Introduction Orofacial granulomatosis (OFG), which includes oral Crohn's disease (CD) is a chronic inflammatory condition presenting characteristically with lip swelling but also affecting the gingivae, buccal mucosa, floor of the mouth and a number of other sites in the oral cavity. It can occur in combination with systemic conditions however, its true relationship with gut CD remains unclear. Previous studies using conventional endoscopy suggest that at least two-thirds of patients with OFG1 have asymptomatic intestinal inflammation. Capsule endoscopy offers a less invasive means of investigating the gut in these patients and not previously been evaluated in any detail in OFG.
The aim was to use capsule endoscopy to determine the presence of gut CD in patients presenting with OFG with active oral inflammation but no gut symptoms.
Methods 30 consecutive patients with biopsy-proven OFG were recruited from the multidisciplinary Oral Medicine/Gastroenterology out-patient clinic at Guy's and St Thomas' NHS Foundation Trust Hospital (London, UK) between January and August 2009.
Result 26 full capsule endoscopies were performed. Three patients failed to attend three consecutive appointments. One capsule remained in the stomach for the first 24 h and failed to capture any images beyond the pylorus. From the completed recordings, small bowel abnormalities (terminal ileal ulceration and erythema) were only seen in one patient. While waiting for her capsule endoscopy, this patient had in fact developed diarrhoea, rectal bleeding and weight loss. A diagnosis of Crohn's disease was made at subsequent colonoscopy and biopsy. The remaining recordings were completely normal.
Conclusion OFG represents a spectrum of disease. Patients can have orofacial manifestations in isolation, but a small proportion have concomitant clinical CD. In patients without intestinal symptoms, a diagnosis of occult CD is very unlikely. GI surveillance using any diagnostic modality should be reserved for patients with GI symptoms or where CD is suspected from history or screening blood tests. Though video capsule endoscopy is attractive and less invasive, ileocolonoscopy with biopsy remains the gold standard in the appropriate patient.