Oral mucosa: manifestations of gastrointestinal & haematological disease Flashcards
Oral manifestations of GIT disorders - primary effects (2)
Part of the disease process e.g. Crohn’s disease
Oral manifestations of GIT disorders - secondary effects (2)
Malabsorption, blood loss
Conditions of interest (4)
GORD Coeliac disease Idiopathic inflammatory bowel disease -Crohn's disease (and oro-facial granulomatosis -OFG) -Ulcerative colitis Intestinal polyposis syndromes
Risk factors for GORD (3)
obesity, smoking, alcohol
Symptoms of GORD (1)
Dyspepsia (heart-burn)
Risk from GORD (2)
Barrett’s oesophagus (pre-malignant)
Oral effects of GORD (2)
Erosion and halitosis
Treatment of GORD (2)
PPIs e.g. omeprazole
Features of coeliac disease (4)
Intolerance to α-gliadin peptides in gluten found in wheat, rye and barley
Any age
Genetically susceptible individual and families
Prevalence 0.5-1% in general population (probably under-diagnosed)
Pathogenesis of coeliac disease (5)
Exposure to gluten Proliferation of lymphocytes Oedema Crypt hyperplasia and sub-total villous atrophy Mostly in duodenum and jejunum
Coeliac disease - malabsorption (5)
Iron (anaemia) Calcium and vitamin D Folic acid } Vitamin C } more advanced disease Vitamin B12 }
Clinical features of coeliac disease (9)
Diarrhoea and Steatorrhoea
Wasting, (failure to thrive), loss of appetite
Abdominal discomfort / pain
Tiredness and weakness
Peripheral neuropathy and CNS disturbances
Tetany and osteomalacia
Dermatitis herpetiformis
Oral ulceration
Increased risk of intestinal neoplasms (lymphoma
Oral manifestations of coeliac diease (6)
Malabsorption gives anaemia resulting in:
Oral ulceration
Glossitis
Candidiasis
Angular cheilitis
Hypoplasia of enamel of permanent teeth-often generalised and symmetrical (secondary to malabsorption)
Diagnosis of coeliac disease (3)
History and clinical signs Blood tests -FBC and haematinics -Anti-endomysial antibodies, tissue transglutaminase antibodies anti-gliadin antibodies, anti-reticulin Endoscopy and jejunal mucosal biopsy.
Treatment for coeliac disease (2)
Exclusion diet to remove gluten from diet
Replacement of haematinics (iron and folate)
Increased risk from coeliac disease (1)
Increased risk of T-cell lymphoma and other bowel malignancies
Features of Crohn’s disease (5)
Young adults; Western world
Any part of GIT
-may affect several separate areas (skip lesions)
-mostly terminal ileum and ascending colon
-can also affect extra-gastrointestinal sites e.g. skin
Transmural inflammation
-granuloma formation - cobblestone appearance
-wall is thickened and lumen narrowed
-aphthous-like ulceration and fissuring
-fistulae and abscesses.
Chronic inflammation
Lymphoid hyperplasia
Clinical features of relapsing and remitting Crohn’s disease (5)
Abdominal pain Diarrhoea Weight loss Malabsorption – B12, bile salts Variable presentation, depends on severity and site(s) and often intermittent
Oral manifestations of Crohn’s disease (8)
Ulceration (may be RAS-like) Glossitis Lip swelling Cobblestone mucosa Tissue tags Fissures and ulcers Angular cheilitis Mucosal inflammation esp attached gingiva
Management of Crohn’s disease (7)
Symptomatic relief
Topical measures first for oral manifestations
Immunosuppressives e.g.methotrexate and azathioprine
Replacement therapy
Anti-TNF antibodies, infliximab etc
Elemental diets
Surgery
Diagnosis of Crohn’s disease (4)
History
-may have known diagnosis – if not then….
Oral biopsy – include muscle
Blood tests:
-FBC and haematinics
-gut anti-bodies, ACE (to exclude sarcoid)
Onward referral
Features of oro-facial granulomatosis (4)
Oral features of Crohn’s disease with no clinical features of gut involvement
Separate entity or Crohn’s disease?
May have an allergic aetiology
Responds to exclusion diet (not all cases)
Other cause of lip swelling need excluding (5)
Crohn’s Sarcoidosis Foreign-body reactions Melkerson-Rosenthal syndrome e.g. triad of lip swelling, fissured tongue and facial palsy Infections (rare): TB, syphilis, leprosy
