iPlayer Radio What's New?
Image for New HIV test, Vitamin D and TB, Vitamin B12, mouth ulcers

Listen now 28 mins

Listen in pop-out player

New HIV test, Vitamin D and TB, Vitamin B12, mouth ulcers

Duration:
28 minutes
First broadcast:
Tuesday 04 September 2012

HIV testing
The first over-the-counter DIY testing kit for HIV is expected to go on sale in America in the next month. It's said to allow people to screen potential sexual partners for HIV before deciding to have sex them - all in the comfort of their own home. But sexual health consultant from London's Chelsea and Westminster hospital Ann Sullivan believes that the idea is flawed as someone could be recently infected and still show a negative result. Her hospital offers an HIV test to all patients who are admitted to the Emergency Department. A positive result is picked up in around 4 people in every thousand tested. Glasgow GP Dr Margaret McCartney analyses the latest HIV figures for the UK - which are on the rise. She advises that safe sex should be practised even with a negative result to help protect people from all sexually transmitted infections.

Vitamin D and TB
As much of the UK enjoys the last of the summer sun, Vitamin D is back in the headlines. The body makes its own Vitamin D with sun exposure - but supplements in tablet form can be taken by anyone who's deficient. A dose of the Vitamin D was given to patients with tuberculosis - along with the regular antibiotics - and it helped to speed up their recovery. Dr Adrian Martineau, who's a Senior Lecturer in Respiratory Infection and Immunity at Queen Mary University, London, says that the Victorian idea of giving "consumptive" patients of sunshine was spot on.

Vitamin B12
A growing number of people believe they're deficient in another Vitamin - B12. Sources of the vitamin include meat, fish and dairy products - so strict vegans can be at risk of deficiency. The vitamin is crucial in the production of red blood red cells and for the normal functioning of the brain and nervous tissue. Symptoms of low levels can include anaemia, tiredness, pins and needles, memory loss and confusion. If it's not addressed promptly the damage can be irreversible. John Hunter who's Professor of Medicine at Cranfield University sees many patients who can't absorb the vitamin because of problems with their gut like Crohn's or Coeliac disease. Another condition - pernicious anaemia - is caused by the lack of a protein required to make absorption possible. As many as 1 in 30 adults have B12 deficiency - rising to 1 in 16 in the over 65s. A blood test which is used to check levels is thought by many doctors and patients to be inaccurate. The top-up injections of B12 are usually given every 2 or 3 months, in spite of many patients saying that their symptoms return well before their next one is due. Martyn Hooper from the Pernicious Anaemia Society says that testing and treatments need to be improved - to stop patients resorting to their own drastic solutions outside mainstream medicine.

Mouth Ulcers
One in 5 of the UK population will get mouth ulcers at some stage of their lives. For some, they can recur every month or so - in painful crops that can take a fortnight to heal. Some are associated with underlying problems such as inflammatory bowel disease, or vitamin and mineral deficiencies, but in many cases no cause is found.
Patients like Ruth have to avoid certain foods - like chocolate and fruit - to reduce the risk of recurrence. She's had ulcers since her teens and now takes immunosuppressant drugs to reduce their impact on her life. Tim Hodgson who's a consultant in oral medicine at the Eastman Dental Institute in London has had some success treating them with drugs like thalidomide. He says that some patients fear that their recurrent ulcers could develop into oral cancer - but that simply isn't the case.

  • Programme Transcript - Inside Health

    Downloaded from www.bbc.co.uk/radio4
    THE ATTACHED TRANSCRIPT WAS TYPED FROM A RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT. BECAUSE OF THE RISK OF MISHEARING AND THE DIFFICULTY IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE BBC CANNOT VOUCH FOR ITS COMPLETE ACCURACY.


    INSIDE HEALTH

    TX: 04.09.12 2100-2130

    PRESENTER: MARK PORTER

    PRODUCER: PAULA MCGRATH


    Porter
    Hello and welcome to Inside Health - in today's programme: Vitamin B12 deficiency - we examine why a growing number of people believe that it is both underdiagnosed, and undertreated. Mouth ulcers - I visit one of Europe's leading dental hospitals to find out what can be done to help people plagued by recurrent attacks. And why a little bit of sun is good for you - as much of the UK basks in the remnants of summer, I will be finding out how the latest research into treating tuberculosis explains why doctors in the pre-antibiotic era were so keen on patients getting plenty of sun.

