Aphthous stomatitis as the debut of Crohn’s disease

Crohn’s disease is an immune-mediated disease characterized by non-specific granulomatous transmural inflammation with segmental damage to any part of the gastrointestinal tract with the formation of extraintestinal and systemic complications. Clinical observation of patient I., 23 years old, a student who was sent for consultation to a gastroenterologist in the direction of a dentist, is presented. Active examination of the gastrointestinal tract during the inspection did not show any complaints. He considers himself ill for 6 months, when he first complained of pain in the neck, sore throat, and body temperature rise to 37.4–37.5 °C, mostly in the evening. Were treated by an otolaryngologist and a dentist without significant effect. In this connection, a biopsy of the ulcerative defect of the left retromolar region was performed, revealing noncaseating granulomatous inflammation. A follow-up examination by a gastroenterologist with colonoscopy and biopsy made it possible to establish Crohn’s disease as the true cause of aphthous stomatitis.

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CROHN’S DISEASE IN CHILDREN: THE CURRENT STATE OF THE PROBLEM

PEDIATRIA Journal named after G N SPERANSKY ◽

10.24110/0031-403x-2021-100-6-78-85 ◽

2021 ◽

Vol 100 (6) ◽

pp. 78-85

Author(s):

A.S. Bekin ◽

◽

E.Yu. Dyakonova ◽

A.N. Surkov ◽

A.P. Fisenko ◽

...

Keyword(s):

Crohn’S Disease ◽

Surgical Treatment ◽

Crohn's Disease ◽

Granulomatous Inflammation ◽

Unknown Etiology ◽

Systemic Complications ◽

Current State ◽

Conservative And Surgical Treatment ◽

Scientific Ideas ◽

Local And Systemic Complications

Crohn's disease (CD) is chronic recurrent bowel disease of unknown etiology, characterized by segmental transmural granulomatous inflammation, mainly with the development of local and systemic complications. Despite the active development of conservative therapy methods, the number of drug-resistant forms of CD and complications of the disease requiring surgical treatment continues to increase. The article reflects modern scientific ideas about the methods of diagnosis, conservative and surgical treatment of CD in children.

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Upper Gastrointestinal Tract Crohn's Disease

Canadian Journal of Gastroenterology ◽

10.1155/1990/758048 ◽

1990 ◽

Vol 4 (1) ◽

pp. 26-32 ◽

Cited By ~ 3

Author(s):

Hugh J Freeman

Keyword(s):

Crohn’S Disease ◽

Gastrointestinal Tract ◽

Crohn's Disease ◽

Treatment Options ◽

Upper Gastrointestinal Tract ◽

Distal Intestine ◽

The Subject ◽

Atypical Presentations ◽

Upper Gastrointestinal

Crohn's disease may involve any site within the gastrointestinal tract. Usually pathology is present in the ileum and/or colon, but atypical presentations may occur with apparently 'isolated' involvement of the oropharynx, esophagus or gastroduodenum. If changes typical of Crohn's disease are detected in the upper gastrointestinal tract, then a careful assessment is required involving radiographic, endoscopic and histologic studies to determine if pathology is present in more distal intestine. In addition , microbiologic studies may be important to exclude infectious causes, especially of granulomas. If these studies are negative, prolonged follow-up may be required to establish a diagnosis of Crohn's disease. Although upper gastrointestinal involvement is increasingly recognized as a significant cause of morbidity in Crohn's disease, the treatment options are limited , largely anecdotal and need to be the subject of detailed epidemiologic investigation and clinical trials.

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Extra-Intestinal Features of Crohn’s Disease

10.5772/intechopen.100164 ◽

2021 ◽

Author(s):

Monjur Ahmed

Keyword(s):

Crohn’S Disease ◽

Clinical Practice ◽

Immune System ◽

Gastrointestinal Tract ◽

Crohn's Disease ◽

Bile Salts ◽

Chronic Inflammatory Disease ◽

Multiple Organs ◽

Immune Mediated ◽

Pulmonary Manifestations

Although Crohn’s disease is a chronic inflammatory disease of the gastrointestinal tract, it can affect multiple organs behaving like a multisystem immune mediated disease. The dysregulated immune system in patients with Crohn’s disease leads to uncontrolled inflammation which primarily affects the gastrointestinal tract but may also affect various extra-intestinal organs. With the increased incidence and prevalence of Crohn’s disease, its extra-intestinal manifestations are increasingly being seen in our clinical practice. The musculoskeletal, mucocutaneous, ophthalmic, hepatobiliary, renal, cardiovascular and pulmonary manifestations of Crohn’s disease have been reviewed in this chapter. Some of these extra-intestinal manifestations are due to systemic inflammation, some of them are due to malabsorption of nutrients and bile salts, and some due to medications given for the treatment of Crohn’s disease. These extra-intestinal manifestations of Crohn’s disease are seen in at least 25% of patients with Crohn’s disease. Some of them correlate well with Crohn’s disease activity but the rest of them have no relation to the activity of Crohn’s disease. Although most of the time the extra-intestinal features are seen after the diagnosis of Crohn’s disease, they can precede or follow the diagnosis of Crohn’s disease. Management of these extra-intestinal manifestations varies as the ones associated with activity of Crohn’s disease respond to remission of Crohn’s disease whereas the ones not related to the activity of Crohn’s disease require specific treatments for those conditions.

