Small-bowel changes in recurrent ulceration of the mouth

Jejunal biopsies of twenty-four patients with aphthous ulcers in whom malabsorption was not found, were studied. Four patients (16%) had subtotal villous atrophy and this structural change reversed after gluten withdrawal. There was a significant increase in intra-epithelial lymphocytes in the aphthous patients compared with healthy controls (p less than 0.001). The lymphocytic infiltration of the epithelium was higher, even in specimens with normal morphology (p less than 0.001). The findings suggest that a significant number of patients with recurrent aphthous stomatitis may have a mild form of gluten enteropathy.