Tongue Issues: Pain, Gastrointestinal Links, and Normal Anatomy

Tongue issues?

I occasionally experience a burning pain on my tongue, which varies in location.
Three years ago, I visited a teaching hospital for an oral examination, where both the attending physician and the chief physician examined me.
The attending physician noted that my tongue was red but didn't indicate any issues, while the chief physician seemed puzzled.
I left it alone, and it improved.
The following summer, it flared up again, and I consulted an ENT specialist who also said everything looked normal.
Later, when the weather cooled down, I forgot about it.
This spring, it recurred, and when I visited a clinic, the doctor conducted a thorough physical examination and deemed everything normal, prescribing B vitamins.
When I took them, I didn't experience the burning sensation, but it returned when I stopped.
I later noticed that my gastrointestinal discomfort seems to correlate with the pain; when I have gastrointestinal issues, my tongue hurts, and the symptoms alleviate otherwise.

I would like to ask the doctor if gastrointestinal issues can affect the tongue.
Today, I have bloating and diarrhea, and my tongue has started to feel uncomfortable again.
A few days ago, it was normal.
Additionally, this year, I have noticed that a specific area at the base of my tongue feels warm.
Based on images I found online, it seems to be the foliate papillae.
I would like to know how the foliate papillae should normally appear, as I cannot see the other side of my tongue in the mirror and am unsure about the symmetry and normality of the shape.
Is it normal for everyone to have different anatomical structures? Currently, at the base of my tongue where the foliate papillae are, I can observe three varying indentations in specific positions, but there are no holes.
Interestingly, during meals, that area tends to feel warm, somewhat similar to geographic tongue.
Is this a normal anatomical structure?

Nìmíng, 30~39 year old female. Ask Date: 2021/09/17

Dr. Ji Zhaoyun reply Otolaryngology

Hello, based on your description, it could be acute glossitis, chronic pharyngitis, or acute lingual tonsillitis.
I recommend seeking medical attention for a laryngoscopy examination (to rule out any masses) and medication treatment.
In addition to medication, please pay attention to the following daily living precautions: avoid lying down for two hours after eating, and refrain from coffee, tea, cigarettes, alcohol, fried foods, and spicy foods, as these can help improve symptoms.
Regarding your statement, "I currently notice three varying indentations in the foliate papillae area at the base of my tongue in specific positions, but there are no holes.
When eating, that area tends to feel warm, somewhat similar to the sensation of geographic tongue.
Is this a normal structure?" Such descriptions cannot determine the condition, so it is advisable to seek medical consultation.
Wishing you peace and health.

Reply Date: 2021/09/17

More Info

The symptoms you're experiencing with your tongue, particularly the burning sensation and discomfort, can indeed be linked to gastrointestinal issues. The tongue is a sensitive organ, and its condition can reflect the overall health of the gastrointestinal tract.
Firstly, it’s important to understand the anatomy of the tongue. The tongue is covered with mucous membrane and contains various types of papillae, including fungiform, foliate, and circumvallate papillae. The foliate papillae, located on the sides of the tongue towards the back, are often referred to as "leaf-like" and can sometimes appear as depressions or grooves. Variations in the appearance of these papillae are normal and can differ from person to person.
Your observation that gastrointestinal discomfort correlates with the burning sensation on your tongue is significant. Conditions such as gastroesophageal reflux disease (GERD), gastritis, or even food intolerances can lead to symptoms that manifest in the mouth, including a burning sensation on the tongue. This is often due to acid reflux, which can irritate the mucous membranes of the mouth and throat, leading to discomfort. Additionally, gastrointestinal issues can affect nutrient absorption, particularly B vitamins, which are crucial for maintaining the health of the mucous membranes. A deficiency in these vitamins can lead to glossitis, which is inflammation of the tongue that may cause burning sensations.

The fact that your symptoms improve with the intake of B vitamins suggests that there may be a nutritional component to your discomfort. It’s also worth noting that stress and anxiety can exacerbate gastrointestinal symptoms, which in turn can lead to oral discomfort. The mind-gut connection is well-documented, and stress can lead to increased stomach acid production, which may worsen reflux symptoms.

Regarding the appearance of your foliate papillae, it’s normal for these structures to vary in shape and size. The presence of grooves or depressions is not uncommon, and as long as there are no signs of ulceration or significant changes in color, it may simply be a normal anatomical variation. However, if you notice any persistent changes, such as lesions or significant discomfort, it would be advisable to seek further evaluation from a healthcare professional.

In summary, your gastrointestinal health can indeed influence the condition of your tongue. If you continue to experience discomfort, it may be beneficial to consult with a gastroenterologist to explore potential underlying conditions that could be contributing to both your gastrointestinal symptoms and the burning sensation on your tongue. Keeping a food diary may also help identify any specific triggers related to your diet that could be exacerbating your symptoms. Additionally, managing stress through relaxation techniques or counseling may also provide relief from both gastrointestinal and oral symptoms.

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