Specific Oral Manifestations in Adults with Crohn’s Disease
Abstract
:- Oral lesions that may be neglected by gastroenterologists may affect quality of life due to pain and weight loss.
- Specific oral lesions were detected in almost 1% of patients with CD.
- Peripheral arthralgia and peripheral arthritis were significantly more likely to occur among patients with oral lesions.
- A multidisciplinary approach can prevent delays in diagnosis.
- Biologic treatments are effective in specific oral lesions in CD.
1. Introduction
2. Materials and Methods
2.1. Study Population and Data Collection
2.2. Management
2.3. Definitions
2.4. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Total n = 676 | |
---|---|
Age at onset of Crohn (years) | 38 (11–65) |
Total disease duration (years) | 6.83 (0.5–29.87) |
Female/Male | 272 /404 |
Smokers (Current/Ex/None), n (%) | 255 (37.7)/168 (24.9)/253 (37.4) |
Family history of IBD, n (%) | 94 (13.9) |
CD (Disease location), n (%) | |
Ileal (L1) | 297 (43.9) |
Colonic (L2) | 76 (11.2) |
Ileo-colonic (L3) | 299 (44.2) |
Upper GI disease (L4) | 4 (0.6) |
CD (Disease behavior), n (%) | |
Inflammatory disease (B1) | 529 (78.3) |
Stenosing (B2) | 45 (6.7) |
Penetrating (B3) | 102 (15.1) |
CD P (Perianal disease) | 193 (28.6) |
Specific oral manifestation, n (%) | 8 (1.18) |
Cobblestoning | 2 |
Orofacial granulomatosis | 3 |
Glossitis (with fissuring) | 2 |
Lip swelling (with fissuring) | 2 |
Extra-intestinal manifestations, n (%) | |
Aphthous ulcer | 88 (13.01) |
Peripheral arthralgia | 166 (24.6) |
Peripheral arthritis | 49 (7.2) |
Ankylosing spondylitis | 25 (3.7) |
Erythema nodosum | 17 (2.5) |
Sacroiliitis | 11 (1.6) |
Uveitis | 10 (1.5) |
Prımary Sclerosing Cholangitis | 8 (1.2) |
Episcleritis | 3 (0.4) |
Pyoderma gangrenous | 3 (0.4) |
Medication (Conventional), n (%) | |
Mesalazine | 490 (72.5) |
Sulfasalazine | 61 (9) |
Budesonide | 80 (11.8) |
Steroids | 291 (43) |
Thiopurine | 304 (45) |
Methotrexate | 62 (9.2) |
Biological therapy, n (%) | |
Adalimumab | 132 (19.5) |
Infliximab | 121 (17.9) |
Vedolizumab | 32 (4.7) |
Ustekinumab | 14 (2.1) |
Sertolizumab | 9 (1.3) |
Resective surgery, n (%) | 229 (33.9) |
Baseline CRP (mg/L), median (IQR) | 6.6 (0.29–167) |
Baseline HB (mg/dL), median (IQR) | 13 (7.2–18) |
Baseline Albumin (g/dL), median (IQR) | 4.2 (2–5.2) |
Baseline CDAI (CD), median (IQR) | 305.5 (214.5–395) |
Patients with no Oral Lesions (n = 580) (1) | Patients with Nonspecific Oral Lesions (n = 88) (2) | Patients with Specific Oral Lesions (n = 8) (3) | P | P 1–2 | P 1–3 | P 2–3 | |
---|---|---|---|---|---|---|---|
Age at onset of Crohn (years), n (%) | 38 (11–65) | 39 (14–58) | 33 (18–55) | 0.552 | - | - | - |
Total disease duration (years), n (%) | 6.49 (0.5–29.87) | 7.72 (0.61–22.76) | 10.32 (5.72–16.64) | 0.100 | - | - | - |
Smokers (current or ex), n (%) | 364 (62.8) | 56 (63.6) | 3 (37.5) | 0.333 | - | - | - |
CD (Disease location), n (%) | |||||||
Ileal (L1) | 255 (44) | 40 (45.5) | 2 (25) | 0.536 | - | - | - |
Colonic (L2) | 66 (11.4) | 8 (9.1) | 2 (25) | 0.380 | - | - | - |
Ileo-colonic (L3) | 255 (44) | 40 (45.5) | 4 (50) | 0.915 | - | - | - |
Upper GI disease (L4) | 4 (0.7) | - | - | 0.717 | - | - | - |
CD (Disease behavior), n (%) | |||||||
Inflammatory disease (B1) | 449 (77.4) | 73 (80) | 7 (87.5) | 0.410 | - | - | - |
Stenosing (B2) | 40 (6.9) | 5 (5.7) | - | 0.684 | - | - | - |
Penetrating (B3) | 91 (15.7) | 10 (11.4) | 1 (12.5) | 0.560 | - | - | - |
