Field E A, Allan R B
Oral Medicine Unit, Liverpool University Dental Hospital and School, Liverpool, UK.
Aliment Pharmacol Ther. 2003 Nov 15;18(10):949-62. doi: 10.1046/j.1365-2036.2003.01782.x.
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 Behçet's disease and other systemic disorders, including coeliac disease, is discussed. Recent evidence concerning the immunopathogenesis of Behçet'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. 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-alpha 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.
口腔溃疡是门诊患者的常见主诉。本综述旨在为胃肠病学家提供口腔溃疡的鉴别诊断方法，以及复发性阿弗他口炎管理的实用指南，包括局部和全身治疗。文中讨论了复发性阿弗他口炎与白塞病及其他全身性疾病（包括乳糜泻）的关联。回顾了有关白塞病免疫发病机制的最新证据，包括对血链球菌作用的重新关注以及可能由感染引发的不适当免疫炎症反应导致组织损伤。概述了这种多系统疾病传统治疗的疗效和局限性，以及新型生物制剂（如抗肿瘤坏死因子-α治疗）的潜在作用。文中描述了口腔溃疡作为炎症性肠病的一种表现及药物治疗并发症的情况。针对将口腔溃疡患者转诊至口腔内科医生/外科医生进行进一步检查（包括必要时进行活检）的指征给出了指导意见。
