Oral Manifestations of Inflammatory Bowel Disease and the Role of Non-Invasive Surrogate Markers of Disease Activity

Abstract

Inflammatory bowel disease (IBD), which includes Crohn’s disease (CD) and ulcerative colitis (UC), can be associated with several extra-intestinal manifestations requiring a multidisciplinary management both in terms of work-up and therapy. Oral lesions are common in patients with IBD, with a prevalence ranging from 5% to 50%. These can represent an oral location of IBD as well as a side-effect of drugs used to treat the intestinal disease. Oral manifestations, occurring in patients with IBD, can be divided in nonmalignant, specific, and non-specific ones, and malignant lesions. While there is undoubtedly a need to search for an IBD in patients with oral lesions associated with intestinal symptoms, the work-up of those with an exclusive oral lesion should be personalized. Fecal calprotectin is a non-invasive marker of intestinal inflammation and may be used to select which patients need to undergo endoscopic examination, thereby avoiding unnecessary investigations. The pharmacological armamentarium to treat oral lesions associated with IBD includes topical or systemic corticosteroids, immunosuppressive agents, and biologic drugs.

Extraintestinal Manifestations of Inflammatory Bowel Disease: Current Concepts, Treatment, and Implications for Disease Management

“…The prevalence of oral lesions is reported in a range from 5% to 50%. [73][74][75] In the pediatric patient population, a prevalence of 7%-23% has been reported. 75 Oral lesions are reported to be more common in patients with CD and more prevalent in children.…”

Dermatological Manifestations in Pediatric Inflammatory Bowel Disease

“…Lesions of the oral cavity may be painful and may lead to impaired oral function or to psychological misbalances due to esthetic involvement [ 9 ]. Lesions of the oral mucosa may seem more severe during a period of disease exacerbation but 30% of patients, especially of pediatric age, present active oral manifestations during IBD remission [ 10 ].…”

“…In a group of 1649 pediatric IBD patients, 97 children presented with extraintestinal manifestations, 21% of which were aphthous stomatitis [ 3 ]. In another retrospective study, 24% of children with IBD presented dermatological manifestations, 18% of which were aphthous stomatitis [ 10 ]. In a study from Iran, oral aphthous lesions were identified in 13% of patients with CD vs 6% of UC patients.…”

The condition of the oral cavity at the time of diagnosis of inflammatory bowel disease in pediatric patients

“…Pathogenesis of oral manifestations of IBD remains unclear. Currently research reported on the potential role of microbiota in the pathogenesis of IBD and its oral location, it has been proposed that dysbiosis (term that means imbalance within the bacterial community) of salivary microbiota (with relative abundance of Streptococcus, Prevotella, Haemophilus, and Veillonella) may play a crucial role 13 . Severe IBD has a less diverse microbiota with fewer commensal microbiota communities and more opportunistic pathogenic bacteria originating from the oral cavity or respiratory tract 14 , 15 .…”

“…Angular cheilitis is characterized by erythema at the corners of the mouth with or without painful fissures and sores. It can be a consequence of anemia or fungal and bacterial infections 13 . In our research prevalence of unspecific inflammatory manifestations in the oral cavity were (35.3%) for children with CD and (18.7%) for children with UC (Table 4 ).…”