Probiotics Can Cure Oral Aphthous-Like Ulcers in Inflammatory Bowel Disease Patients: A Review of the Literature and a Working Hypothesis
Abstract
:1. Introduction
1.1. Oral Manifestations in IBD
1.2. Morphology: Comparative Microscopic Anatomy of Oral and Intestinal Mucosa
1.3. The Intestinal Microbiota and the Surrounding Mucous: The Fifth Layer of the Bowel Wall
2. Pathobiology of ALU in IBD and Therapeutic Proposal
2.1. Pathobiology: A Focus on Dysbiosis
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- Alteration of Treg/Th17 due to dysregulated TLRs on antigen-presenting cells [27];
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- Resistance to colonization, i.e., ability of the gut microbiota to limit the proliferation of external pathogens. It has been observed that in patients with autoimmune disorders (e.g., systemic lupus erythematosus), resistance to colonization was lower than in healthy controls;
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- Superantigens, derived from bacteria and viruses that have the ability to activate immune cells by simultaneously binding to the major proteins of the class II histocompatibility complex (MHC II) present in the antigen-presenting cells and to specific receptors present in activated T cells [32];
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- Mucosal responses to microbiota, i.e., inflammatory cytokines that activate nearby autoreactive cells [30];
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2.2. ALU Treatment: Can Probiotics Be Useful?
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- Co-aggregation and growth inhibition;
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- Bacteriocin and hydrogen peroxide production;
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- Competitive exclusion through antagonistic activities on adhesion and nutrition;
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- Immunomodulation.
3. Conclusions
Funding
Conflicts of Interest
References
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Nonspecific Oral Lesions | Clinical Presentation |
---|---|
Aphtous stomatitis | Shallow, round ulcers surrounded by an erythematous halo with a central fibrin membrane |
Angular cheilitis | Erythema with/without painful fissures and sores at the corners of the mouth |
Glossitis | Painful atrophy of the tongue |
Pyostomatitis vegetans | Small exophytic lesions covered with a vulnerable membrane, their cracking and confluence results in the characteristicsign of a “snail track” |
Oral Lichen/Oral Lichenoid reactions | Associated to taste disturbances |
Gingivitis/Periodontitis | Associated to a vitamin D deficiency |
Specific Oral Lesions | Clinical Presentation |
---|---|
Indurated tag-like lesions (mucosal tags) | White reticular tags (labial and buccal vestibules, retromolar region) |
Cobblestoning | Fissured and corrugated swollen mucosa with hyperplastic appearance (posterior buccal mucosa) |
Mucogingivitis | Edematous, hyperplastic and granular gingiva (whole gingiva up to the mucogingival line) |
Lip swelling | Associated to vertical fissures |
Deep linear ulcerations | Associated to hyperplastic margins (vestibule) |
Tongue and midline lip fissuring | Lip and tongue fissures |
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Cappello, F.; Rappa, F.; Canepa, F.; Carini, F.; Mazzola, M.; Tomasello, G.; Bonaventura, G.; Giuliana, G.; Leone, A.; Saguto, D.; et al. Probiotics Can Cure Oral Aphthous-Like Ulcers in Inflammatory Bowel Disease Patients: A Review of the Literature and a Working Hypothesis. Int. J. Mol. Sci. 2019, 20, 5026. https://doi.org/10.3390/ijms20205026
Cappello F, Rappa F, Canepa F, Carini F, Mazzola M, Tomasello G, Bonaventura G, Giuliana G, Leone A, Saguto D, et al. Probiotics Can Cure Oral Aphthous-Like Ulcers in Inflammatory Bowel Disease Patients: A Review of the Literature and a Working Hypothesis. International Journal of Molecular Sciences. 2019; 20(20):5026. https://doi.org/10.3390/ijms20205026
Chicago/Turabian StyleCappello, Francesco, Francesca Rappa, Federica Canepa, Francesco Carini, Margherita Mazzola, Giovanni Tomasello, Giuseppe Bonaventura, Giovanna Giuliana, Angelo Leone, Dario Saguto, and et al. 2019. "Probiotics Can Cure Oral Aphthous-Like Ulcers in Inflammatory Bowel Disease Patients: A Review of the Literature and a Working Hypothesis" International Journal of Molecular Sciences 20, no. 20: 5026. https://doi.org/10.3390/ijms20205026