ORAL MUCOSAL CHANGES IN CELIAC PATIENTS ON A GLUTEN-FREE DIET

Oral mucosal lesions or dental enamel defects may be the only presenti ng features of coeliac disease. A series of 128 patients with coeliac disease (CD) on a gluten-free diet (GFD), 8 patients with a newly diag nosed CD, and 30 healthy controls participated in a clinical and histo pathological study of their oral mucosa. Oral mucosal lesions occurred in 71/128 GFD-treated CD patients, in 4/8 untreated and in 10/30 cont rols, and oral symptoms in 85/128, in 6/8 and in 10/30, respectively. Five CD patients had aphthous ulcers. Moderate to severe lymphocytic i nflammation occurred in 36/117 and in 14/117 of the biopsy specimens o f GFD-treated CD patients, in 1/8 and 2/8 of untreated CD patients, an d in 3/30 and in 1/30 of controls, respectively. Intraepithelial T-cel ls were significantly more frequent in GFD-treated CD patients than in controls. There was no difference between untreated CD patients and c ontrols. In the lamina propria of the GFD-treated CD patients, T-cells were more frequent than in the other groups. Mast cells were signific antly 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 complia nce with a GFD may be related to the high prevalence of oral changes a nd symptoms. In addition, T-cell infiltration in the oral mucosa tends to increase with a longer duration of CD, independent of GFD-treatmen t. Clinically, it is important to study the oral cavity of patients su spected of having CD where the only clue to the disease may reside, si nce no less than 66% of the patients in this study had oral symptoms.