Title: Prevalence of oral manifestations in coeliac disease and associated factors
Version: 0 Date: 19 Nov 2024
Reviewer's report:
Oral manifestations such as dental enamel defects,  aphthous ulceration and glossodynia were
analyzed in a large cohort of celiac disease patients compared with controls considering potential
individual factors.  Dental enamel defects resulted significantly more prevalent in CD patients
than in controls (27% and 4%, respectively).  GFD brought relief to 69% of CD patients
experiencing those manifestations prior to the CD diagnosis. Interestingly and less reported in
previous studies, glossodynia on GFD was more prevalent in the CD cohort than in the controls
(14% and 6%, respectively).
The authors found also that oral manifestations were associated with abdominal symptoms at
CD diagnosis, longer diagnostic delay and gender (female).
Comments:
-previous studies on oral manifestations raised the the potential causative role of nutritional
deficiency of iron and vitamins. Could the authors report data on vitamin B12, iron and folate
serum levels of CD patients?
-Other literature studies have suggested a correlation between malabsorption and digestive
symptoms with degree of intestinal lesion (Marsh score) and or an immuno-mediated
pathogenesis revealed by the correlation between anti-tTG IgA serum titers as well as other IgA
autoantibodies. Could authors provide such a analysis and discuss this pathogenetic hypothesis?
-It is not clear to this referee how the compliance to GFD was assessed (if assessed). A
suboptimal compliance could explain, at least in part, the occurrence of oral manifestation after
starting GFD. In this regard, an important information worth mentioning, is the association
between anti-tTG IgA serum titers at diagnosis and after GFD initiation. Moreover, the authors
stated that "Family members of the enrolled patients were also recruited and screened for coeliac
disease  using serum endomysial and tissue transglutaminase antibodies tests as a part of the
original study in 2006–2010". It would be of major rllevance to describe the assay used at
that time since the specificity of first-generation anti-tTG IgA assays based on guinea pig
transglutimanse is lower than following assays based on recombinant human tTG as previously
demonstrated (The role of antitissue transglutaminase assay for the diagnosis and monitoring
of coeliac disease: a French-Italian multicentre study. J Clin Pathol. 2003 May;56(5):389-93.
doi: 10.1136/jcp.56.5.389. ). This important point should be clarified and discussed when a
comparison with previous literature studies are added..
Title: Prevalence of oral manifestations in coeliac disease and associated factors
Version: 0 Date: 19 Nov 2024
Reviewer's report:
Oral manifestations such as dental enamel defects,  aphthous ulceration and glossodynia were
analyzed in a large cohort of celiac disease patients compared with controls considering potential
individual factors.  Dental enamel defects resulted significantly more prevalent in CD patients
than in controls (27% and 4%, respectively).  GFD brought relief to 69% of CD patients
experiencing those manifestations prior to the CD diagnosis. Interestingly and less reported in
previous studies, glossodynia on GFD was more prevalent in the CD cohort than in the controls
(14% and 6%, respectively).
The authors found also that oral manifestations were associated with abdominal symptoms at
CD diagnosis, longer diagnostic delay and gender (female).
Comments:
-previous studies on oral manifestations raised the the potential causative role of nutritional
deficiency of iron and vitamins. Could the authors report data on vitamin B12, iron and folate
serum levels of CD patients?
-Other literature studies have suggested a correlation between malabsorption and digestive
symptoms with degree of intestinal lesion (Marsh score) and or an immuno-mediated
pathogenesis revealed by the correlation between anti-tTG IgA serum titers as well as other IgA
autoantibodies. Could authors provide such a analysis and discuss this pathogenetic hypothesis?
-It is not clear to this referee how the compliance to GFD was assessed (if assessed). A
suboptimal compliance could explain, at least in part, the occurrence of oral manifestation after
starting GFD. In this regard, an important information worth mentioning, is the association
between anti-tTG IgA serum titers at diagnosis and after GFD initiation. Moreover, the authors
stated that "Family members of the enrolled patients were also recruited and screened for coeliac
disease  using serum endomysial and tissue transglutaminase antibodies tests as a part of the
original study in 2006–2010". It would be of major rllevance to describe the assay used at
that time since the specificity of first-generation anti-tTG IgA assays based on guinea pig
transglutimanse is lower than following assays based on recombinant human tTG as previously
demonstrated (The role of antitissue transglutaminase assay for the diagnosis and monitoring
of coeliac disease: a French-Italian multicentre study. J Clin Pathol. 2003 May;56(5):389-93.
doi: 10.1136/jcp.56.5.389. ). This important point should be clarified and discussed when a
comparison with previous literature studies are added..
Please review this paper.
user
Title: Prevalence of oral manifestations in coeliac disease and associated factors
Version: 0 Date: 19 Nov 2024
Reviewer's report:
Oral manifestations such as dental enamel defects,  aphthous ulceration and glossodynia were
analyzed in a large cohort of celiac disease patients compared with controls considering potential
individual factors.  Dental enamel defects resulted significantly more prevalent in CD patients
than in controls (27% and 4%, respectively).  GFD brought relief to 69% of CD patients
experiencing those manifestations prior to the CD diagnosis. Interestingly and less reported in
previous studies, glossodynia on GFD was more prevalent in the CD cohort than in the controls
(14% and 6%, respectively).
The authors found also that oral manifestations were associated with abdominal symptoms at
CD diagnosis, longer diagnostic delay and gender (female).
Comments:
-previous studies on oral manifestations raised the the potential causative role of nutritional
deficiency of iron and vitamins. Could the authors report data on vitamin B12, iron and folate
serum levels of CD patients?
-Other literature studies have suggested a correlation between malabsorption and digestive
symptoms with degree of intestinal lesion (Marsh score) and or an immuno-mediated
pathogenesis revealed by the correlation between anti-tTG IgA serum titers as well as other IgA
autoantibodies. Could authors provide such a analysis and discuss this pathogenetic hypothesis?
-It is not clear to this referee how the compliance to GFD was assessed (if assessed). A
suboptimal compliance could explain, at least in part, the occurrence of oral manifestation after
starting GFD. In this regard, an important information worth mentioning, is the association
between anti-tTG IgA serum titers at diagnosis and after GFD initiation. Moreover, the authors
stated that "Family members of the enrolled patients were also recruited and screened for coeliac
disease  using serum endomysial and tissue transglutaminase antibodies tests as a part of the
original study in 2006–2010". It would be of major rllevance to describe the assay used at
that time since the specificity of first-generation anti-tTG IgA assays based on guinea pig
transglutimanse is lower than following assays based on recombinant human tTG as previously
demonstrated (The role of antitissue transglutaminase assay for the diagnosis and monitoring
of coeliac disease: a French-Italian multicentre study. J Clin Pathol. 2003 May;56(5):389-93.
doi: 10.1136/jcp.56.5.389. ). This important point should be clarified and discussed when a
comparison with previous literature studies are added..
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