Anxiety and small intestinal bacterial overgrowth: associations with recurrent aphthous ulcers
Abstract Background Recurrent aphthous ulcer (RAU) is the most prevalent oral mucosal disease, yet its etiology remains unclear. Anxiety and depression have been linked to the onset of RAU, but research findings were contradictory. The association of intestinal diseases with RAU implies a potential...
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BMC
2025-05-01
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| Series: | BMC Oral Health |
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| Online Access: | https://doi.org/10.1186/s12903-025-05998-0 |
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| author | Zijian Liu Mingxing Lu Wei Wang Jingli Tang Shufang Li Qianyun Guo Yutian Wang Xingyun Liu Xing Wang Zhe Cheng Qian Wang Jianqiu Jin Ying Han Hongwei Liu Lihong Cui |
| author_facet | Zijian Liu Mingxing Lu Wei Wang Jingli Tang Shufang Li Qianyun Guo Yutian Wang Xingyun Liu Xing Wang Zhe Cheng Qian Wang Jianqiu Jin Ying Han Hongwei Liu Lihong Cui |
| author_sort | Zijian Liu |
| collection | DOAJ |
| description | Abstract Background Recurrent aphthous ulcer (RAU) is the most prevalent oral mucosal disease, yet its etiology remains unclear. Anxiety and depression have been linked to the onset of RAU, but research findings were contradictory. The association of intestinal diseases with RAU implies a potential role of gut microbiota in the development of this condition. This study aims to explore the correlation between the presence and severity of RAU and psychological factors, as well as gut microbiota dysbiosis. Methods The Zung’s self-rating anxiety scale (SAS), Zung’s self-rating depression scale (SDS), and Pittsburgh sleep quality index (PSQI) were used to assess the participants’ psychological status. The lactulose hydrogen-methane breath test was performed to detect the presence of small intestinal bacterial overgrowth (SIBO) in RAU patients. The long-term severity of RAU is quantified using the monthly number of ulcers. Compare the differences in outcomes between individuals with RAU and the healthy population, and explore the factors influencing the severity of RAU. Results Forty-nine patients and 49 controls were included. The RAU group had significantly higher SAS scores (t = 2.18, p = 0.034), and SIBO positivity (χ 2 = 75.67, p < 0.001). Factors correlated with the monthly number of ulcers included SAS score (r = 0.52, p < 0.001), symptoms of anxiety (r = 0.42, p = 0.004), SDS score (r = 0.46, p = 0.002), PSQI score (r = 0.35, p = 0.020), and SIBO positivity (r = 0.42, p = 0.005). Multiple linear regression analyses indicated that anxiety and SIBO may influence the severity of RAU. Moreover, SAS score (r = 0.38, p = 0.010) and SDS score (r = 0.38, p = 0.009) exhibited correlations with SIBO. Conclusions RAU patients are at a higher risk of anxiety and gut microbiota dysbiosis, which could potentially escalate the severity of RAU. The role of the brain-gut axis in the pathogenesis of RAU warrants further exploration. |
| format | Article |
| id | doaj-art-91e45c7d2f1443778331eab979da50b0 |
| institution | OA Journals |
| issn | 1472-6831 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
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| series | BMC Oral Health |
| spelling | doaj-art-91e45c7d2f1443778331eab979da50b02025-08-20T02:15:01ZengBMCBMC Oral Health1472-68312025-05-0125111010.1186/s12903-025-05998-0Anxiety and small intestinal bacterial overgrowth: associations with recurrent aphthous ulcersZijian Liu0Mingxing Lu1Wei Wang2Jingli Tang3Shufang Li4Qianyun Guo5Yutian Wang6Xingyun Liu7Xing Wang8Zhe Cheng9Qian Wang10Jianqiu Jin11Ying Han12Hongwei Liu13Lihong Cui14Department of Oral Medicine, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Peking University School and Hospital of StomatologyDepartment of Oral Medicine, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Peking University School and Hospital of StomatologyDept. of Gastroenterology, Chinese PLA General HospitalDept. of Gastroenterology, Chinese PLA General HospitalDepartment of Oral Medicine, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Peking University School and Hospital of StomatologyDepartment of Oral Medicine, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Peking University School and Hospital of StomatologyDepartment of Oral Medicine, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Peking