Oral manifestations in Crohn's disease and orofacial granulomatosis

Research output: ThesisDoctoral ThesisCollection of Articles


Crohn´s disease (CD) is a chronic inflammatory disease that can affect any part of the digestive tract, including the mouth. The reported prevalence of oral manifestations in CD varies widely and ranges from 0.5% to 80%. Orofacial granulomatosis (OFG) is a rare chronic inflammation presenting in the oral cavity and around the mouth without intestinal involvement. Typical is labial or facial oedema and ulceration in the oral mucosa. Melkersson-Rosenthal syndrome (MRS) is considered to be one manifestation of OFG, where granulomatous inflammation and oedema is accompanied by recurrent facial palsy and fissured tongue. Oral lesions in CD, OFG, and MRS cannot be clinically or histologically distinguished. Patients with OFG may develop CD and it is debated whether OFG is an oral manifestation of CD, or a separate inflammatory disorder. In addition, it is unknown whether patients with MRS are prone to develop CD in follow-up. The aim of this thesis was to investigate and compare conditions presenting with orofacial symptoms —OFG, CD, and MRS— and study the connection between these entities. This thesis consists of studies on patients with pediatric-onset OFG, patients with pediatric-onset CD who had reached adulthood and patients with triad or oligosymptomatic MRS or its monosymptomatic form cheilitis granulomatosa (CG). Otorhinolaryngological and dental examinations, evaluation of nutrition from food records, and laboratory tests were included. Orofacial findings were photographed and recorded using a structural schema. Possible factors predicting bowel disease in orofacial patients were of special interest. In patients with CD, health-related quality of life (HRQoL) was evaluated. Blood samples were collected to investigate inflammatory markers and anti-Saccharomyces cerevisiae antibodies A (ASCAbA) and G (ASCAbG). In patients with OFG, the HLA-haplotypes (Human leucocyte antigen) were also examined to evaluate the role of HLA in the pathogenesis of OFG. Stool samples were collected to evaluate faecal calprotectin, a surrogate marker for intestinal inflammation. We found that prognosis for OFG is good. Symptoms tend to diminish during the course of the disease. Of the patients with pediatric-onset OFG, 72% developed CD. Elevated ASCAbA may serve as a factor predicting the underlying or developing CD in patients with OFG. Examination of HLA-haplotypes showed that tissue antigen HLA-B*44 might be a marker for OFG, but further studies are needed. In patients with CD the oral symptoms seem to be inactive when the gut disease is under good therapeutic control. However, patients with CD and a history of perianal abscessing disease seem to be prone to oral manifestations. Of the patients with MRS or CG, in total 11.1% had a diagnosis of inflammatory bowel disease (IBD) which suggests a link between MRS and IBD, not only CD but ulcerative colitis as well. None of the nutritional factors or dental findings correlated to oral findings in patients with OFG or pediatric-onset CD. Otorhinolaryngological findings were minor in both groups. Thus, OFG and CD do not seem to increase otorhinolaryngological comorbidity
Original languageEnglish
Awarding Institution
  • University of Helsinki
  • Kolho, Kaija-Leena, Supervisor
  • Pitkäranta, Anne, Supervisor
Place of PublicationHelsinki
Print ISBNs978-951-51-5117-9
Electronic ISBNs978-951-51-5146-9
Publication statusPublished - 2019
MoE publication typeG5 Doctoral dissertation (article)

Bibliographical note

M1 - 77s. + liitteet

Fields of Science

  • Cheilitis
  • Edema
  • Granulomatosis, Orofacial
  • Haplotypes
  • HLA Antigens
  • HLA-B44 Antigen
  • Inflammatory Bowel Diseases
  • Mouth Mucosa
  • Saccharomyces cerevisiae
  • Tongue, Fissured
  • 3125 Otorhinolaryngology, ophthalmology
  • 3121 General medicine, internal medicine and other clinical medicine

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