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Crohn disease - Oral Mucosal Lesion
See also in: Overview,Anogenital
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Crohn disease - Oral Mucosal Lesion

See also in: Overview,Anogenital
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Contributors: Michael W. Winter MD, Carl Allen DDS, MSD, Sook-Bin Woo MS, DMD, MMSc
Other Resources UpToDate PubMed

Synopsis

Crohn disease is a disease of chronic inflammation in the gastrointestinal tract that can involve anywhere from the mouth to the anus. It is characterized by transmural inflammation and often noncaseating granulomas. The etiology is unclear, but it is likely triggered by a combination of genetic and environmental factors, with mucosal injury caused in part by immune activation against healthy intestinal microbiota.

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.

Codes

ICD10CM:
K50.918 – Crohn's disease, unspecified, with other complication

SNOMEDCT:
34000006 – Crohn's disease

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • 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

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed: 12/19/2016
Last Updated: 11/02/2017
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Crohn disease - Oral Mucosal Lesion
See also in: Overview,Anogenital
Print 8 Images
View all Images (8)
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Crohn disease : Abdominal pain, Diarrhea, Fatigue, Oral ulcers, Abdominal cramp, Abdominal distension, Abdominal mass, Weight loss
Clinical image of Crohn disease
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