The mouth as a window: A multi-center retrospective study of oral extraintestinal manifestations of IBD and their management

TL;DR

This study examines oral symptoms in inflammatory bowel disease patients and suggests treatment strategies based on disease type and medication effectiveness.

Contribution

The study identifies specific treatments associated with improvement in oral extraintestinal manifestations of Crohn's disease and ulcerative colitis.

Findings

Aphthous ulcers were the most common oral extraintestinal manifestation in IBD patients.

Colchicine was significantly associated with improvement in Crohn's disease-related oral symptoms.

Systemic corticosteroids, colchicine, and topical tacrolimus showed benefits in ulcerative colitis oral manifestations.

Abstract

Up to 50% of patients with inflammatory bowel disease (IBD) have associated oral extraintestinal manifestations (OEIMs). We aim to describe the prevalence of OEIMs in IBD and propose a therapeutic algorithm.

Electronic health records of adult patients with IBD who presented with at least one oral symptom between January 2017 and November 2021 at a tri-state tertiary academic medical center were retrospectively reviewed. Data included demographics, IBD history, oral diagnoses, OEIM treatments, clinical outcomes, and comorbidities.

A total of 116 patients were included; 67 (57.8%) had Crohn's disease (CD) and 49 (42.2%) had ulcerative colitis (UC). Aphthous ulcers were the most common OEIM (80.2%). Frequently used treatments included compounded or mixed mouthwashes (51.7%), topical corticosteroids (33.6%), systemic corticosteroids (20.7%), and topical anesthetics (19.8%). In CD, colchicine was significantly associated with OEIM improvement (p=0.009). In UC, systemic corticosteroids (p=0.03), colchicine (p=0.048), and topical tacrolimus (p=0.048) were significantly associated with improvement.

OEIMs are common in IBD and can influence treatment decisions. Colchicine and topical agents demonstrated benefit in selected cases. These findings support multidisciplinary care and inform a therapeutic algorithm for OEIM management in IBD.

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