Oral Manifestations of GI Disorders

Question 1

What is recurrent aphthous stomatitis?

Describe epidemiology

Answer 1

Canker sore– occurs exclusively on non-keratinized mucosa (not dorsum of tongue, gingiva, hard palate)

Aphthous stomatitis usually develops after puberty with recurrences; no sex predilection

Question 2

What is the difference between minor/major aphthous stomatitis?

Answer 2

1cm= major; heal with scarring

Question 3

In which disorders do you see aphthous stomatitis?

Answer 3

Crohn’s disease and ulcerative colitis (IBD)==> result from immune response to underlying disorder (not direct consequence of either disorder)

Question 4

Describe histologic appearance of aphthous stomatitis

Answer 4

Mixed inflammatory response– neutrophils, plasma cells, maybe eosinophils

Question 5

Describe oral lesions in Crohn’s patients (4)

Answer 5

Ulcerations
Localized/generalized erythema
Hyperplastic, polypoid or papular lesions
Non-caseating granulomas (50% cases)

Question 6

What type of lesion is pathognomonic for Crohn’s disease

Answer 6

Linear ulcerations

Question 7

What types of lesions are seen ini UC?

Answer 7

Ulcerative lesions==> nonspecific and often prodromal

Question 8

What are the oral manifestations of celiac disease? (2)

Answer 8

Ulcerations
Enamel pitting=> predominantly permanent teeth

Both are nonspecific

Question 9

What is an oral manifestation that occurs in GERD?

Answer 9

Enamel erosion due to increasing acidity of oral cavity

Question 10

What are oral manifestations of FAP (3) and HNPCC (1)?

Answer 10

FAP: osteomas, odontomas (mini-teeth), supernumerary teeth

HNPCC: fordyce granules (ectopic sebaceous glands that are white-yellow in color)

Question 11

What is the histologic appearance of fordyce granules?

Answer 11

Sebaceous glands in oral mucosa

Question 12

Describe the oral manifestations observed in Peutz Jeghers Syndrome

Answer 12

Hyperpigmentation/freckling of lips

This is pathognomonic for Peutz-Jeghers

Question 13

What is pyostomatitis vegetans?

How does it present?

Answer 13

Oral manifestation of IBD or GI malignancy

They look hella nasty–“snail track lesions” but have minimal oral discomfort

Question 14

Describe the histologic appearance of pyostomatitis vegetans

Answer 14

Separation of epithelium and accumulation of neutrophils and eosinophils within blister

Question 15

What is treatment for pystomatitis vegetans? (2)

Answer 15

Treat GI disease

Systemic corticosteroid therapy

Question 16

What is malignant acanthosis nigricans?

Answer 16

Unusual manifestation of GI cancer, other malignancies

Hyperkeratotic brownish patches in folds of skin with leathery texture– usually not intraoral

Question 17

Describe histologic appearance of malignant acanthuses nigricans

Answer 17

Hyperkeratotic epithelium with papillary architecture