CD P (Perianal disease), n (%) | 171 (29.5) | 20 (22.7) | 2 (25) | 0.415 | - | - | - |
Extra-intestinal manifestations, n (%) | |||||||
Peripheral arthralgia | 108 (18.6) | 51 (58) | 7 (87.5) | <0.001 | <0.001 | <0.001 | 0.141 |
Peripheral arthritis | 30 (5.2) | 16 (18.2) | 3 (37.5) | <0.001 | <0.001 | 0.008 | 0.191 |
Ankylosing spondylitis | 21 (3.6) | 4 (4.5) | - | 0.781 | - | - | - |
Sacroiliitis | 7 (1.2) | 3 (3.4) | 1 (12.5) | 0.016 | 0.133 | 0.006 | 0.298 |
Erythema nodosum | 12 (2.1) | 5 (5.7) | - | 0.118 | - | - | - |
Pyoderma gangrenous | 2 (0.3) | 1 (1.1) | - | 0.571 | - | - | - |
Uveitis | 8 (1.4) | 2 (2.3) | - | 0.763 | - | - | - |
Episcleritis | 3 (0.5) | - | - | 0.779 | - | - | - |
Primary sclerosing cholangitis | 8 (1.4) | - | - | 0.512 | - | - | - |
Baseline CRP (mg/L), median (IQR) | 6.7 (0.4–167) | 4.75 (0.29–150) | 6.9 (2–52.9) | 0.418 | - | - | - |
Baseline HB (mg/dL), median (IQR) | 13 (8.3–17.6) | 12.95 (7.2–18) | 15.2 (10.6–15.4) | 0.782 | - | - | - |
Baseline Albumin (g/dL), median (IQR) | 4.2 (2–5.2) | 4.1 (2.7–5.1) | 4 (3.9–4.7) | 0.862 | - | - | - |
Need for steroid, n (%) | 250 (43.1) | 35 (39.8) | 6 (75) | 0.156 | - | - | - |
Biological therapy, n (%) | 178 (30.7) | 23 (26.1) | 5 (62.5) | 0.097 | - | - | - |
Resective surgery, n (%) | 193 (33.3) | 33 (37.5) | 3 (37.5) | 0.720 | - | - | - |
1. Case | 2. Case | 3. Case | 4. Case | 5. Case | 6. Case | 7. Case | 8. Case | Total, n (%), Median (IQR) | |
---|---|---|---|---|---|---|---|---|---|
Age at oral lesion detected (years) | 46 | 51 | 68 | 30 | 47 | 31 | 23 | 48 | 46.5 (23–68) |
Female/Male | M | M | M | F | M | M | M | F | 2/6 (25–75%) |
Smokers (Current/Ex/None) | N | N | C | C | N | C | N | N | 3/5 (37.5/62.5%) |
CD (Disease location) | |||||||||
Ileal (L1) | + | + | 2 (25%) | ||||||
Colonic (L2) | + | + | 2 (25%) | ||||||
Ileo-colonic (L3) | + | + | + | + | 4 (50%) | ||||
Upper GI disease (L4) | |||||||||
CD (Disease behavior) | |||||||||
Inflammatory disease (B1) | + | + | + | + | + | + | + | 7 (87.5%) | |
Stenosing (B2) | |||||||||
Penetrating (B3) | + | 1 (12.5%) | |||||||
CD P (Perianal disease) | + | + | 2 (25%) | ||||||
Resective surgery | + | + | + | 3 (37.5%) | |||||
Extra-intestinal manifestations | |||||||||
Peripheral arthralgia | + | + | + | + | + | + | + | 7 (87.5%) | |
Peripheral arthritis | + | + | + | 3 (37.5%) | |||||
Sacroiliitis | + | 1 (12.5%) | |||||||
Medication | |||||||||
Current treatment before oral lesion | IM | IFX | ADA | IM | IM | IM | IM | IM | |
Oral lesion treatment | IM | UST | UST | IFX | IM + steroid | IM + ADA | IM + ADA | IM + steroid | |
CRP (mg/L) | 21 | 52.9 | 20 | 151 | 58.7 | 8.9 | 6 | 50 | 35.50 (6–151) |
CDAI | 280 | 346 | 278 | 480 | 374 | 252 | 357 | 227 | 313 (227–480) |
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Cagir, Y.; Durak, M.B.; Simsek, C.; Yuksel, I. Specific Oral Manifestations in Adults with Crohn’s Disease. J. Clin. Med. 2024, 13, 3955. https://doi.org/10.3390/jcm13133955
Cagir Y, Durak MB, Simsek C, Yuksel I. Specific Oral Manifestations in Adults with Crohn’s Disease. Journal of Clinical Medicine. 2024; 13(13):3955. https://doi.org/10.3390/jcm13133955
Chicago/Turabian StyleCagir, Yavuz, Muhammed Bahaddin Durak, Cem Simsek, and Ilhami Yuksel. 2024. "Specific Oral Manifestations in Adults with Crohn’s Disease" Journal of Clinical Medicine 13, no. 13: 3955. https://doi.org/10.3390/jcm13133955