽

10.3899/jrheum.081000 ◽

2009 ◽

Vol 36 (5) ◽

pp. 965-969 ◽

Cited By ~ 13

Author(s):

EDOARDO ROSATO ◽

DANIELA De NITTO ◽

CARMELINA ROSSI ◽

VALERIO LIBANORI ◽

GIUSEPPE DONATO ◽

...

Keyword(s):

Celiac Disease ◽

Systemic Sclerosis ◽

Autoimmune Diseases ◽

Tissue Transglutaminase ◽

Duodenal Mucosa ◽

High Incidence ◽

Histological Results ◽

Culture Supernatants ◽

Positive Results ◽

Antiendomysial Antibodies

Objective.To evaluate the presence of celiac disease in patients with systemic sclerosis (SSc). The association of autoimmune diseases with celiac disease has been reported, but few publications deal with the combination of SSc and celiac disease.Methods.We investigated the presence of anti-tissue transglutaminase (anti-tTG) antibodies and serum antiendomysial antibodies (anti-EMA) in 50 patients with SSc. All subjects were on a gluten-containing diet. Duodenal mucosa histology and biopsy culture were performed in anti-tTG-positive patients; anti-EMA and IgA, IgG1 anti-tTG were detected in culture supernatants.Results.The incidence of celiac disease in patients with SSc was found to be 8%. Serum anti-tTG antibody-positive results were detectable in 5 out of 50 patients with SSc, but only in 4 of them was the diagnosis confirmed by histological results (Marsh classification).Conclusion.Our data show an increased prevalence of celiac disease in patients with SSc.

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