Images

Image of the month provided by P-ECCO: 

Lip swealling, aphae and arthritis

Orofacial granulomatosis and arthritis may be due to several different conditions¹. However the coexistence of these findings should prompt the clinician to investigate possible Crohn’s disease^2;3, using full endoscopic and histological work-up..

Careful observation of the oral mucosa may reveal signs that may lead to further investigation and diagnosis of Crohn’s disease⁴.

Adequate treatment with exclusive enteral nutrition may lead to quick improvement and remission of active disease (image, 2 weeks after starting treatment):

References:

1.    K. L. Kolho, K. Heiskanen, M. Verkasalo, and A. Pitkaranta, "Orofacial granulomatosis in children--a challenge for diagnosis and treatment," Int.J.Pediatr.Otorhinolaryngol. 75 (2011) 864-7.

2.    Assche G. Van, A. Dignass, W. Reinisch, C. J. van der Woude, A. Sturm, Vos M. De, M. Guslandi, B. Oldenburg, I. Dotan, P. Marteau, A. Ardizzone, D. C. Baumgart, G. D'Haens, P. Gionchetti, F. Portela, B. Vucelic, J. Soderholm, J. Escher, S. Koletzko, K. L. Kolho, M. Lukas, C. Mottet, H. Tilg, S. Vermeire, F. Carbonnel, A. Cole, G. Novacek, M. Reinshagen, E. Tsianos, K. Herrlinger, B. Oldenburg, Y. Bouhnik, R. Kiesslich, E. Stange, S. Travis, and J. Lindsay, "The second European evidence-based Consensus on the diagnosis and management of Crohn's disease: Special situations," J.Crohns.Colitis. 4 (2010) 63-101.

Image of the month provided by EpiCom: 

The map shows the incidence of IBD in the EpiCom study centres.

The incidence of inflammatory bowel diseases (IBDs), consisting of Crohn's disease (CD) and ulcerative colitis (UC), is subject to considerable variation worldwide. Until recently only few data were available on the epidemiology of IBD in Eastern European countries. However, recent studies from Hungary and Croatia have reported sharp increases in IBD incidence that means they are now comparable to Western European countries. The reason for these changes remains unknown. The EpiCom-study was initiated in 31 centres from 14 Western and 8 Eastern European countries to investigate the differences in incidence in Europe. A prospective, uniformly diagnosed by international diagnostic criteria, population-based inception cohort of patients diagnosed with IBD was created for this purpose.

References:

1)      Molodecky N a, Soon IS, Rabi DM, et al. Increasing Incidence and Prevalence of the Inflammatory Bowel Diseases with Time, Based on Systematic Review. Gastroenterology 2011;142:46–54.e42.

2)      Lakatos L, Mester G, Erdelyi Z, et al. Striking elevation in incidence and prevalence of inflammatory bowel disease in a province of western Hungary between 1977-2001. World journal of gastroenterology : WJG 2004;10:404–9.

3)      Burisch J, Duricova D, Turcan S, et al. Incidence of IBD and phenotype at diagnosis in Europe - first results from the EpiCom study. Gut 2012; 61 (Suppl 3) A20