    But first HIV/Aids and a new testing kit that allows you to screen a potential sexual partner for HIV before you have sex them - all in the comfort of your own home. The US Food and Drug Administration has just approved the first over-the-counter DIY testing kit for both types of HIV, and it is expected to go on sale in America within the next month. Inside Health's Dr Margaret McCartney has been looking into it for us - how does it work Margaret?

    McCartney
    Well it's a test kit that the patient would buy and bring home with them and they rub a swab, that's part of the kit, from their upper and lower gums and that then is placed into a developer vial chemical and then the result is read in 20-40 minutes afterwards.

    Porter
    So it's an immediate test that can be used in your own home with a potential partner - is that the idea?

    McCartney
    It's certainly one of the ways that's been very well talked about, I think, in the US has been the ability for someone to use it with a potential sexual partner at home before they have sex.

    Porter
    And how's it been received by doctors in the States?

    McCartney
    Yeah I mean well the Food and Drug Administration has approved it and there's been a lot of...

    Porter
    But that basically just means it works doesn't it?

    McCartney
    Yeah and there's been a lot of HIV advocates, so people who are advocating for people with HIV infection and for AIDS who've thought this is a fantastic idea because it empowers people, it gives people an ability to test themselves without having to get involved with doctors or hospitals, it's something that can be done in the privacy of their own home and they think that it might be very acceptable for men, in particular, who are may be having sex with other men and may be are not up front about that.

    Porter
    What about here?

    McCartney
    In the UK it's illegal to offer home use HIV testing but that doesn't mean to say you can't find them and I had a look on the internet yesterday and it's absolutely perfectly possible to obtain for yourself several varieties of HIV test kits to be done in your own home. Last year the MHRA - our medicines watchdog in the UK - declared that they were illegal and they shouldn't be used because they were extremely unreliable as well. So it is possible to get them but I certainly would not recommend that anyone did.

    Porter
    Well we're also joined by Ann Sullivan, who's a consultant in sexual health and HIV at the Chelsea and Westminster Hospital in London. Ann, you must have heard of these tests that are being used, what's the take on them here in the UK?

    Sullivan
    I mean I think at the moment, as Margaret says, there would be a lot of concern about quality control but also if that partner has just been infected we know that the most infectious stage is when you're CO converting and newly contracted actually, these tests will be negative, whereas if you come in and access the proper test with the advice that we give then you're much more likely get a reliable result. So I agree it would be empowering, it might improve testing but we do have a lot of concerns about quality.

    Porter
    It could falsely reassure is effectively what you're saying.

    Sullivan
    Absolutely.

    Porter
    So your potential partner tests as negative, so you don't practice safe sex, and you end up catching it. And Margaret other than falsely reassuring somebody are there any other problems with this sort of home testing?

    McCartney
    Yeah I mean I think that a lot of doctors are quite concerned and I think quite reasonably concerned about what happens to a person who finds out, on their own perhaps without anyone immediately to speak to that their test result is possibly a potentially positive. And I think that does create dilemmas in about how we would approach that person and support them and of course we test because there would need to be a confirmatory test done before you would give someone a true diagnosis. And the other problem, I think, that people have raised concerns about is that someone could be coerced into taking a test, so someone doesn't really consent to it but gets it done because they're put under pressure. And I think that wouldn't be a desirable situation, there's a right time for people to get tested and a wrong time.

    Porter
    And presumably your advice, Margaret, would be that if they're concerned that their potential partner may have HIV or indeed any other sexually transmitted infection then you should practice the sort of sex that means it's unlikely to spread anyway?

    McCartney
    Well absolutely and it's very interesting that the FDA in their approval statement said it's important never to use a negative test result to decide on whether to engage in behaviour that puts you at risk for HIV infection, so they've really put a bit of a get out clause in there - don't rely on the test too much.

    Sullivan
    As an alternative we're doing some trials now where people can do what we call home sampling, rather than home testing, and I suppose our take on it would be we'd rather make testing much more widely available, safe testing.

    Porter
    Which is exactly what you do do at the Chelsea and Westminster, you've got what I would call a very inclusive policy. Can you explain what your policy is at the hospital at the moment?

