The purpose of this prospective study was to identify the prevalence of haematinic deficiency in a large panel of patients with recurrent aphthous stomatitis (RAS) and to ascertain the effect of replacement therapy.
Patients and Methods:
197 patients with RAS were recruited to the study. A detailed ulcer history, clinical examination and haematological investigations, including a full blood count, serum ferritin levels, red cell folate levels and serum vitamin B12 levels were carried out for each patient. In addition, a coeliac screen was performed for all patients under 12 years of age and those with any bowel symptoms. Patients with a deficiency state were referred to their general medical practitioners (GMPs) for management of the deficiency and reviewed six months later when the response to supplementation was ascertained and haematological investigations were repeated.
A deficiency state was identified in 28.9% of RAS patients, with iron deficiency accounting for 96% of these; 4.6% of parents were vitamin B12 deficient, with 3.5% having a combined iron/vitamin B12 deficiency. No patient had a folate deficiency or a positive coeliac screen. Anaemia was present in only 10.5% of those patients with reduced haematinic levels. 8.6% of iron deficient patients were ulcer-free following supplementation, while 42.9% reported considerable improvement. Only 2 out of 6 patients with a combined deficiency had their iron and vitamin B12 levels corrected on review. However, this had resulted in complete ulcer resolution in one patient, and considerable improvement in the other.
The prevalence of haematinic deficiency was high in the study population. However few patients had complete resolution of ulceration following replacement therapy.
recurrent aphthous stomatis, oral ulceration, ferritin, folic acid, vitamin B12