Management of Atrophic Glossitis
Atrophic glossitis should be managed by identifying and treating the underlying cause, with particular focus on correcting hematinic deficiencies (iron, vitamin B12, folate), treating H. pylori infection if present, and addressing autoimmune conditions that may be responsible for the condition. 1
Diagnostic Approach
Clinical Assessment
- Recognize characteristic features: partial or complete absence of filiform papillae on the dorsal surface of the tongue, resulting in a smooth, red appearance 1
- Assess for symptoms: pain or burning sensation when consuming spicy or hot foods 2
- Document duration of symptoms and previous treatments attempted
Laboratory Evaluation
- Complete blood count to assess for anemia 1
- Serum hematinic levels:
- Iron
- Vitamin B12
- Folic acid
- Serum homocysteine level 1
- Autoantibody testing:
- Gastric parietal cell antibodies (GPCA)
- Thyroglobulin antibodies (TGA)
- Thyroid microsomal antibodies (TMA) 1
- Testing for H. pylori infection 3, 4
- Blood glucose to rule out diabetes mellitus 2
Treatment Algorithm
1. Correct Nutritional Deficiencies
- For iron deficiency: oral iron supplementation
- For vitamin B12 deficiency: oral or parenteral B12 supplementation
- For folate deficiency: oral folate supplementation
- Consider vitamin B complex supplementation to address multiple potential deficiencies 1
2. Treat Underlying Conditions
H. pylori infection:
- Eradicate using appropriate antibiotic regimen
- Confirm successful eradication using non-serological testing 3
Autoimmune gastritis:
- Monitor and manage associated vitamin B12 and iron deficiencies
- Screen for concomitant autoimmune disorders, particularly thyroid disease 3
Candidiasis:
- Antifungal therapy for patients with positive culture or direct cytologic evidence of Candida 2
Protein-calorie malnutrition:
- Nutritional support and dietary counseling 5
3. Address Comorbidities
- Manage diabetes mellitus if present
- Treat xerostomia if contributing to symptoms
- Discontinue medications that may contribute to symptoms (if possible)
Monitoring and Follow-up
- Reassess symptoms after 2-3 months of treatment
- Repeat laboratory tests to confirm correction of deficiencies
- For patients with autoimmune gastritis, consider endoscopic evaluation to assess for atrophic gastritis and risk of gastric cancer 3
Special Considerations
- Patients with GPCA-positive atrophic glossitis have higher frequencies of hemoglobin, iron, and vitamin B12 deficiencies and hyperhomocysteinemia, requiring more aggressive monitoring and treatment 1
- Elderly patients with atrophic glossitis should be evaluated for protein-calorie malnutrition, as it is a common finding in this population 5
- Patients with persistent symptoms despite correction of deficiencies may need further evaluation for neuropathic pain syndromes 6
Common Pitfalls to Avoid
- Misdiagnosing atrophic glossitis as burning mouth disorder without proper laboratory evaluation 6
- Failing to test for autoimmune markers in patients with persistent symptoms
- Overlooking Candida infection as a potential cause, especially in patients with risk factors such as diabetes, malignancy, or recent antibiotic use 2
- Treating symptoms without identifying and addressing the underlying cause
By systematically evaluating for nutritional deficiencies, autoimmune conditions, infections, and other underlying causes, most cases of atrophic glossitis can be effectively managed with significant improvement in symptoms and tongue appearance.