    Sullivan
    Sure. At the moment we're offering all people who come to emergency department an HIV test and anyone who's admitted to...

    Porter
    Whatever they go in with?

    Sullivan
    Whatever they go in with - exactly. So what we didn't want to do was ask people to target certain people, so the patients don't like and the doctors find that quite hard to remember, so it's much better just everybody. And also people who are admitted to our acute care unit are also offered tests. We're also expanding into what we call indicator conditions which are conditions we know occur more commonly in HIV but we don't know how often people with those conditions have HIV, so we're offering all of those people tests as well.

    Porter
    So they'd be conditions like what?

    Sullivan
    Diarrhoea, certain skin conditions, nerve problems - it covers everything - pneumonia.

    Porter
    And what sort of results do you have, what's your pick up rate been?

    Sullivan
    When we originally started it was down about point two per cent - so two people per thousand - but as we've spread it out a bit more we're getting about point nine, so that's almost one in a hundred and we know that cost effectiveness is - the cut off is suggested to be point one, so we're well above what we would expect.

    Porter
    One in a hundred's a pretty high pick up rate if you're not actually targeting high risk groups.

    Sullivan
    But we're also in an area where there is a lot of HIV, so our, what we call our background prevalence in the community is seven per thousand, so it is a high area anyway.

    Porter
    Margaret, where are we now in terms of HIV, what do the statistics tell us?

    McCartney
    Yeah, I mean we get our statistics from the Health Protection Agency and what we do know is that having seen a decline in HIV infections since about 1995 we know that infections are once again starting to rise again and particularly in men who have sex with men again.

    Porter
    Is that what you're seeing in your clinic?

    Sullivan
    Absolutely, particularly young gay men.

    Porter
    And is that because the message is - the safe sex message - perhaps isn't quite as - or people think HIV it's just something that happened 20 years ago, it's obviously an on-going issue but it's not quite at the forefront of everyone's mind anymore?

    Sullivan
    Yeah I think it's a mixture of two things: I think the publicity that was very prominent in the early days and everyone being very frightened and scared and I think that's fallen off the information to young people but I also think while we're giving this message that now HIV's very treatable and you're expected to have a normal life expectancy in a way that's had a negative impact in that people aren't taking this seriously and so even though we're very inclusive offering HIV tests to everyone and reassuring that we can treat them if they have HIV people need to be aware that it is still a lifelong serious potentially life threatening condition.

    Porter
    Margaret, what about the media stories that there's a growing problem with sexually transmitted infections amongst people who are returning to the dating scene - this is the sort of the person perhaps who's been married for 20 years who's back out meeting men or women, is there any evidence to support that?

    McCartney
    Yeah, I mean it's very interesting because I think the perception of a lot of people is that sexual infections are really only a young person's problem so that there has been this idea out there that if you're older you're not really at risk of sexual infections and the statistics just don't bear that out and in fact in older people - over 45s - their risks of having a sexually transmitted infection is actually increasing and certainly talking to patients quite often they don't really feel that risk maybe entering into a new relationship after a period of monogamy. So I suppose the message is just always use a condom and get tested if you think you've been at risk.

    Porter
    And in absolute numbers how many people do we think in the UK are currently - have HIV?

    Sullivan
    So there's approximately 90,000 people living with HIV but about a quarter don't know they're infected, that's about 22,000 people.

    Porter
    And how does that fit in with sexually transmitted infections in general - is there evidence that people are acquiring more infections and HIV as well?

    Sullivan
    Yeah I mean I think it's certainly the case that when people get sexually transmitted infection they're more likely to contract HIV in the upcoming year and I think there's also an idea that when you have a sexually transmitted infection you're more infectious with HIV, so they're very closely interlinked and they're also used as a marker so the rise in, for example, gonorrhoea in gay men of 60% in the last year indicates that there's a lot of unsafe sex going on.

    Porter
    Ann Sullivan and Margaret McCartney - thank you both very much. And if you would like more details on HIV testing, do visit our website - go to bbc.co.uk/radio4 and follow the links to Inside Health.

    Vitamin D is back in the headlines this week following the publication of new research suggesting that giving high doses of the sunshine vitamin alongside the standard antibiotics can speed up recovery from tuberculosis. Dr Adrian Martineau is Senior Lecturer in Respiratory Infection and Immunity at Queen Mary University.

