Review
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World J Gastroenterol. Dec 14, 2013; 19(46): 8571-8579
Published online Dec 14, 2013. doi: 10.3748/wjg.v19.i46.8571
Oral manifestation in inflammatory bowel disease: A review
Kamran B Lankarani, Gholam Reza Sivandzadeh, Shima Hassanpour
Kamran B Lankarani, Department of Internal Medicine, Healthcare Policy Research Center, Shiraz University of Medical Sciences, Shiraz 71348, Fars, Iran
Gholam Reza Sivandzadeh, Department of Internal Medicine, Gastroenterohepatology Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz 7193711351, Fars, Iran
Shima Hassanpour, Gastroenterohepatology Research Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz 7193711351, Fars, Iran
Author contributions: Lankarani KB and Sivandzadeh GR contributed equally to this work; Hassanpour S contributed to the literature review and preparing of the manuscript.
Correspondence to: Gholam Reza Sivandzadeh, MD, Department of Internal Medicine, Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Namazi Hospital, Zand St., Shiraz 7193711351, Fars, Iran. ghsivand@sums.ac.ir
Telephone: +98-711-6473236 Fax: +98-711-6474316
Received: August 15, 2013
Revised: September 30, 2013
Accepted: November 1, 2013
Published online: December 14, 2013
Abstract

Inflammatory bowel diseases (IBDs), including Crohn’s disease (CD) and ulcerative colitis, not only affect the intestinal tract but also have an extraintestinal involvement within the oral cavity. These oral manifestations may assist in the diagnosis and the monitoring of disease activity, whilst ignoring them may lead to an inaccurate diagnosis and useless and expensive workups. Indurated tag-like lesions, cobblestoning, and mucogingivitis are the most common specific oral findings encountered in CD cases. Aphthous stomatitis and pyostomatitis vegetans are among non-specific oral manifestations of IBD. In differential diagnosis, side effects of drugs, infections, nutritional deficiencies, and other inflammatory conditions should also be considered. Treatment usually involves managing the underlying intestinal disease. In severe cases with local symptoms, topical and/or systemic steroids and immunosuppressive drugs might be used.

Keywords: Inflammatory bowel disease, Crohn’s disease, Ulcerative colitis, Extra-intestinal manifestations, Pyostomatitis vegetans, Aphthous stomatitis, Cobblestoning, Mucogingivitis, Oral manifestation

Core tip: Although the gastrointestinal tract is the primary site of involvement in inflammatory bowel disease (IBD) patients, some cases might present with non-intestinal manifestations, such as oral lesions. These oral manifestations may aid in the diagnosis and the monitoring of disease activity, whilst ignoring them may lead to an inaccurate diagnosis and useless and expensive workups. Indurated tag-like lesions, cobblestoning, mucogingivitis, aphthous stomatitis, and pyostomatitis vegetans are the main oral presentations of IBDs. With the growing incidence of IBDs and the increased likelihood of encountering these particular manifestations, this review summarizes various oral findings seen in IBD cases by describing their unique morphologic description, treatment recommendations, and probable differential diagnosis.