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Dr Farhad Shahram, of Tehran University of Medical Sciences, and colleagues studied 247 aphthous stomatitis patients (aged, on average, 33 years) who had at least three aphthous attacks during the year. (Aphthous stomatitis is a painful open ulcer, such as a canker sore, in the mouth that is white or yellow and surrounded by a bright red area. It tends to reappear in times of stress and is associated with viral infections, food allergies and other conditions.)

The team measured antibodies and other immune factors associated with coeliac disease, and patients with negative results were excluded. Those with positive results underwent biopsies of the lining of the small intestine. Of the 247 patients, seven patients with positive blood tests underwent upper GI endoscopy and duodenal biopsies. Endoscopic findings suggested gluten sensitivity in two patients and were normal in five patients but the biopsy findings suggested gluten sensitivity in all seven patients.

These patients were, on average, 27 years old and had had the condition for over four years. They had not responded to conventional mouth ulcer medications ­ – topical corticosteroids, tetracycline, and colchicine. Four started a strict gluten-free diet and all four showed a significant improvement within two to six months.

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