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SUBSTANTIATION OF DIAGNOSIS AND TREATMENT OF CHRONIC RECURRENT APHTHOUS STOMATITIS IN CROHN’S DISEASE

Wiadomości Lekarskie ◽

10.36740/wlek202003120 ◽

2020 ◽

Vol 73 (3) ◽

pp. 512-516

Author(s):

Oksana Y. Feleshtynska ◽

Olena O. Dyadyk

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Oral Mucosa ◽

Morphological Study ◽

Comparison Group ◽

Granulomatous Inflammation ◽

Main Group ◽

Recurrent Aphthous Stomatitis ◽

Aphthous Stomatitis ◽

Diagnosis And Treatment

The aim: To substantiate the diagnosis and treatment of chronic recurrent aphthous stomatitis in Crohn’s disease. Materials and methods: The analysis of diagnostic and treatment of 52 patients with chronic recurrent aphthous stomatitis in Crohn’s disease (main group), mean age 31.8 + 2.3 was performed. The comparison group consisted of 50 patients with chronic recurrent aphthous stomatitis not associated with Crohn’s disease (mean age 34.7 + 1.8). Patients in both groups were studied for clinical manifestations, morphological and immunohistochemical studies the aphthae on the oral mucosa were performed. Results: An objective evaluation of the oral mucosa showed that the aphthae on the oral mucosa in patients of both groups did not differ visually. In the morphological study, the patients in the main group had granulomatous inflammation of the oral mucosa, characteristic of Crohn’s disease, while the patients in the comparison group had fibrinous inflammation. Immunohistochemical study of the cell infiltrate phenotype in the area of the lesion revealed that the patients in the main group there prevailed CD68+macrophages, the appearance of both intraepithelial and cell infiltrates of T-lymphocyte suppressors, which is characteristic of Crohn’s disease. Conclusions: Diagnosis of chronic recurrent aphthous stomatitis in Crohn’s disease is based on biopsy of the aphthae on the oral mucosa and their morphological examination, the results of which confirm the presence of granulomatous inflammation, with a large number of macrophages, the presence of T-lymphocytes, characteristic of Crohn’s disease, while recurrent aphthous stomatitis of another genesis morphologically detect fibrinous inflammation. The choice of therapeutic tactics for chronic recurrent aphthous stomatitis depends on the results of the morphological study. When granulomatous inflammation is detected in patients with chronic recurrent aphthous stomatitis, which is characteristic of Crohn’s disease, in addition to topical treatment of the oral mucosa, specific therapy with mesalazine drugs is prescribed.

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Crohn’s disease initiated with extraintestinal features

BMJ Case Reports ◽

10.1136/bcr-2019-229916 ◽

2019 ◽

Vol 12 (4) ◽

pp. e229916

Author(s):

Jeffrey Chang ◽

Chia-Cheng Li ◽

Marina Achtari ◽

Eleana Stoufi

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Oral Prednisone ◽

Perianal Fistula ◽

Lower Lip ◽

Full Remission ◽

Immune Mediated ◽

Paediatric Case ◽

Intestinal Symptoms

Crohn’s disease (CD) is a multifactorial, chronic immune-mediated disorder. The oral cavity is involved in 0.5% to 20% of the patients with CD. Oral manifestations of CD are sometimes nonspecific and can be overlooked by the clinicians. These manifestations may precede intestinal symptoms and can serve as indicators for early diagnosis. To increase awareness and to contribute to the standard intervention, here we report a paediatric case with persistent idiopathic swelling of the lower lip and perianal fistula. Microscopic examinations revealed multiple non-necrotising granulomas with chronic inflammation, oedema and lymphangiectasia. The patient was treated with metronidazole 500 mg and ciprofloxacin 500 mg twice a day for one month. The perioral lesions were managed with topical 0.03% tacrolimus and oral prednisone 10 mgtwice a day for one month, followed by a tapered regimen of 10 mg/day for another month. The patient’s symptoms improved without full remission at the 6-month follow-up.

