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Rajbhandari R, Blakemore S, Gupta N, Adler AJ, Noble CA, Mannan S, Nikolli K, Yih A, Joshi S, Bukhman G. Crohn’s disease in low and lower-middle income countries: A scoping review. World J Gastroenterol 2020; 26:6891-6908. [PMID: 33268969 PMCID: PMC7684456 DOI: 10.3748/wjg.v26.i43.6891] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/04/2020] [Accepted: 10/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND While Crohn’s disease has been studied extensively in high-income countries, its epidemiology and care in low and lower-middle income countries (LLMICs) is not well established due to a lack of disease registries and diagnostic capacity.
AIM To describe the published burden, diagnostic/treatment capacity, service utilization, challenges/barriers to individuals with Crohn’s in LLMICs and their providers.
METHODS We conducted a scoping review utilizing a full search strategy was developed and conducted in PubMed, Embase and World Health Organization Global Index Medicus. Two independent reviewers screened the titles and abstracts of all of the publications found in this search, reviewed selected publications, and extracted relevant data, which underwent descriptive review and was analyzed in Excel.
RESULTS The database search yielded 4486 publications, 216 of which were determined to be relevant to the research questions. Of all 79 LLMICs, only 21 (26.6%) have publications describing individuals with Crohn’s. Overall, the highest number of studies came from India, followed by Tunisia, and Egypt. The mean number of Crohn’s patients reported per study is 57.84 and the median is 22, with a wide range from one to 980.
CONCLUSION This scoping review has shown that, although there is a severe lack of population-based data about Crohn’s in LLMICs, there is a signal of Crohn’s in these settings around the world.
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Affiliation(s)
- Ruma Rajbhandari
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, United States
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02199, United States
| | - Samantha Blakemore
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, United States
| | - Neil Gupta
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02199, United States
- Partners in Health, NCD Synergies, Boston, MA 02199, United States
| | - Alma J Adler
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02199, United States
| | - Christopher Allen Noble
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02199, United States
- Partners in Health, NCD Synergies, Boston, MA 02199, United States
| | - Sara Mannan
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, United States
| | - Klejda Nikolli
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, United States
| | - Alison Yih
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, United States
| | - Sameer Joshi
- Western Reserve Health Education, Trumbull Regional Medical Center, Warren, OH 44483, United States
| | - Gene Bukhman
- Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, United States
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02199, United States
- Partners in Health, NCD Synergies, Boston, MA 02199, United States
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Skrzat A, Olczak‐Kowalczyk D, Turska‐Szybka A. Crohn's disease should be considered in children with inflammatory oral lesions. Acta Paediatr 2017; 106:199-203. [PMID: 27896868 DOI: 10.1111/apa.13686] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 11/01/2016] [Accepted: 11/25/2016] [Indexed: 12/12/2022]
Abstract
This systematic review presents the oral manifestations of paediatric Crohn's disease. Our review of 28 papers published from 2000 to 2015 showed that the prevalence of oral manifestations was 10-80%. Specific symptoms included mucosal tags, swelling of the lips, cheeks and gingiva, and cobblestoning mucosa. Nonspecific symptoms included aphthous-like ulcers, angular cheilitis, lip fissuring and gingivitis. CONCLUSION The oral manifestations of Crohn's disease might precede intestinal inflammation or coincide with it. Crohn's disease should be considered in children with multiple oral manifestations and paediatric dentists, and gastroenterologists should be involved in their coordinated evaluation and follow-up.
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Affiliation(s)
- Anna Skrzat
- Students’ Scientific Group by Department of Paediatric Dentistry Medical University of Warsaw Warsaw Poland
| | | | - Anna Turska‐Szybka
- Department of Paediatric Dentistry Medical University of Warsaw Warsaw Poland
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Abstract
Palatal ulcers are a common presentation and can be conveniently divided into developmental and acquired causes, the latter of which is subdivided into acute and chronic causes. Most commonly seen dermatologic causes have associated skin manifestations. Acute and multiple ulcers are usually infectious or drug induced in origin. Recurrent ulcers are largely dominated by aphthosis, while chronic ulcers are seen in immunocompromised patients and can occasionally be malignant. It is essential to involve the oral and maxillofacial surgeons early in the therapeutic management to tackle the inevitable complications that may ensue in the chronic cases.
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Affiliation(s)
- Kabir Sardana
- Department of Dermatology Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.
| | - Shuchi Bansal
- Department of Dermatology Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
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Fatahzadeh M. Inflammatory bowel disease. ACTA ACUST UNITED AC 2010; 108:e1-10. [PMID: 19836703 DOI: 10.1016/j.tripleo.2009.07.035] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Revised: 07/13/2009] [Accepted: 07/14/2009] [Indexed: 12/14/2022]
Abstract
Inflammatory bowel diseases (IBDs) encompass ulcerative colitis, Crohn's disease, and indeterminate colitis, all of which are characterized by remission and exacerbation of gastrointestinal symptoms, and a variety of extraintestinal manifestations including those affecting the oral cavity. Although not particularly a cause for mortality, inflammatory bowel diseases are associated with significant morbidity and impact on the quality of life. This article reviews clinical presentation, diagnostic criteria, and therapeutic modalities for the 2 main types of inflammatory bowel disease and discusses manifestations of these conditions in the oral cavity. The role of the oral health care provider in timely recognition and referral for medical work-up as well as management of oral complaints is also emphasized.
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Affiliation(s)
- Mahnaz Fatahzadeh
- New Jersey Dental School, University of Medicine & Dentistry of New Jersey, Newark, NJ, USA.
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Quezada S, Turner PL, Alexiev B, Daly B, Cross R. Severe refractory orofacial Crohn's disease: report of a case. Dig Dis Sci 2009; 54:2290-5. [PMID: 19082722 DOI: 10.1007/s10620-008-0588-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Accepted: 10/17/2008] [Indexed: 12/20/2022]
Abstract
Oral involvement is common in patients with Crohn's disease (CD) and can precede intestinal symptoms, making diagnosis difficult. We report a case of severe orofacial CD. A 41-year-old woman presented with palate and tongue ulcers. Biopsies showed acute inflammation with ulcer. Colonoscopy demonstrated ascending colon ulceration. Biopsies revealed acute colitis and mild architectural distortion. Prednisone was started but the symptoms recurred with taper; steroids were resumed and infliximab (IFX) 5 mg/kg was infused. After improvement, oral pain and weight loss returned. A G tube was placed. Mercaptopurine was started at 1.5 mg/kg per day. IFX was increased to 10 mg/kg. Debridement of the oral ulcers and a skin graft to the lips was performed. Pathology from oral and facial lesions was consistent with granulation tissue and fibrosis with chronic inflammation. She was readmitted several months later for weight loss and dehydration. Abdominal pain, distension, and feculent drainage developed around the G tube. Repeat computed tomography (CT) scan demonstrated pneumatosis. Laparotomy revealed purulent drainage from a perforated segment of sigmoid colon. Histology was consistent with perforated CD. Despite ventilatory and hemodynamic support and broad-spectrum antibiotics, the patient died 1 week later. Our case highlights the difficulty in diagnosing and managing orofacial CD. In this case, medical treatment was initiated based on a high index of suspicion. CD was only confirmed after intestinal resection very late in the disease course. Treatment of orofacial CD includes topical or systemic steroids, immunomodulators, and anti-tumor necrosis factor (TNF) therapies. As our case demonstrated, patients can be refractory to therapy.
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Affiliation(s)
- Sandra Quezada
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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