Oral Extrainstestinal Manifestations of Inflammatory Bowel Disease: Treatment for Oral Symptoms

Objectives Inflammatory bowel disease (IBD) can be associated with extraintestinal manifestations (EIMs). Oral EIMs (OEIMs) may increase morbidity in patients with IBD. Most OEIMs resolve with successful treatment of IBD. In some cases, further local or systemic therapies are needed for control OEIMs. The aim of our study was to describe the Mayo Clinic experience with OEIMs of IBD and to summarize the treatments used for oral symptoms. Methods A retrospective review of electronic medical records from the three Mayo Clinic academic centers studied adult patients with Crohn's disease (CD) or ulcerative Colitis (UC) and one or more OEIM of IBD affecting lips or oral mucosa. A summary of each OEIM and its treatment was provided analyzed for each IBD subtype separately. Continuous variables were summarized with the sample median and range; categorical variables were summarized with number and percentage of patients. Kruskal-Wallis test for continuous measures and Fisher Exact test for categorical measures were performed to identify relationship or compare difference. Results We included 119 adult IBD patients with OEIMs, 67 with CD and 52 with UC. The most used treatment for IBD at time of oral symptoms was infliximab (31.3%) for CD and mesalamine (28.8%) for UC. The most common treatment used for oral symptoms in CD patients’ was compounded mouthwashes (53.7%) and topical corticosteroids (43.3%). The most frequent treatment for OEIMs in UC patients were compounded mouthwashes (50.0%), topical corticosteroids (21.2%) and topical anesthetics (19.2%). About a third (29.4%) of patients had OEIMs that led to changes in IBD treatment (21.0%) or new systemic agents (8.4%) being given specifically for OEIMs. Colchicine (p=0.009) and dapsone (p=0.066) were associated with improvement of OEIMS in CD cohort. For UC, systemic corticosteroids (p=0.027), topical tacrolimus (p=0.031) and colchicine (p=0.031) were associated with improvement in OEIMs. Conclusions Therapeutic control of IBD can lead to resolution of OEIMs. Nevertheless, some patients need additional local or systemic treatment. Compounded mouthwashes and topical corticosteroids were most commonly prescribed, though not significantly associated with improvement in the OEIMs. Inflammatory bowel disease (IBD) can be associated with extraintestinal manifestations (EIMs). Oral EIMs (OEIMs) may increase morbidity in patients with IBD. Most OEIMs resolve with successful treatment of IBD. In some cases, further local or systemic therapies are needed for control OEIMs. The aim of our study was to describe the Mayo Clinic experience with OEIMs of IBD and to summarize the treatments used for oral symptoms. A retrospective review of electronic medical records from the three Mayo Clinic academic centers studied adult patients with Crohn's disease (CD) or ulcerative Colitis (UC) and one or more OEIM of IBD affecting lips or oral mucosa. A summary of each OEIM and its treatment was provided analyzed for each IBD subtype separately. Continuous variables were summarized with the sample median and range; categorical variables were summarized with number and percentage of patients. Kruskal-Wallis test for continuous measures and Fisher Exact test for categorical measures were performed to identify relationship or compare difference. We included 119 adult IBD patients with OEIMs, 67 with CD and 52 with UC. The most used treatment for IBD at time of oral symptoms was infliximab (31.3%) for CD and mesalamine (28.8%) for UC. The most common treatment used for oral symptoms in CD patients’ was compounded mouthwashes (53.7%) and topical corticosteroids (43.3%). The most frequent treatment for OEIMs in UC patients were compounded mouthwashes (50.0%), topical corticosteroids (21.2%) and topical anesthetics (19.2%). About a third (29.4%) of patients had OEIMs that led to changes in IBD treatment (21.0%) or new systemic agents (8.4%) being given specifically for OEIMs. Colchicine (p=0.009) and dapsone (p=0.066) were associated with improvement of OEIMS in CD cohort. For UC, systemic corticosteroids (p=0.027), topical tacrolimus (p=0.031) and colchicine (p=0.031) were associated with improvement in OEIMs. Therapeutic control of IBD can lead to resolution of OEIMs. Nevertheless, some patients need additional local or systemic treatment. Compounded mouthwashes and topical corticosteroids were most commonly prescribed, though not significantly associated with improvement in the OEIMs.