Researchers studied people with oral lichen planus (OLP), a condition causing painful sores in the mouth. They discovered that some OLP patients have antibodies that attack their stomach cells, and these patients are much more likely to have blood problems and vitamin deficiencies. The study compared three groups: people with OLP who had these antibodies, people with OLP who didn’t have them, and healthy people. Those with the antibodies had higher rates of anemia, low iron, low vitamin B12, and high homocysteine levels. This finding suggests that mouth sores might be connected to deeper problems with how the body absorbs nutrients.

The Quick Take

  • What they studied: Whether people with a specific type of mouth sores (oral lichen planus) who have stomach antibodies are more likely to have blood problems and vitamin deficiencies compared to people without these antibodies or healthy people.
  • Who participated: The study included 1,176 total people: 139 with mouth sores and stomach antibodies, 449 with mouth sores but no stomach antibodies, and 588 healthy people with no mouth sores or antibodies.
  • Key finding: People with mouth sores and stomach antibodies were significantly more likely to have low red blood cell counts, low iron, low vitamin B12, and high homocysteine levels compared to both healthy people and those with mouth sores but no stomach antibodies.
  • What it means for you: If you have painful mouth sores that won’t go away, your doctor may want to check your blood for vitamin and mineral deficiencies, especially if you have stomach-related antibodies. However, this study shows a connection, not necessarily that one causes the other, so talk to your doctor about what testing makes sense for you.

The Research Details

This was a cross-sectional study, which means researchers took a snapshot in time and compared three different groups of people. They measured specific blood markers in all participants, including red blood cell size, hemoglobin (the protein that carries oxygen), iron levels, vitamin B12, folic acid, and homocysteine (an amino acid in the blood). They also tested for the presence of gastric parietal cell antibodies (GPCA), which are proteins the immune system makes that attack stomach cells.

The researchers compared blood test results between the three groups to see if people with mouth sores and stomach antibodies had different levels of these markers compared to the other groups. This type of study is useful for finding patterns and connections between conditions, though it can’t prove that one thing directly causes another.

Understanding whether mouth sores are connected to blood and vitamin problems is important because it could help doctors diagnose and treat patients more completely. If mouth sores are a sign of deeper nutritional problems, catching and treating those problems early might help prevent more serious health issues. This research suggests that doctors should look beyond just treating the mouth sores and consider checking for nutritional deficiencies.

This study included a large number of participants (over 1,100 people), which makes the findings more reliable. The researchers measured specific blood markers using standard laboratory tests, which are objective and accurate. However, because this is a cross-sectional study, it only shows that these conditions occur together, not that one causes the other. The study was published in a peer-reviewed journal, meaning other experts reviewed it before publication. The main limitation is that we don’t know if treating the vitamin deficiencies would improve the mouth sores.

What the Results Show

The study found that people with mouth sores and stomach antibodies had much higher rates of several blood problems. Specifically, they were more likely to have macrocytosis (abnormally large red blood cells), low hemoglobin (anemia), low iron levels, and low vitamin B12 levels compared to healthy people.

Among the 139 people with mouth sores and stomach antibodies, the researchers found that many had these deficiencies. When they looked at the 107 people with mouth sores but no stomach antibodies who had anemia, the most common types were: normocytic anemia (52.3% of cases, where red blood cells are normal size but there aren’t enough of them), iron deficiency anemia (21.5% of cases), and thalassemia trait-induced anemia (16.8% of cases).

Another important finding was that people with mouth sores and stomach antibodies had higher levels of homocysteine, an amino acid that, when elevated, may be linked to heart and blood vessel problems. This suggests that the connection between mouth sores and stomach antibodies might affect multiple body systems.

The study also found that people with mouth sores and stomach antibodies had higher rates of folic acid deficiency compared to healthy people, though the difference wasn’t as dramatic as with vitamin B12 and iron. The presence of stomach antibodies appeared to be the key factor—people with mouth sores but without these antibodies had much lower rates of these deficiencies, more similar to healthy people.

This research builds on the researchers’ earlier work, which found that about 23.6% of people with oral lichen planus (mouth sores) had these stomach antibodies. This new study goes deeper by showing that having these antibodies is connected to specific blood and vitamin problems. Previous research has suggested that oral lichen planus might be an autoimmune condition (where the body’s immune system attacks its own cells), and this study supports that idea by showing a connection to stomach antibodies and nutritional deficiencies.

The main limitation is that this study shows these conditions occur together but doesn’t prove that one causes the other. We don’t know if the stomach antibodies cause the vitamin deficiencies, if the vitamin deficiencies cause the mouth sores, or if both are caused by something else entirely. The study is also limited to people who already had mouth sores or were healthy controls—we don’t know how common these antibodies are in the general population. Additionally, the study doesn’t tell us whether treating the vitamin deficiencies would improve the mouth sores or other symptoms.

The Bottom Line

If you have persistent painful sores in your mouth that don’t heal within a few weeks, ask your doctor about testing for oral lichen planus and checking your blood for vitamin B12, iron, and folic acid deficiencies. If you’re diagnosed with oral lichen planus, especially if you have stomach-related symptoms, ask your doctor about testing for gastric parietal cell antibodies and getting blood work to check for nutritional deficiencies. If deficiencies are found, your doctor may recommend supplements or dietary changes. These recommendations are based on moderate evidence showing a connection between these conditions.

This research is most relevant for people with persistent mouth sores, people with a family history of autoimmune conditions, and people experiencing unexplained fatigue or weakness (which could indicate anemia or vitamin deficiency). It’s also important for doctors and dentists who treat patients with mouth sores. People without mouth sores don’t need to worry about this condition, but if you have other autoimmune conditions, you might want to discuss with your doctor whether similar testing would be helpful.

If you have vitamin or mineral deficiencies, it typically takes several weeks to months of supplementation to see improvement in blood levels and symptoms. Mouth sores might take longer to heal—usually several weeks to months even with treatment. Don’t expect overnight results; nutritional deficiencies develop over time and take time to correct.

Want to Apply This Research?

  • If you have oral lichen planus or are being treated for related deficiencies, track your mouth sore severity (using a 1-10 scale), energy levels, and any symptoms like fatigue or weakness. Log these daily or weekly, and note when you start any supplements or dietary changes. This helps you and your doctor see if treatments are working.
  • Start keeping a food diary to track your intake of vitamin B12-rich foods (like meat, fish, eggs, and dairy), iron-rich foods (like red meat, beans, and leafy greens), and folic acid-rich foods (like leafy greens, legumes, and fortified grains). This helps identify if dietary gaps might be contributing to deficiencies. Share this with your doctor to discuss whether supplements are needed.
  • Set reminders for regular blood work as recommended by your doctor (typically every 3-6 months if you’re being treated for deficiencies). Track your test results over time to see if levels are improving. Also monitor your mouth sore symptoms and overall energy levels between doctor visits. If you’re taking supplements, track adherence to make sure you’re taking them consistently.

This research shows a connection between mouth sores, stomach antibodies, and blood/vitamin deficiencies, but it does not prove that one causes the other. If you have persistent mouth sores, unusual fatigue, or other concerning symptoms, consult with a healthcare provider for proper diagnosis and treatment. Do not start taking supplements or make major dietary changes without discussing with your doctor first, as some supplements can interact with medications or cause problems in certain conditions. This information is for educational purposes and should not replace professional medical advice.