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Pediatric Metastatic Crohn's Disease

Journal of Coloproctology ◽

10.1055/s-0041-1724066 ◽

2021 ◽

Vol 41 (01) ◽

pp. 079-082

Author(s):

Amanda Trindade de Oliveira ◽

Raissa Albuquerque Calais de Oliveira ◽

Matheus Matta Machado Duque Estrada Meyer ◽

Ilson Geraldo da Silva ◽

Matheus Duarte Massahud

Keyword(s):

Crohn’S Disease ◽

Gastrointestinal Tract ◽

Crohn's Disease ◽

Skin Lesions ◽

Rapid Progression ◽

Colorectal Surgeon ◽

Transmural Inflammation ◽

Gastrointestinal Complaints ◽

Intravenous Steroids ◽

Metastatic Crohn's Disease

AbstractCrohn's disease (CD) is a chronic, relapsing, idiopathic condition, characterized by granulomatous, transmural inflammation of the gastrointestinal tract, which can affect its entire length, from mouth to anus. Metastatic Crohn's disease (MCD) is a rare form of skin involvement and is defined by skin lesions without contiguity with the gastrointestinal tract. A 9-year-old patient presented with gastrointestinal complaints and gross skin lesions in the vulva and perianal region. The diagnosis of Crohn's disease was made when the patient was 11 years old, after being evaluated by the colorectal surgeon. Treatment was started with a “top-down” approach, with a sustained response for four years. Afterwards, there was a relapse of the skin disease in previously normal areas, without overt symptoms. Treatment consisted of steroids and local infiltration of infliximab, without improvement. A year later, there was a rapid progression of the skin lesions, and the drug changed to adalimumab, also without response and worsening of the skin lesions. The patient was admitted to the hospital and intravenous steroids were initiated, along with surgical debridement of the lesions. After some improvement, ustekinumab was initiated with satisfactory response. Pediatric MCD has an important impact on the patient's quality of life, with influences on growth and social development.

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STRICTUREPLASTY AS AN ORGAN-SAVING METHOD IN PATIENTS WITH SMALL BOWEL CROHN'S DISEASE (case report)

Koloproktologia ◽

10.33878/2073-7556-2019-18-3-77-83 ◽

2019 ◽

Vol 18 (3(69)) ◽

pp. 77-83

Author(s):

A. V. Vardanyan ◽

M. Kh. Toboeva ◽

I. V. Zarodnyuk ◽

L. P. Orlova

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Granulomatous Inflammation ◽

Clinical Problem ◽

Surgical Approaches ◽

Large Area ◽

Systemic Complications ◽

Disease Case ◽

Wide Range

Crohn's disease (CD) is a complex, chronic recurrent disease with transmural, segmental, granulomatous inflammation in all parts of the gastrointestinal tract with high risk of local and systemic complications. The disease is progressive, despite a wide range of modern conservative and surgical approaches. One of the most common causes of surgery for CD is strictures, which are result of prolonged, non-specific inflammation and later cicatricial changes in the intestinal wall. The occurrence of strictures is a serious clinical problem, due to the lack of effective methods of diagnosis and treatment. In fact, there are two type of surgery – resection of the affected area and organ-saving procedure. At the same time, when performing extensive resections of the small bowel, the patient loses a large area of absorption surface, which often leads to the short bowel syndrome. Recently, the majority of foreign experts prefer organ-saving procedure – strictureplasty. In this paper, we present a case of successful application of this procedure for complicated form of Crohn's disease.

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Recurrent Hepatocellular Carcinoma in Patient with Crohn’s Disease: Incidental or Expected Outcome of Azathioprine?

Case Reports in Gastrointestinal Medicine ◽

10.1155/2015/939136 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4

Author(s):

Youssef Botros ◽

Mary Mathews ◽

Hiren Patel ◽

Nihar Shah ◽

Walid Baddoura ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Case Reports ◽

Disease Patient ◽

Aminosalicylic Acid ◽

Immune Mediated ◽

Increased Risk ◽

History Of

Hepatocellular carcinoma (HCC) usually occurs in patients with underlying risk factors such as liver cirrhosis and chronic hepatitis B. Although patients with Crohn’s disease (CD) are at an increased risk to develop malignancies such as colon cancer, the incidence of HCC in this population is extremely rare. We report a case of 62-year-old male with long history of CD treated with azathioprine (AZA) and aminosalicylic acid (ASA) who was incidentally diagnosed with HCC, for which left hepatectomy was done. Four years later during routine follow-up, patient had another hepatic lesion and underwent resection of the mass. The mechanism of occurrence of HCC in patient with CD is still controversial and may include immune mediated changes and medication related complications. AZA was reported in all case reports of CD that developed HCC. Through this report we hope to explore the complex pathophysiological mechanisms contributing to the development of HCC in the Crohn’s disease patient population.

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