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Coeliac disease
• Coeliac disease is a permanent
intolerance to gliadin the protein
component of wheat. It is a lifelong
inflammatory condition of the
gastrointestinal tract that affects the small
intestine in genetically susceptible
individuals. Coeliac disease is
characterized by malabsorption due to
morphological abnormalities in the small
intestinal mucosa
reversible
• These changes are reversible on
withdrawal of gluten from the diet. The first
detailed description of coeliac disease in
children was given in 1887. Classically,
coeliac disease is characterized by the
development of diarrhoea, loss of appetite,
and wasting when a weaning diet
containing gluten is introduced, together
with secondary effects of malabsorption
such as anaemia
• Coeliac disease is also known as coeliac
sprueâ and it is interesting that the name
sprueâ was derived from the Dutch word
for aphthous ulcer, this indicating the high
proportion of sufferers with oral ulceration
adult coeliac disease
• In adult coeliac disease,
• diarrohea,
• weight loss, and weakness are the classic
signs and symptoms
qiyaastii
• Approximately 5-10 per cent of patients
with coeliac disease have an affected firstdegree relative. There is also a recognized
association of coeliac disease with other
autoimmune diseases such as insulindependent diabetes mellitus.
Approximately 5-10 per cent of people with
this sort of diabetes will also have coeliac
disease.
diagnosis
• Definitive diagnosis of coeliac disease
requires the demonstration of
characteristic mucosal abnormalities in
biopsies of the small bowel (usually
obtained via endoscopy
Dentists and coelic disease
• Dentists may suspect coeliac disease
because of enamel defects on permanent
teeth—particularly lower incisors.
Inflammatory bowel disease
(IBD)
• The inflammatory bowel diseases are
lifelong conditions resulting from aberrant
inflammation of the mucosal lining of the
gastrointestinal tract. The two main
categories are Crohn's disease, which
may affect the gut anywhere from mouth
to anus, and ulcerative colitis, which is
predominantly within the colon.
Oral manifestations of coeliac
disease
•
•
•
•
Oral ulceration—RAS
Glossitis
Angular cheilitis
Enamel hypoplasia
Clinical features of orofacial
granulomatosisâ oral Crohn's
disease
oral Crohn's disease
• Swelling of lips and face*
Mucosal tags or cobblestoning
Oral ulceration (RAS and non-RAS)
Angular cheilitis
Lip fissures
Persistent lymphadenopathy
Perioral erythema and scaling of skin
Full-widthâ gingivitis
Orofacial swelling
• Orofacial swelling, particularly involving
the lips, is the most consistent feature of
OFG and the most common reason for
patients presenting for investigation and
treatment.
The swelling of the lips
• The swelling of the lips is painless, has a
firm, rubbery consistency; and can involve
both upper and lower lips, individually or
together. It can be unilateral or bilateral.
crohn”s Disease
Buccal mucosa
OFG: aetiology and other
associations
• The aetiology of OFG unrelated to
systemic disease remains unclear.
However, allergy, infections, and
hereditary causes have all been
implicated, together with infectious agents
such as Mycobacterium paratuberculosis,
and ‘ bacteria.
Management of OFG
• Patients with OFG must be appropriately
investigated, not only to confirm the
diagnosis but to identify any provoking
factors and signs and symptoms,
suggestive of an underlying systemic
condition, such as CD or sarcoidosis
A full range
• A full range of haematological and
biochemical investigations, including
inflammatory markers, should be
undertaken, together with an estimation of
the serum angiotensin-converting enzyme
(ACE) and a chest radiograph. Biopsy of
an affected site (usually the labial or
buccal mucosa and occasionally the
gingivae) should be carried out
Patients with OFG
• Patients with OFG often seek treatment for
lip swelling, which causes distress and
embarrassment
Treatment
• of OFG is unsatisfactory and response to
drug-therapy is disappointing
treatment
• Topical steroids and antiseptic and
analgesic mouthwashes can be helpful for
managing the oral ulceration, associated
with OFG. Angular cheilitis and lip fissures
frequently become secondarily infected
but in many cases can be improved by the
application of
an antifungal or antibiotic cream (for
example, nystatin, fusidic acid,
miconazole), as indicated by microbiology.
Ulcerative colitis
• Ulcerative colitis is a disease, usually
beginning in young adult life, in which
inflammatory changes in the colonic
mucosa and submucosa lead to
widespread ulceration
complicated by
• This ulceration may be complicated by
haemorrhage, perforation, and,
occasionally, by the eventual onset of
malignancy. Pain, diarrhoea, and
generalized abdominal discomfort are the
predominant symptoms
aetiology
• The aetiology of ulcerative colitis is not
clear, although it seems to be one of the
‘diseases of civilization’. The
treatment of ulcerative colitis is by the use
of sulfasalazine and steroids, used either
locally. Surgery may be necessary if
medical treatment fails.
Different B/W
• Crohn's disease can affect any part of the
gastrointestinal tract. Ulcerative colitis only
affects the large bowel.
Gastro-oesophageal reflux
disorder (GORD)
gastro-oesophageal reflux
• Healthy individuals experience gastrooesophageal reflux after a meal and this is
due to the relaxation of the lower
oesophageal sphincter. In patients with
gastro-oesophageal reflux disorder
(GORD), there is increased frequency and
duration of reflux and damage is caused to
the oesophageal mucosa by regurgitation
of gastric contents
• As a result there can be reflux
oesophagitis, ulceration, stricture, or
epithelial metaplasia (oesophagus).
Symptoms of GORD include heart-burn,
epigastric pain, and regurgitation.
However, some patients, the ‘silent
refluxers’, have no symptoms.
Drug therapy
• Drug therapy is usually successful for
GORD and consists of simple antacids (or
covering agents), H2 receptor blockers (for
example, cimetedine) that
inhibit gastric acid secretion, or protonpump inhibitors (for example, omeprazole)
that inhibit acid production
Surgery
• Surgery is rarely indicated but patients
who develop oesophageal strictures may
need periodic dilatation. Patients with
GORD may develop dental erosion
particularly of the palatal aspects of the
teeth, and, in patients who are
asymptomatic, this erosion may be the
only indicator of pathological GORD.
Patients who regularly chew antacid