    Martineau
    Well we had two main findings: The first was that giving Vitamin D in addition to antibiotics accelerated the clearance of TB bacteria from the lungs of TB patients by about two weeks, so the patients who had standard therapy alone cleared the bacteria in five weeks and those who standard therapy plus Vitamin D cleared in three weeks. The second major finding was that when we looked at the serum and plasma samples taken from these patients we found that a whole panel of inflammatory markers resolved more quickly in the patients who had Vitamin D than in those who had standard therapy.

    Porter
    So this is suggesting that Vitamin D is somehow helping the immune system fight the infection - we'll come on to that in a moment but first of all does it then justify the sort of old practice, if you like, of wheeling TB patients out into the sunshine because of course Vitamin D is produced by sunlight falling on our skin?

    Martineau
    Absolutely right, there's nothing new under the sun and Vitamin D was really used as early as the mid-19th Century to treat tuberculosis.

    Porter
    By accident or by design?

    Martineau
    By design actually, one of the very fast randomised control trials ever performed was done in 1849 in the - what is now - the Brompton Hospital, what was then the London Hospital for Consumption and Diseases of the Chest, in which over a thousand patients were randomised to receive either cod liver oil or standard treatment, which was simply bed rest.

    Porter
    And cod liver oil being a good source of Vitamin D.

    Martineau
    Yes among other vitamins. And what was found was that the patients with so-called consumption - the TB patients - who had the cod liver oil, had a much lower mortality rate than those who received the standard therapy at the time. Then later on in the 19th Century TB sanatoria were set up and a common practice was for TB patients to have so-called helia therapy or compulsory sunbathing which they were wheeled out into the sunshine in their underwear to enjoy the benefits of alpine sunshine. And of course this is one of the best ways for the body to make Vitamin D. So this was all tied together then in the 1920s when people realised that both sunshine and cod liver oil could cure rickets and then when Vitamin D was first synthesised in an industrial process it was used to treat TB in the pre-antibiotic era.

    Porter
    Because that's what we mostly think of Vitamin D deficiency leading to bone problems, it's essential for normal bone health and you get rickets if you don't get enough but actually it plays a number of other roles and this study suggests that it plays a role in the immune system.

    Martineau
    Absolutely. I think the last 20 years have really seen a revolution in the way that we think about what Vitamin D does and this has arisen partly as a result of basic science work showing that Vitamin D receptors, which are the receptors in the cell that signal via Vitamin D, are actually expressed not just in bone cells but in a whole range of tissues - 36 different tissues in the body, including of course white blood cells, which are the cells which fight infection.

    Porter
    How do we think the Vitamin D is helping in the fight against TB and does it have implications for other infections?

    Martineau
    Well we think it's working in two main ways. The first way is to switch on, if you like, the production of natural antibiotic substances in the white blood cells and we've shown that these substances in test tubes can kill the TB bacterium. But the second way - and one that's particularly highlighted by this new research - is that Vitamin D can dampen down inflammatory responses which can be harmful.

    Porter
    Does this have implications for other conditions?

    Martineau
    Well I think it may well do, certainly these anti-microbial peptides, these natural antibiotics, that are switched on by Vitamin D have a very broad spectrum of activity, so they could potentially be used to have activity against a range of viruses or other bacteria which can cause lung infections.

    Porter
    Is there any evidence to suggest that Vitamin D levels - because a lot of people in this country have sub-optimal Vitamin D levels, particularly during the winter - that they play any role in immune based things like allergy or infection, increases your chance of catching colds that sort of stuff?

    Martineau
    Well it's certainly true that Vitamin D levels in the population are lowest in winter and spring and this coincides with the highest risk of getting upper respiratory tract infections and influenza and in fact this is a theory we're now pursuing in a current clinical trial in patients with asthma and chronic obstructive pulmonary disease, giving them Vitamin D supplements or placebo and seeing if we can prevent colds which are the key triggers of exacerbations in these patients.

    Porter
    Dr Adrian Martineau talking to me earlier.

    And from a vitamin we get from the sun, to one that we get from our diet - or at least one that we should do. We need vitamin B12 to build healthy red blood red cells, and for the normal functioning of the brain and nervous tissue. Deficiency can lead to a wide range of problems including anaemia, fatigue, pins and needles, weakness, memory loss and confusion. And, if not picked up promptly, the damage can be irreversible.