University School and Hospital of StomatologyDepartment of Oral Medicine, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Peking University School and Hospital of StomatologyDepartment of Oral Medicine, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Peking University School and Hospital of StomatologyDepartment of Oral Medicine, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Peking University School and Hospital of StomatologyDepartment of Oral Medicine, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Peking University School and Hospital of StomatologyDepartment of Oral Medicine, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Peking University School and Hospital of StomatologyDepartment of Oral Medicine, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Peking University School and Hospital of StomatologyDepartment of Oral Medicine, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Peking University School and Hospital of StomatologyDept. of Gastroenterology, Chinese PLA General HospitalAbstract Background Recurrent aphthous ulcer (RAU) is the most prevalent oral mucosal disease, yet its etiology remains unclear. Anxiety and depression have been linked to the onset of RAU, but research findings were contradictory. The association of intestinal diseases with RAU implies a potential role of gut microbiota in the development of this condition. This study aims to explore the correlation between the presence and severity of RAU and psychological factors, as well as gut microbiota dysbiosis. Methods The Zung’s self-rating anxiety scale (SAS), Zung’s self-rating depression scale (SDS), and Pittsburgh sleep quality index (PSQI) were used to assess the participants’ psychological status. The lactulose hydrogen-methane breath test was performed to detect the presence of small intestinal bacterial overgrowth (SIBO) in RAU patients. The long-term severity of RAU is quantified using the monthly number of ulcers. Compare the differences in outcomes between individuals with RAU and the healthy population, and explore the factors influencing the severity of RAU. Results Forty-nine patients and 49 controls were included. The RAU group had significantly higher SAS scores (t = 2.18, p = 0.034), and SIBO positivity (χ 2 = 75.67, p < 0.001). Factors correlated with the monthly number of ulcers included SAS score (r = 0.52, p < 0.001), symptoms of anxiety (r = 0.42, p = 0.004), SDS score (r = 0.46, p = 0.002), PSQI score (r = 0.35, p = 0.020), and SIBO positivity (r = 0.42, p = 0.005). Multiple linear regression analyses indicated that anxiety and SIBO may influence the severity of RAU. Moreover, SAS score (r = 0.38, p = 0.010) and SDS score (r = 0.38, p = 0.009) exhibited correlations with SIBO. Conclusions RAU patients are at a higher risk of anxiety and gut microbiota dysbiosis, which could potentially escalate the severity of RAU. The role of the brain-gut axis in the pathogenesis of RAU warrants further exploration.https://doi.org/10.1186/s12903-025-05998-0Recurrent aphthous ulcersAnxietyPsychologyGut microbiota dysbiosisSmall intestinal bacterial overgrowth |
| spellingShingle | Zijian Liu Mingxing Lu Wei Wang Jingli Tang Shufang Li Qianyun Guo Yutian Wang Xingyun Liu Xing Wang Zhe Cheng Qian Wang Jianqiu Jin Ying Han Hongwei Liu Lihong Cui Anxiety and small intestinal bacterial overgrowth: associations with recurrent aphthous ulcers BMC Oral Health Recurrent aphthous ulcers Anxiety Psychology Gut microbiota dysbiosis Small intestinal bacterial overgrowth |
| title | Anxiety and small intestinal bacterial overgrowth: associations with recurrent aphthous ulcers |
| title_full | Anxiety and small intestinal bacterial overgrowth: associations with recurrent aphthous ulcers |
| title_fullStr | Anxiety and small intestinal bacterial overgrowth: associations with recurrent aphthous ulcers |
| title_full_unstemmed | Anxiety and small intestinal bacterial overgrowth: associations with recurrent aphthous ulcers |
| title_short | Anxiety and small intestinal bacterial overgrowth: associations with recurrent aphthous ulcers |
| title_sort | anxiety and small intestinal bacterial overgrowth associations with recurrent aphthous ulcers |
| topic | Recurrent aphthous ulcers Anxiety Psychology Gut microbiota dysbiosis Small intestinal bacterial overgrowth |
| url | https://doi.org/10.1186/s12903-025-05998-0 |
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