Clinical Review

Lesson of the week: Emergence of classic enteropathy after longstanding gluten sensitive oral ulceration

BMJ 1998; 316 doi: (Published 17 January 1998) Cite this as: BMJ 1998;316:206
  1. Usha Srinivasan, clinical registrara,
  2. Donald G Weir, regius professor of physicb,
  3. Conleth Feighery, associate professor of immunologya,
  4. Cliona O’Farrelly, director of research laboratoryc
  1. aDepartment of Immunology, St James's Hospital, Dublin 8, Dublin
  2. bDepartment of Clinical Medicine, Trinity College Dublin, Dublin
  3. cEducation and Research Centre, St Vincent's Hospital, Dublin, Dublin
  1. Correspondence to: Dr U Srinivasan Department of Rheumatology, University Hospital Wales, Cardiff CF4 4XW
  • Accepted 8 July 1997


The mechanisms responsible for recurrent oral ulcers have yet to be defined. Oral ulcers occur in several conditions, including connective tissue disease, viral infections, and gastrointestinal disorders such as inflammatory bowel disease and gluten sensitive enteropathy or coeliac disease. Treatment of gluten sensitivity with a diet that is free of gluten results in resolution of small intestinal lesions and often also oral ulcers.1 While some patients present with gluten sensitivity and recurrent oral ulcers without gastrointestinal abnormalities,2 the possibility that some of these patients may subsequently develop enteropathy has not been confirmed. We report on a patient with gluten sensitivity and oral ulcers who developed abnormalities of the small intestine without gastrointestinal symptoms after many years of surveillance.

Case report

A 14 year old boy presented to the coeliac outpatient clinic in St James's Hospital, Dublin, with a history of oral ulcers since 3 years of age. His mother had longstanding coeliac disease but had had no oral ulcers; there was no …

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