Oral ulceration is a common complaint of patients attending out-patient clinics.
The aim of this review is to provide the gastroenterologist with a differential diagnosis of oral ulceration, and a practical guide for the management of recurrent aphthous stomatitis, including topical and systemic therapy.
The association of recurrent aphthous stomatitis with Behc¸et’s disease and other systemic disorders, including coeliac disease, is discussed.
Recent evidence concerning the immunopathogenesis of Behc¸et’s disease is reviewed, including renewed interest in the role of Streptococcus sanguis and possible infectious triggering of an inappropriate immunoinflammatory response, resulting in tissue damage.
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The efficacy and limitations of conventional treatment for this mutisystem disorder are outlined together with the potential role of novel biological agents, such as anti-tumour necrosis factor-a therapy.
Oral ulceration, as a manifestation of inflammatory bowel disease and a complication of drug therapy, is described. Guidance is given concerning indications for referral of patients with oral ulceration to an oral physician/surgeon for further investigations, including biopsy if appropriate.
°Review article: oral ulceration – aetiopathogenesis, clinical diagnosis and management in the gastrointestinal clinic
°E. A. FIELD & R. B. ALLAN