    B12 is found mainly in meat, fish and dairy products and most people take in enough to meet their needs - although vegans may struggle. But eating a B12 rich diet isn't always enough - you need to absorb the vitamin too, something people with pernicious anaemia struggle to do because they lack a protein needed to assimilate B12. Others may not absorb enough because of bowel conditions like Coeliac, Crohn's or ulcerative colitis, and some medicines can interfere with B12 too. Whatever the cause, B12 deficiency is common - affecting as many as one in 30 younger adults, rising to one in 16 in the over 65s. Levels are checked using a blood test, and once topped up, stores are generally maintained by an injection every two to three months. But many patients, and some doctors, don't believe this is often enough.

    Martyn Hooper is Chair of the Pernicious Anaemia Society

    Hooper
    By the time I first went to my doctor I'd already developed serious nerve damage to my peripheral nerves. I associated it with a fall that I'd had, went to my GP, GP said well you've had a fall, things will get better.

    Porter
    What were you actually complaining of though - what had you noticed?

    Hooper
    Numbness, complete numbness in my legs and balance problems. I was still in full time teaching at the time, I was having problems dealing with information overload, I was experiencing mood swings, becoming irritable with students - a whole raft of problems but I didn't associate it with anything to do with B12.

    Porter
    So as well as the problems with the nerves in your legs you actually think that your brain wasn't functioning properly - you were in a fog basically.

    Hooper
    It's cognitive impairment yeah.

    Porter
    Now looking back you know what was causing it but how long was it before you discovered that it was to do with your B12?

    Hooper
    By the time I couldn't walk, it was my sister who actually took blood off me - she's a nurse - and sent it in and the next day I had a call from the personnel department that my doctor wanted to see me urgently. So I'd already developed the nerve damage, because the symptoms are so insidious, because they happen over a number of years and you associate it with general ageing process or lifestyle, I didn't associate it with symptoms with B12 deficiency.

    Hunter
    It's a crucial vitamin which is essential for the correct formation of red cells in the blood, it's also necessary for the nutrition of the brain and the nerves.

    Porter
    John Hunter is Professor of Medicine at Cranfield University.

    Hunter
    So if you lack B12 you get overwhelming tiredness and this may be associated with anaemia which used to be called pernicious anaemia and there may also be brain damage, there may be dementia, there may be degeneration of the spinal cord and there may be damage to peripheral nerves.

    Porter
    Where are most of us getting our B12 from and why do some people become deficient?

    Hunter
    The main sources of Vitamin B12 are meat, fish and dairy products and so very strict vegetarians, vegans, may have a diet which is lacking in the vitamin but most people get enough in their diets and they become deficient either because the absorption of the vitamin is inadequate or they have excessive demands to use up the vitamin in the body.

    Porter
    And those demands might be?

    Hunter
    Well this is one of the things we're working on - there are certain drugs which may increase the demands for the vitamin but also we believe that certain bacteria growing in the bowel can compete with the body cells for taking up the vitamin. So it's possible if you have disease of the small intestine for bacteria to grow there and these bacteria will take up the vitamin more readily than body cells so although there's plenty of the vitamin in the diet not enough gets into the bloodstream and the patients become deficient.

    Porter
    Because of the insidious onset, and vague nature, of many of the symptoms of B12 deficiency, it is often missed.

    Hunter
    There's been a recent study in the New England Journal of Medicine showing that the basic blood test we do at the moment is often quite inaccurate. We have a normal range of 180 to about 900 and I think that actually anywhere in the 300 or less is likely to have an inadequate amount of the vitamin present.

    Porter
    So the blood test is falsely reassuring us there, particularly in presumably early cases so until it gets very severe we're not picking it up with our standard blood tests - so that's problem number one.

    Hunter
    So first of all the doctor has to think a bit and then he has to have a reliable test, which at the moment he really doesn't.

    Porter
    So we're not necessarily thinking of it, the test isn't as good as it could be. Okay which brings me on to the second concern: Once a diagnosis is made the treatment involves giving Vitamin B12 injections but our patients consistently and many of them come back to us and say these aren't working for me, they don't last very long.

