American Journal of Otolaryngology–Head and Neck Medicine and Surgery 28 (2007) 288
www.elsevier.com/locate/amjoto
Letters to the Editor
Is B12 vitamin deficiency really the cause of recurrent
aphthous stomatitis?
To the Editor:
The exact cause of recurrent aphthous stomatitis (RAS)
is not known, and there are many factors that are thought
to be involved with the development of RAS. The recent
article of Koybasi et al [1], bRecurrent aphthous stoma-
titis: investigation of possible etiologic factors,Q is interest-
ing, but I assume that there are 2 points that should be
clarified about this article.
First, 35.2% of the subject group were found to be B12
vitamin–deficient, and none of control group was found to
be B12 vitamin–deficient. Thus, approximately 35% of the
study group were expected to be megaloblastic anemic.
The authors reported the study group’s mean hoemo-
globin (Hb) value as 13.532, and the mean hematocrit
value as 40.06. Whereas for the control group (wherein
none was found B12-deficient), the values reported were
13.419 and 38.37, respectively. Are the results of this
study regarding vitamin B12, hemoglobin, and hematocrit
reliable? Have the authors used internal and external
controls for biochemical and hematological tests during
the study period? I could not find any explanation about
this topic.
Second, we do not have any knowledge about how the
hemoglobin and hematocrit levels of these subjects were
determined by the authors. The mean corpuscular volume
(MCV) level should also have been reported for the B12-
deficient group; however, the MCV level was not
indicated in this article. Why was this topic not defined
in the Methods section, and why did the reviewers not
need this explanation?
In conclusion, many factors may be related with RAS.
Can we deem B12 deficiency as a related factor of RAS
although there are still some missing points in this study?
I think that after the authors clarify these queries, readers
can have a clearer view about this topic.
Asude Bubirova, MD, PhD
Private Clinic of Health and Human
Section of Haematologia
370001 Baku, Azerbaijan
E-mail address: bubirova@yahoo.com
doi:10.1016/j.amjoto.2006.09.014
0196-0709/$ – see front matter D 2007 Published by Elsevier Inc.
Reference
[1] Koybasi S, Parlak AH, Serin E, et al. Recurrent aphthous stomatitis:
investigation of possible etiologic factors. Am J Otolaryngol 2006;
27:229 - 32.
Vitamin B12 and recurrent aphthous stomatitis
Dear editor,
We appreciate Dr Bubirova’s letter; however, we think
there are a few things that need to be stressed more. Our
article clearly stated that the exact cause of recurrent apthous
stomatitis is still unknown. We do not agree with Dr
Bubirova that all of our vitamin B12–deficient patients must
be expected as having megaloblastic anemia. Referring to
Table 1 in the article, one can see that the mean values of the
vitamin B12 levels were close to each other and that the levels
were not low enough to cause overt anemia. In addition, our
laboratory results are definitely reliable based on the external
quality results that are regularly being checked by the Bio-
Rad External Quality Assurance Program.
The second point that Dr Bubirova asked was of MCV
levels. Although there was a statistically significant rela-
tionship between MCV levels and RAS occurrence, (binary
logistic regression, P = .041), we purposely did not give the
results so as to not confuse the readers about the
hematologic parameters.
As stated in our article, we definitely believe that serum
vitamin B12 levels are closely related to RAS occurrence
and that serum vitamin B12 level is one of the tests that must
be performed for every RAS patient.
Serap Koybasi, MD
Department of Otolaryngology
Bolu, Turkey
E-mail address: serapkoybasi@yahoo.com
Erdýnc Serýn
Department of Biochemistry
Bolu, Turkey
doi:10.1016/j.amjoto.2006.09.015