Winter 2014

Double Trouble

Is there a link between mouth ulcers and gastrointestinal disease? 

By Julie Flaherty

They are small, painful and can turn your favorite lemon sorbet into a world of hurt. They are canker sores, and if you are one of the 20 percent of people who get them, you know that these noncontagious mouth ulcers can make eating, drinking and even talking a feat.

A number of things tend to trigger them, from trauma to the mouth (think of an accidental bite to the cheek or a toothbrush jab) to a diet lacking in certain vitamins and minerals. But surprisingly, we don’t really know why they develop.

At least one researcher is looking beyond the mouth for answers. Joel Weinstock, professor and chief of the gastroenterology/hepatology division at Tufts Medical Center, is conducting a study that will look at the colons of people who get canker sores to see if they have similar lesions in their intestinal lining.

300WCankerWhile the connection may not seem obvious, canker sores often show up in patients who have illnesses such as inflammatory bowel disease. People with Crohn’s disease, for example, often develop canker sores during a flare-up of their gastrointestinal symptoms. Weinstock has seen many patients with ulcers both in their mouth and in their intestinal lining. “They look very similar,” he notes.

Like canker sores, the cause of Crohn’s disease is unclear, but it is believed to be the result of the immune system overreacting to the organisms that live in the gut. “If you get a break in the epithelium, you start reacting way beyond what you should,” Weinstock says. “Maybe the same process is happening in the mouth.” The mouth and intestine, after all, are really two distant parts of the digestive tract.

“The question is then, is this common mouth ulcer that we see really more of a manifestation of the general tendency for the whole [digestive tract] to overreact?”  he asks.

Julie Flaherty, the editor of Tufts Nutrition magazine, can be reached at

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