    Hunter
    Well this is how I first became interested in the topic because I had so many patients with Crohn's Disease who had diseases of the ileum - the lower part of the small bowel - or had had resections of that part of the gut that they needed B12 injections and lo and behold they were saying that they were getting tired before the next injection was due but that when they had that injection they were instantly very much better. And so I started bringing forward the time of their injection - okay you can have it every six weeks. And then I found that general practitioners were writing back to me and saying - well it says in the book it's every three months, I can't give it more frequently than the British National Formulary recommends.

    Porter
    But it's not just the book, I mean [indistinct word] from our local laboratory are telling us to do it as well and so we get a lot of that and you're saying that's not right?

    Hunter
    That's not right. In my view it's absolutely essential that the injections are timed according to the way the patients feel and if the patient feels that symptoms are coming back they should have an earlier injection. And what we need is a more reliable test and that's another thing we're hoping to work on in the next year.

    Porter
    In the meantime some people with B12 deficiency are resorting to extreme measures. Martyn Hooper:

    Hooper
    People are bypassing the traditional doctor now, they're going to everything from beauty therapists to hairdressers, having Methylcobalamin infusions, which is large amounts into an intravenous drip and then injecting themselves without the knowledge of their doctor, without the assent of their doctor.

    Porter
    Well it seems to me that there's this big gulf there and I mean there's the one group who are going to all those sort of events and at the other end are the doctors saying well this is what the textbooks say, this is what our local lab's telling us - the sensible way forward is somewhere twist the two?

    Hooper
    Yeah and indeed all that we're campaigning for is for somebody who knows what they're doing to take hold of this because it is a serious issue. I've got over six and a half thousand members now and they all complain about the same thing - that nine of the 10 telephone calls that our volunteers take are to do with the frequency of injections.

    Porter
    Martyn Hooper. And if you would like to know more about B12 deficiency and pernicious anaemia do visit the website - go to bbc.co.uk/radio4 and follow the links to Inside Health. And if you have a health query that you would like us to look into then please get in touch - insidehealth@bbc.co.uk

    Padma e-mailed us to ask if there is a link between recurrent mouth ulcers and cancer. One in five of the UK population will get mouth ulcers at some stage, but for some they can recur every month or so - in painful crops that take a fortnight to heal. Some are associated with underlying problems such as inflammatory bowel disease, or vitamin and mineral deficiencies, but in many cases no cause is found.

    Ruth
    Right in my cupboard there's chocolate and that's probably one of the worst things I can eat with mouth ulcers but also in my fridge are things like salad cream, any kind of pickles, anything like that will upset my mouth and also the one thing that I do enjoy - socialising - and obviously drink is a huge problem, especially wine for some reason tends to upset the mouth more.

    Porter
    Like many of those affected Ruth been troubled by recurrent mouth ulcers since she was a teenager.

    Ruth
    When you get loads of mouth ulcers all your glands in your neck tend to swell, so you feel miserable and run down continually. It's obviously difficult at work because people would assume that I was actually miserable and I wasn't just talking I was in a mood - well I wasn't it was just that it was so painful to talk. The worst thing is when you've got loads of ulcers and obviously some of them get to huge size you can't actually sleep because of the pain and this was like a huge problem for me - not getting proper sleep, I'm going into work not being able to eat properly, you can't go out and you're just miserable.

    Porter
    Dr Tim Hodgson is a Consultant in Oral Medicine and Honorary Lecturer at the Eastman Dental Institute.

    Hodgson
    The problem with the mouth is it's an unclean environment and therefore when you get a hole, which is what an ulcer is, it's secondarily infected with the bugs that live in the mouth and therefore we can get them to heal quicker if we make that environment cleaner by using topical antiseptic mouthwashes and that's the treatment that's got most evidence in ulcers.

    Porter
    This will be used to treat the ulcers once they're present or would they be using regular mouthwashes?

    Hodgson
    No this is when the ulcers are present, so this is an antiseptic mouthwash used twice a day when the ulcers are there tends to shorten the duration the ulcer is present by one to two days. So that helps people. But also ulcers are painful and people can't eat and speak and the other thing we tend to prescribe regularly is a mouthwash called Benzydamine hydrochloride which is an analgesic as well as an anti-inflammatory mouthwash, that gets rid of the pain and also takes some of the inflammation away from the ulcer.

