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Abstract

Objectives

Oral extraintestinal manifestations (OEIMs) of inflammatory bowel disease (IBD) may impact IBD treatment. The aims of this study were to: (1) determine which OEIMs are most prevalent among patients with IBD, (2) investigate the presence of a temporal association between GI luminal disease activity and OEIMs, and (3) determine how often changes in therapeutic management of IBD are needed in the presence of OEIMs.

Study Design

A retrospective cohort study was performed for adult patients with IBD evaluated between January 2017 and November 2021 with at least one oral complaint. Demographic data were collected from the charts of these patients. Kruskal-Wallis test for continuous measures and Fisher’s Exact test for categorical measures were used.

Results

A total of 116 patients with IBD and who had presented with at least one oral finding during the study time period were identified. Aphthous ulcers were the most common oral presentationin both Crohn’s disease (CD) (85.1%) and ulcerative colitis (UC) (75.0%). OEIMs were associated with CD activity in the small intestine (p=0.004) and colon (p<0.001). UC pancolitis was associated with OEIMs (p=0.002). In 32.7% of patients, OEIMs led to either an increase in dose or frequency of IBD therapy. In an additional 16.4% of patients, new systemic agents were started because of the OEIMs.

Conclusion

This study provides evidence that patients with IBD may develop OEIMs synchronous with IBD flares and may require escalation of IBD therapy when OEIMs occur.

Graphical Abstract
Graphical Abstract
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Lay Summary

Patients with IBD may develop oral extraintestinal manifestations (OEIM) synchronous with IBD flares and may require escalation of IBD therapy when OEIMs occur.

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Author notes

Katherine Bodiford and Jana G. Hashash Indicates shared senior authorship

© The Author(s) 2025. Published by Oxford University Press on behalf of Crohn's & Colitis Foundation.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected].
Issue Section:
Observations and Research
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