Introduction
Inflammatory bowel disease (IBD) comprises two major pathological conditions affecting the gastrointestinal tract, i.e., Crohn´s disease (CD) and ulcerative colitis (UC). CD can affect any part of the GI, while UC affects the large intestine. IBD can also involve many other organs of the body from mouth to anus, including the oral cavity.
The incidence of IBD is increasing, especially in newly industrialized countries.1 In Europe, the incidence of CD ranges between 0.4 and 22.8 per 100 000 people per year and UC between 2.4 and 44.0 per 100 000 people per year.2 The prevalence is approximately 0.2% of the European population.2
Patients with IBD suffer from abdominal pain, diarrhea, weight loss, secondary anemia, and fistulas.3 Oral manifestations may appear years before systemic symptoms.3 These include aphthous ulcers, mucogingivitis, lip swelling, angular cheilitis, mucosal tags, cobblestoning, and deep linear ulcerations. Histopathologically, granulomatous lesions can be seen. The etiology of IBD remains unknown, but it is believed to be multifactorial, involving genetic, immunologic, and environmental factors.2,3,4,5 IBD should be considered a systemic disease, since extraintestinal manifestations (EIMs) present in 5% to 50% of all IBD cases. EIMs can affect nearly every organ and might appear prior to the first diagnosis of IBD, simultaneously, or after resection of the affected bowel segment. EIMs, such as primary sclerosing cholangitis (PSC) as a hepatobiliary manifestation, must be recognized early to prevent severe morbidity and mortality. We report the case of a young female with oral manifestation four years before diagnosis of Crohn´s disease and subsequent PSC.