    Porter
    Looking through the research that's been done into this is there any intervention that's ever been proven to reduce the frequency of the attacks?

    Hodgson
    Topical anti-inflammatory medications like corticosteroids do help lots of patients but unfortunately there have not been large randomised control trials that would support that but in reality the majority of our patients who get regular ulcers that are impacting to a huge extent on their quality of life we would use an anti-inflammatory corticosteroid mouthwash in the first instance and that would give them significant improvement. But then there's a group that won't even respond to those that you then go on to systemic medication - so tablets to swallow that we'd use.

    Porter
    And what sort of medication are we talking about?

    Hodgson
    Interesting - a mixed bunch. The first one we'd use is colchicine, which is actually an anti-gout medicine that when it was prescribed to patients with gout who also had ulcers their ulcers disappeared. We could also use some of the immunomodulators like azathioprine. And also the one with probably the greatest evidence base is thalidomide, which obviously has got other side effects that we need to be incredibly careful about when we use it.

    Porter
    So that's a difficult drug to use if you're going to be giving it to women, would you give it to a woman?

    Hodgson
    We have given it to women but it has to be given with a series of conditions to prevent obviously pregnancy developing. So they'd have to have pregnancy tests on a regular basis etc.

    Ruth
    I've had various different drugs and one of my first drugs that I tried long term was a drug called thalidomide, which was obviously given in pregnancy years ago, had to have lots of interviews in order to obtain this drug. Unfortunately that didn't work for me. But the main thing that I take now is azathioprine, which is an immune suppressant drug and that actually helps me and makes my life so much easier.

    Porter
    A lot of the patients that we see in general practice come in concerned that their mouth ulcers, their recurrent mouth ulcers, are a sign of some sort of deficiency or that supplements might help - is there any evidence to support that?

    Hodgson
    Yeah the first thing we would do in any patient that presents with mouth ulcers is check that they're not low in iron, Vitamin B12 or folate because there's no doubt that being deficient in any of those three what we call haematinics would make mouth ulcers worse. Although even though we find that in some patients, a small number, correcting that deficiency won't necessarily make the mouth ulcers go away, it will help with frequency and duration but it won't necessarily make the mouth ulcers go away completely.

    Porter
    Does having recurrent mouth ulcers make somebody more susceptible to more sinister mouth conditions - I'm thinking of cancers and the like?

    Hodgson
    No, it's a completely different process, these are recurrent inflammatory events and obviously mouth cancer is a malignant or a cancer event.

    Porter
    What's the natural history of these recurrent - say they often start in childhood - left to their own devices do they eventually burn themselves out?

    Hodgson
    So some children they'll disappear, in other people they would get more severe. And it's interesting that some people with mouth ulcers will tell you that they are worse when they're stressed, so stress is a huge factor in this particular condition. So they have a life event or life becomes difficult and they will tell you that their mouth ulcers will become more frequent or there'll be more of them or they'll become larger or more persistent.

    Porter
    Dr Tim Hodgson. And to clarify - recurrent ulcers may not predispose to oral cancer, but a persistent one that doesn't heal is suspicious. If a mouth ulcer lasts more than three weeks get it checked out by your doctor or dentist.

    In next week's Inside Health I will be finding out about progress in the quest for the holy grail of orthopaedics - growing new cartilage to reline arthritic joints.

    But before I go I must just share a comment from a listener. She asked to remain anonymous because the e-mail is about her mother-in-law who has lived to a ripe old age despite not eating the best of diets and being, well, how shall I put this, a little on the plump side!

    "My mother-in-law may be overweight but she is 101, has never taken any medication, and hasn't seen a GP since 1949."

    I could do with a few patients like that.

    ENDS

Broadcasts

Free download

  1. Image for Inside Health

    Inside Health

    Demystifying the health issues of the day that confuse us. Inside Health, with Dr Mark Porter, will…

BBC © 2014 The BBC is not responsible for the content of external sites. Read more.

This page is best viewed in an up-to-date web browser with style sheets (CSS) enabled. While you will be able to view the content of this page in your current browser, you will not be able to get the full visual experience. Please consider upgrading your browser software or enabling style sheets (CSS) if you are able to do so.

Added. Check out your playlist Dismiss