Table 4.

Studies of recurrent aphthous stomatitis (RAS) in patients with celiac disease (CD)

Author, Year	Number of CD patients with RAS / Total CD patients (%)	Comments
Stevens, 1980	88/144 (61%)
Andersson-Wenckert et al., 1984	6/17 (35%)	“Recurrent oral ulcerations” were reported by 6 of 17 children with CD and 5 of 19 controls
Majorana et al., 1992	19/113 (17%)	In the 19 patients with both CD and RAS, a significant association was found between DRw10 and DQw1 HLA antigens and the two diseases.
Meini et al., 1993	20/113 (18%)	Follow-up to the above series by Majorana et al., 1992. In all 20 cases, a marked improvement in RAS was noted within 1 year of starting a gluten-free diet. Re- challenge with a gluten-containing diet resulted in relapse of RAS in 9 of 10 cases.
Corazza et al., 1993	36/226 (16%)	Chart review of 226 patients diagnosed with CD revealed that 1 of 22 CD patients (4.5%) were diagnosed with RAS in 1972–1977; 8 of 63 (12.7%) in 1978–1973; and 27 of 141 (19.1%) in 1984–1989.
Srinivasan et al., 1998	1/1 (100%)	Case report of a 14 year old boy with a history of oral ulcers since the age of 3 years with increased gliadin antibody levels and normal duodenal biopsy. Use of a gluten- free diet caused resolution of the oral ulcers and re-challenge with a regular diet resulted in recurrence. The patient presented again at age 20 with severe oral ulcers on a regular diet, a duodenal biopsy confirmed celiac disease. Once again, a gluten-free diet resulted in resolution of the oral ulcers
Lahteenoja et al., 1998	4/128 (3%)	Presence of RAS was found in 4 of 128 CD patients on a gluten-free diet compared to 0 of 30 healthy controls (p = 0.327) and 0 of 8 patients with newly diagnosed (untreated) CD.
Sedghizadeh et al., 2002	25/61 (41%)	Presence or history of RAS in 25 of 61 (41%) CD patients vs. 17 of 62 (27%) age- and gender- matched healthy controls (p = 0.11).
de Freitas et al., 2002	15/48 (31%)	Reviewed records for 48 adult CD patients and found a history of oral aphthae in 15.
Sood et al., 2003	19/96 (20%)	RAS history based on medical records.
Bucci et al., 2006	24/72 (33%)	Found RAS to be present in 24 of 72 (33.3%) CD patients and 38 of 162 (23.4%) healthy controls (p > 0.05).Among the 24 patients with both RAS and CD, in 5 patients RAS resolved with a gluten-free diet, in 1 patient it improved, and in 10 patients RAS persisted even with a gluten-free diet. The remaining 8 patients continued gluten intake and RAS persisted in all of them.
Procaccini et al., 2007	18/50 (36%)	Reported that history, records or clinical signs of RAS were present in 18 of 50 (36%) CD patients vs. 6 of 50 (12%) age- and gender-matched controls (p = 0.009).
Campisi et al., 2007	37/197 (19%)	Screened 197 CD patients and found the clinical presence (34 patients) or history (3 patients) of RAS in a total of 37 cases. In comparison, RAS was found in 3 of 413 healthy controls (p < 0.0001). After a year on a gluten-free diet, 33 of the 37 cases reported complete resolution of RAS. The other 4 cases had persistently elevated serum antibodies to tissue transglutaminase, indicating non-compliance with a gluten-free diet.
Campisi et al., 2007	61/269 (23%)	Extended their previous series and found the presence or history of “aphthous-like ulcers” was present in 61 of 269 (22.7%) CD patients vs. 41 of 575 (7.1%) healthy controls (p < 0.0001).53 of the 61 patients presented for a one year follow-up. Of the 53 patients, 46 adhered strictly to a gluten-free diet: 33 of them reported complete remission of RAS, 4 reported improvement and the remaining 9 reported no change; 7 of the 53 patients did not comply with the gluten-free diet: 6 of them reported no change.
Cheng et al., 2010	28/67 (42%)	History of RAS in 42.4% of 67 CD patients vs. 23.2% of 69 controls (p = 0.02).