Oral mucosal changes in coeliac patients on a gluten-free diet.
Oral mucosal lesions or dental enamel defects may be the only presenting features of coeliac disease. A series of 128 patients with coeliac disease (CD) on a gluten-free diet (GFD), 8 patients with a newly diagnosed CD, and 30 healthy controls participated in a clinical and histopathological study of their oral mucosa. Oral mucosal lesions occurred in 71/128 GFD-treated CD patients. in 4/8 untreated and in 10/30 controls, and oral symptoms in 85/128, in 6/8 and in 10/30, respectively. Five CD patients had aphthous ulcers. Moderate to severe lymphocytic inflammation occurred in 36/117 and in 14/117 of the biopsy specimens of GFD-treated CD patients, in 1/8 and 2/8 of untreated CD patients, and in 3/30 and in 1/30 of controls, respectively. Intraepithelial T-cells were significantly more frequent in GFD-treated CD patients than in controls. There was no difference between untreated CD patients and controls. In the lamina propria of the GFD-treated CD patients, T-cells were more frequent than in the other groups. Mast cells were significantly more frequent in patients with GFD-treated CD. Nine GFD-treated CD patients had raised serum endomysium IgA antibody titres, although five of them reported to follow a strict GFD. A lack of strict compliance with a GFD may be related to the high prevalence of oral changes and symptoms. In addition, T-cell infiltration in the oral mucosa tends to increase with a longer duration of CD, independent of GFD-treatment. Clinically, it is important to study the oral cavity of patients suspected of having CD where the only clue to the disease may reside, since no less than 66% of the patients in this study had oral symptoms.
Lähteenoja
H
H
Department of Medicine, University of Turku, Finland. hannu.lahteenoja@tyks.fi
Toivanen
A
A
Viander
M
M
Mäki
M
M
Irjala
K
K
Räihä
I
I
Syrjänen
S
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000906:Antibodies / Q000032:analysis; D001706:Biopsy; D002446:Celiac Disease / Q000178:diet therapy*; D002648:Child; D002675:Child, Preschool; D018753:Diet, Protein-Restricted; D004044:Dietary Proteins / Q000008:administration & dosage*; D004847:Epithelial Cells / Q000473:pathology; D005260:Female; D005983:Glutens / Q000008:administration & dosage*; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis; D008214:Lymphocytes / Q000473:pathology; D008297:Male; D008407:Mast Cells / Q000473:pathology; D008875:Middle Aged; D009059:Mouth Diseases / Q000473:pathology*; D009061:Mouth Mucosa / Q000473:pathology*; D009210:Myofibrils / Q000473:pathology; D010349:Patient Compliance; D013281:Stomatitis, Aphthous / Q000473:pathology; D013601:T-Lymphocytes / Q000473:pathology
D000906:Antibodies; D004044:Dietary Proteins; D007070:Immunoglobulin A; D005983:Glutens