Crohn disease - Oral Mucosal Lesion
Symptoms from Crohn disease can vary considerably, both due to location but also to the severity of disease involvement. Approximately one-third of patients present first with oral findings. Patients may complain of swelling of the lips and face and sores or growths in the mouth. Patients may experience dysphagia.
Other findings may include abdominal pain, bloody or nonbloody diarrhea, weight loss or malnutrition, fistulas, or abscesses (often perianal). Extraintestinal manifestations can also involve joints, skin, eyes, vasculature, the lungs, or the kidneys. Chronic inflammation from Crohn disease can lead to fistula and stricture formation, which predispose to small and large bowel obstructions, infections secondary to fistula tracts, and malnutrition as a result of long-standing intestinal inflammation. These complications result in much of the morbidity from Crohn disease, highlighting the importance of achieving and sustaining deep remission as a primary goal of treatment.
Crohn disease presents most typically in the second to fourth decades of life, with a slight female predominance. While no clear genetic mutation is linked to the development of Crohn disease, there are many genetic mutations that are associated with Crohn disease. For unclear reasons, Crohn disease is more prevalent at higher latitudes and in certain patient populations, namely individuals of Ashkenazi Jewish descent and individuals of Northern European descent in the United States.
Crohn disease is a chronic disease with many pharmacologic options that can be used depending on the severity of symptoms and on radiographic and endoscopic findings. Many patients are able to achieve remission, although the disease is progressive in nature and characterized by disease flares.
K50.918 – Crohn's disease, unspecified, with other complication
34000006 – Crohn's disease
- Recurrent aphthous stomatitis – This may look similar, but biopsies would not show the presence of granulomas.
- Behçet disease – This tends to involve Turkish and Japanese populations with eye, genital, and skin findings; biopsy would not show granulomas.
- Chronic oral erythema multiforme – This does not show the presence of granulomas.
- Pyostomatitis vegetans – These ulcers are usually more extensive and histologically are acantholytic.
- Recurrent herpes simplex virus – In an immunocompetent host, this does not generally involve the nonkeratinized mucosa typical for Crohn disease and aphthous ulcers.
- Orofacial granulomatosis – Patients with this may actually have extra-gastrointestinal Crohn disease; the 2 are indistinguishable, clinically and histologically.
- Granulomatosis with polyangiitis