Oral manifestations of inflammatory bowel disease Flashcards
What is OFG/Orofacial Granulomatosis
Chronic inflammatory disease
relapsing and remitting lip swelling
can also involve
- perioral skin
- buccal mucosa
- gingiva
- floor of mouth
- tongue
OFG aetiology
unknown
interacting factors
- host immune response
- environmental triggers - allergies
- genetic susceptibility
OFG histopathology
typically non-caseating granulomas with or without multinucleate giant cells
granulomas deep in oral mucosa
- missed if specimen too shallow
lymphoedema
dilated lymphatics
pervisacular lymphatic infiltrate
indistinguishable from Crohn’s
OFG clinical features
lip swelling
buccal cobblestoning
gingival enlargement
stag horning
mucosal tags
linear ulceration
skin changes
OFG investigations
FBC, haenatinitics - inflammatory markers
fecal calprotein
oral biopsy - deep
endoscopy and biopsy if abdominal symptoms
serum ACE
patch testing
OFG treatment
benzoate and cinnamon exclusion diet
- beneficial in 54%-78%
- strict adherence for 3 months and introduce foods one at a time
liquid enteral nutrition 6 weeks
topical steroid for intramural involvement
- betamethasone 500mcg tablets in water
- flixonase 400mcg nasules in water
- beclomethasone 100mcg inhaler
- clobetasol ointment 0.05%
topical 0.1% tacrolimus for skin involvement and lip swelling
intralesional triamcinolone 40mg/ml
OFG biologics treatment options
anti-TNF drugs
- infliximab initially and adalimumab
ustekinumab
treatments won’t work for chronically established lip enlargement
OFG and Crohn’s links
children with OFG much more likely to develop Crohn’s as adults
lower threshold for investigation
where OFG presents alone it should be considered a separate entity to Crohn’s with oral involvement
ulcerative colitis oral manifestations
Pyostomatitis vegetatans
- rare condition
- multiple pustules on an erythematous base
- affects labial and buccal mucosa and tonsillar region of gingiva
- can erode to form snail track ulcers
RAS features
common
up to 20% of population
usually presents in childhood or adolescence
often family history
systemically well
recurrent ulcers
- shallow
- painful
- round/oval
- single/multiple
RAS predisposing factors
trauma
stress
haematinic deficiency in 20%
- supplements does not often lead to resolution
cessation of smoking
endocrine
RAS preventative management
correct haematological deficiencies
remove causes of mucosal trauma
dietary elimination of precipitating foods
SLS free toothpaste
RAS symptomatic management
chlorhexine mouthwash
Difflam/Benzydamine mouthwash
Gelclair, gengigel
RAS suppressive management
topical corticosteroids
systemic therapies such as prednisolone, azathioprine etc
