Oral Manifestations of IBD Flashcards
what is orofacial granulomatosis
persistent enlargement of soft tissues, characterised by non-caseating granulomatous inflammation in the absence of diagnosable crohns or sarcoidosis
prevalence and cause of OFG
0.8%
6-20% crohns with oral involvement
genetic + environment
mycobacterium?
deficiency, gut inflammation
delayed hypersensitivity reaction
triggers - benzoates, cinnamon, sorbate, SLS
describe the appearance of OFG
lip swelling, lymphoedema
lip fissures
peri-oral dermatitis
angular cheilitis
buccal cobblestoning
mucosal tags
gingival erythema
submandibular staghorning
ulceration
tongue swelling
describe the histological appearance of OFG
- non-caseating granulomas +/- giant cells
- granulomas deep in mucosa
- lymphoedema
- dilated lypmhatics
- perivascular lymphatic infiltrate
indistinguishable from crohns
investigations for OFG
photos, differentiation
FBC, haematinics
inflammatory markers (ESR, CRP)
fecal calprotectin
deep biopsy
endoscopy/MRI if abdominal symptoms
serum ACE to exclude sarcoidosis
patch testing
management of OFG
exclusion diet of cinnamon, benzoate, sorbate 3 months, slow reintroduction
betamethasone 500mcg + 10ml water, rinse 5 mins, 5x
flixonase 400mct nasules
beclometasone 100mcg inhaler
clobetasol ointment 0.05%
lip swelling = intralesional triamcinolone 40mg/ml
liquid feeding if needed
systemic -
aza, mycophenolate, prednisolone
biologics -
for crohns, less so ofg
anti-tnf [infliximab, adalimimab]
name the varied types of diagnoses
OFG - absence of crohns or sarcoidosis
crohns with oral involvement
crohns alone
how does ulcerative colitis appear
pyostomatitis vegans
multiple pastels on erythematous base
labial/buccal mucosa, gingival, tonsillar
Aphthous ulcers, angular cheoliria, floristry
can erode to form snail track ulcer
what can happen with repeated episodes of OFG
baseline lip enlargement
= fibrosis
name granulomatous diseases in the head and neck region
OFG, sarcoidosis, granulomatous polyangitis, syphilis, tuberculosis, crohns
why is there lip oedema in OFG
chronic granulomatous inflammation, increased vascular permeability, lymphatic obstruction and fibrosis
compression of lymphatic vessels, impairs drainage and triggers swelling
inflammatory mediators TNF-alpha
Why is faecal calprotectin required for a child presenting with OFG
to assess for crohns disease
OFG may preceed
non invasive
elevated levels suggests occult GI inflammation
Explain why growth of a child needs to be monitored in OFG
possible underlying crohns - growth failure can be early sign
iron, folate,,b12 deficiencies
malnutritions
growth hormone resistance/interferences
delays of puberty
timely intervention
what is sarcoidosis
condition where the immune system overreacts, causing inflammation and the formation of granulomas (small, inflamed lumps) in various organs.
