Gastroenterology and Oral Lesions

Gastrointestinal Diseases Overview

• Common gastrointestinal tract (GIT) diseases include Crohn’s disease, ulcerative colitis, and gastro-oesophageal reflux disease (GERD).
• Understanding signs, symptoms, pathogenesis, management, and how these conditions relate to dental practice is essential.

Inflammatory Bowel Diseases (IBD)

• IBD is characterized by chronic mucosal inflammation, primarily affecting the colon and rectum in ulcerative colitis.
• Symptoms of ulcerative colitis include bloody diarrhea, abdominal pain, and fecal urgency.
• Laboratory tests often reveal elevated inflammatory markers (ESR, CRP) and fecal calprotectin levels.

Oral Manifestations of Ulcerative Colitis

• Major and minor aphthous ulcers commonly appear on buccal mucosa.
• Pyostomatitis vegetans presents as purulent inflammation primarily on buccal and labial mucosa.
• Hairy leukoplakia may occur, associated with HIV.

Crohn's Disease

• Crohn’s disease can occur anywhere in the gastrointestinal tract, unlike ulcerative colitis.
• Extra-intestinal manifestations may affect eyes, joints, mouth, and skin.

Oral Manifestations of Crohn's Disease

• Persistent linear and deep ulcers, cobblestone mucosal architecture, and indurated swelling of the lips.

Dental Management of IBD

• Routine dental care helps in monitoring oral health.
• Oral lesions may be diagnosed and managed with topical steroids and sodium bicarbonate rinses.
• Dexamethasone elixir can be used for extensive lesions.

Gastritis

• Gastritis involves inflammation of the gastric mucosa, commonly linked to H. pylori infection and NSAIDs use.
• Classified into acute, chronic, atrophic, and erosive gastritis.

Definitions

• Acute Gastritis: Neutrophilic infiltration of the gastric mucosa.
• Chronic Gastritis: Mononuclear infiltrate with loss of normal tissue architecture.
• Atrophic Gastritis: Chronic inflammation leading to gland loss, often replaced by fibrosis.
• Erosive Gastritis: Superficial erosions causing potential bleeding.

Peptic Ulcer Disease

• Characterized by ulceration due to factors like H. pylori infection, drug-induced conditions, and mucosal pallor.

Gastroesophageal Reflux Disease (GERD)

• GERD involves regurgitation of stomach contents into the esophagus, causing symptoms like heartburn and potential esophageal injury.

Risk Factors for GERD

• Include smoking, caffeine and alcohol consumption, stress, obesity, pregnancy, scleroderma, sliding hiatal hernia, and asthma.

Red Flag Symptoms

• Dysphagia, anemia, unintentional weight loss, and evidence of GI bleeding indicate potential complications needing referral for EGD.

Oral Manifestations of GERD

• May include dysgeusia, erosion, mucosal erythema, xerostomia, and esophageal stricture.

Dental Management of GERD

• Sodium bicarbonate mouth rinses can mitigate dysgeusia.
• Topical fluoride applications support mineralization.
• Maintain sufficient hydration and consider salivary substitutes.

Malabsorption Disorders

• Pernicious Anemia: Often from Vitamin B12 deficiency due to gastric mucosa atrophy, leading to macrocytic normochromic anemia.
  • Diagnosis involves serum Vitamin B12 and methylmalonic acid levels.
• Oral manifestations include an inflamed "beefy red" tongue, glossitis, glossodynia, and burning mouth.

Folic Acid Deficiency Anemia

• A macrocytic anemia resulting from a lack of dietary folic acid, particularly in diets low in leafy vegetables.