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World J Gastroenterol. Jul 7, 2016; 22(25): 5655-5667
Published online Jul 7, 2016. doi: 10.3748/wjg.v22.i25.5655
Oral pathology in inflammatory bowel disease
Miranda Muhvić-Urek, Marija Tomac-Stojmenović, Brankica Mijandrušić-Sinčić
Miranda Muhvić-Urek, Department of Oral Medicine and Periodontology, School of Dental Medicine, University of Rijeka, 51000 Rijeka, Croatia
Marija Tomac-Stojmenović, School of Medicine, University of Rijeka, 51000 Rijeka, Croatia
Brankica Mijandrušić-Sinčić, Division of Gastroenterology, Department of Internal Medicine, University Hospital Center Rijeka, 51000 Rijeka, Croatia
Author contributions: Muhvić-Urek M, Tomac-Stojmenović M and Mijandrušić-Sinčić B performed data acquisition and wrote the manuscript; Muhvić-Urek M and Mijandrušić-Sinčić B revised the manuscript; and Mijandrušić-Sinčić B approved the final manuscript.
Conflict-of-interest statement: No conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Mijandrušić-Sinčić Brankica, MD, PhD, Associate Professor, Division of Gastroenterology, Department of Internal Medicine, University Hospital Center Rijeka, Krešimirova 42, 51000 Rijeka, Croatia.
Telephone: +385-99-4366292 Fax: +385-51-658826
Received: March 23, 2016
Peer-review started: March 24, 2016
First decision: May 12, 2016
Revised: May 27, 2016
Accepted: June 15, 2016
Article in press: June 15, 2016
Published online: July 7, 2016

The incidence of inflammatory bowel diseases (IBD) - Crohn’s disease (CD) and ulcerative colitis (UC) - has been increasing on a global scale, and progressively, more gastroenterologists will be included in the diagnosis and treatment of IBD. Although IBD primarily affects the intestinal tract, extraintestinal manifestations of the disease are often apparent, including in the oral cavity, especially in CD. Specific oral manifestations in patients with CD are as follows: indurate mucosal tags, cobblestoning and mucogingivitis, deep linear ulcerations and lip swelling with vertical fissures. The most common non-specific manifestations, such as aphthous stomatitis and angular cheilitis, occur in both diseases, while pyostomatitis vegetans is more pronounced in patients with UC. Non-specific lesions in the oral cavity can also be the result of malnutrition and drugs. Malnutrition, followed by anemia and mineral and vitamin deficiency, affects the oral cavity and teeth. Furthermore, all of the drug classes that are applied to the treatment of inflammatory bowel diseases can lead to alterations in the oral cavity due to the direct toxic effects of the drugs on oral tissues, as well as indirect immunosuppressive effects with a risk of developing opportunistic infections or bone marrow suppression. There is a higher occurrence of malignant diseases in patients with IBD, which is related to the disease itself and to the IBD-related therapy with a possible oral pathology. Treatment of oral lesions includes treatment of the alterations in the oral cavity according to the etiology together with treatment of the primary intestinal disease, which requires adequate knowledge and a strong cooperation between gastroenterologists and specialists in oral medicine.

Keywords: Crohn’s disease, Ulcerative colitis, Drug-related side effects and adverse reactions, Inflammatory bowel disease, Extraintestinal manifestations, Malnutrition

Core tip: Inflammatory bowel diseases (IBD), Crohn’s disease (CD) and ulcerative colitis affect the intestinal tract, but can also present with extraintestinal manifestations and complications. In CD, disease-specific lesions with granulomatous changes can occur in the oral cavity. However, non-specific lesions are more common in IBD and are mostly caused by malnutrition and medications. All of the drug classes that are applied in the treatment of IBD can lead to lesions in the oral cavity. This paper offers an overview of the oral pathology with a detailed description of the complications related to malnutrition and IBD therapy.