Lähteenoja H, Toivanen A, Viander M, Mäki M, Irjala K, Räihä I, Syrjänen S
Department of Medicine, University of Turku, Finland.
Eur J Oral Sci. 1998 Oct;106(5):899-906. doi: 10.1046/j.0909-8836.1998.eos106501.x.
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.
口腔黏膜病变或牙釉质缺陷可能是乳糜泻唯一的临床表现。128例接受无麸质饮食（GFD）的乳糜泻（CD）患者、8例新诊断的CD患者和30名健康对照者参与了一项关于其口腔黏膜的临床和组织病理学研究。128例接受GFD治疗的CD患者中有71例出现口腔黏膜病变，8例未治疗的患者中有4例出现，30名对照者中有10例出现；口腔症状分别在128例中的85例、8例中的6例和30例中的10例出现。5例CD患者有阿弗他溃疡。在接受GFD治疗的CD患者的活检标本中，36/117和14/117出现中度至重度淋巴细胞炎症，未治疗的CD患者中1/8和2/8出现，对照者中3/30和1/30出现。接受GFD治疗的CD患者上皮内T细胞明显比对照者更常见。未治疗的CD患者和对照者之间没有差异。在接受GFD治疗的CD患者的固有层中，T细胞比其他组更常见。肥大细胞在接受GFD治疗的CD患者中明显更常见。9例接受GFD治疗的CD患者血清肌内膜IgA抗体滴度升高，尽管其中5例报告严格遵循GFD。对GFD缺乏严格依从性可能与口腔改变和症状的高发生率有关。此外，口腔黏膜中的T细胞浸润倾向于随着CD病程延长而增加，与GFD治疗无关。临床上，研究疑似患有CD的患者的口腔很重要，因为该疾病的唯一线索可能就在口腔，因为本研究中不少于66%的患者有口腔症状。
