Peculiarities of the algorithm of diagnostics of oral mucosa pathology in patients with Crohn’s disease and nonspecific ulcerative colitis

INTRODUCTION. The manifestations of Crohn’s disease (CD) and ulcerative colitis (UC) in the oral cavity include both nonspecific lesions and specific lesions directly associated with intestinal inflammation. Oral lesions that remain undiagnosed may subsequently be difficult to manage with therapeutic and preventive measures.
AIM. To evaluate the developed diagnostic algorithm for oral mucosal pathology in patients with CD and UC.
MATERIALS AND METHODS. The comprehensive clinical and dental examination included an assessment of complaints, medical history, findings from an objective examination, and laboratory investigations.
RESULTS. This retrospective, multicenter study included young adults with CD and UC who were under regular medical supervision in gastroenterology departments and adhered to general treatment protocols. Clinical manifestations of lip vermilion pathology were observed in 51.43% and 42.85% of patients with CD and UC, respectively (p < 0.01), including glossodynia in 31.43% (p < 0.01) and 17.15% (p < 0.05) of cases. The main complaints of patients with diagnosed oral mucosal pathology were unpleasant sensations in the form of soreness and pain when consuming irritant foods in 100% and 65.71% of cases, respectively; discomfort during speech in 31.43% and 25.71% of cases; and dry mouth in 51.43% and 25.71% of cases. Burning sensation in the oral cavity was reported in 31.43% and 17.15% of patients.
CONCLUSIONS. The correlation between clinical manifestations of oral mucosal pathology and laboratory findings necessitates biochemical monitoring of reduced vitamin B6 and B12 levels in the blood. Deficiency of these vitamins was observed in 42.9% and 28.57% of patients with CD and in 34.4% and 20.0% of patients with UC, justifying the diagnosis of desquamative glossitis (KACD = 0.73 and KAUC = 0.64). The diagnosis of fissured tongue was established in 42.9% and 28.57% of CD patients and in 14.3% and 8.6% of UC patients (KACD = 1.0, KAUC = 0.64). In CD patients in remission with vitamin B12 deficiency, the relative risks for the development of aphthous stomatitis, fissured tongue, and burning mouth syndrome with glossodynia were OR = 7.1 (CI: 1.2–41.0), OR = 11.5 (CI: 1.7–77.2), and OR = 29.3 (CI: 4.1–200.0), respectively. In the same group, vitamin B6 deficiency increased the risk of fissured tongue (OR = 12.7, CI: 1.3–121.4) and burning mouth syndrome with glossodynia (OR = 13.5, CI: 2.3–80.8). In UC patients, deficiencies in vitamin B12 and B6 were criteria for the development of recurrent aphthous stomatitis (OR = 19.2, CI: 1.9–196.5 and OR = 9.2, CI: 1.4–59.6, respectively), fissured tongue (OR = 13.5, CI: 1.6–115.9 and OR = 9.8, CI: 1.2–77.7, respectively), and burning mouth syndrome with glossodynia (OR = 8.7, CI: 1.02–63.8 and OR = 17.3, CI: 2.2–138.2, respectively). Low hemoglobin levels in CD patients increased the risk of geographic glossitis (OR = 4.9, CI: 1.01–29.4) and the manifestation of burning mouth syndrome with glossodynia (OR = 6.0, CI: 1.2–29.7). Interdisciplinary collaboration between dentists, gastroenterologists, general practitioners, and neurologists is essential for the early diagnosis of lip vermilion and oral mucosal pathology in patients with CD and UC manifestations.

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