P0700 PROSPECTIVE EVALUATION OF ORAL CROHNS DISEASE IN CHILDREN

Abstract

Introduction: Previous reports indicate that oral lesions occur in 6 to 20% of patients with Crohn’s disease (CD). A recent retrospective study at our centre revealed a significantly higher incidence of disease specific oral lesions (48%) in patients undergoing formal evaluation by a paediatric dental surgeon. The aim of this study was to prospectively document the proportion of children with oral lesions at initial evaluation for suspected inflammatory bowel disease. Methods: Data were collected between Jan 1999 and Dec2001. All children suspected of having IBD were included in the study. Systematic dental examinations were carried out on the day of endoscopy and findings documented. Information regarding age, sex, presenting symptoms, oral symptoms, family history, medications, findings on clinical examination, routine laboratory results and barium follow-through studies were recorded. All children underwent upper gastrointestinal endoscopy and colonoscopy. Biopsy specimens were taken from grossly affected tissue and unaffected gastric and colonic mucosa. Oral biopsies were taken as appropriate. Results: Forty-eight of 49 patients with CD were examined by the dentist. Findings consistent with oral CD were found in 20 patients (41.7%). Non-specific changes were found in 8(16.7%) patients, while 20(41.7%) patients had a normal oral examination. Six patients with oral CD were on medications at the time of evaluation. Patients with oral CD were more likely to complain of oral symptoms, 14 /20(70%) versus 9/28 (32.1%) of patients without oral CD (p=0.013). Oral findings included mucogingivitis (12), tags (4), deep ulceration (4), cobblestoning (3), lip swelling (3) and pyostomatitis vegetans (1). Non-caseating granulomas were found in each of the eight oral biopsies that were performed. Two patients with granulomas in oral biopsies had no granulomas in biopsies from elsewhere in the GI tract. There was no difference in the systemic symptoms or laboratory markers in patients with or without oral CD. When comparing disease location between patients with and without oral CD five patients were excluded as they had H. Pylori infection (n=43). Children with oral CD were more likely to have perianal disease 10/20 (50%) compared to 4/23 (17.4%) (p =0.023), but other sites of disease were similarly affected in both groups. In seven patients (36.84%) with oral CD was the mouth found to be abnormal by the gastroenterologist. Only in 25(58.1%) of patients did the consultants findings correlate with those of the dentist. Conclusion: Children with CD commonly have oral CD findings even in the absence of symptoms. These oral changes provide important diagnostic information. Expert dental evaluation is necessary in order to accurately identify these oral lesions.