AS is better known as canker sores. They may seem like a fairly benign, limited condition, but in the presence of so many other problems that occur with IBD they can be very upsetting and painful. They may be a caused by the IBD itself, or be a side effect of a nutritional deficiency. Fortunately they are not normally serious and treatment is aimed at reducing discomfort, or correcting any nutritional problems that may be present. AS is not contagious and can not be spread to other people.
Symptoms
AS are shallow ulcers in the mucosa (lining) of the mouth. They may appear anywhere in the mouth, but are frequently found on the inside of the lower lip or cheeks, or on the sides or base of the tongue. They may last from 1 to 2 weeks to months. The ulcers may appear whitish or yellow with a red base, with a grayish layer that develops when they begin to heal. The ulcers tend to recur after healing. There may be a burning or tingling sensation before the appearance of the ulcers.Causes
Except for those ulcers that are caused by a nutritional deficiency or another condition (such as Crohn’s disease that affects the mouth), it is not known why AS may appear in some people with IBD. Some theories include a weakened immune system, stress, bacteria, or trauma.Nutritional deficiencies that may cause or contribute to the formation of AS ulcers are iron, folic acid, and vitamin B-12 deficiencies. Insufficiencies of these vitamins and minerals are also commonly caused by underlying IBD.
Diagnosis
AS that is not very troublesome or painful does not necessarily require a specific visit to a physician. However, it should be discussed at the next visit to the gastroenterologist who is treating the IBD. If the ulcers become large, very painful, or do not heal, a physician should be consulted as soon as possible. A gastroenterologist can determine if the ulcers are in fact AS, in most cases simply by their appearance, and if further testing or any treatment is needed. Mouth ulcers can be caused by other conditions (such as contact dermatitis, herpes infection, hand-foot-and-mouth disease, and lupus) that may need treatment so they should always be seen by a physician for a diagnosis.If the ulcers do appear troublesome, the physician may order tests such as a complete blood cell count; erythrocyte sedimentation rate; and iron, folate, and B-12 levels. A culture or biopsy of the lesions may also be taken.
Treatment
Mild cases of AS may not require any treatment as the ulcers will heal on their own. Troublesome ulcers may be treated with a topical corticosteroid in a paste, cream, spray, or rinse. Mouth rinses that reduce the amount of bacteria in the mouth may also be used. Cases of AS that are related to a serious underlying condition such as HIV infection may be treated with oral medication.If the ulcers that are irritated by some foods there may need to be a change in diet. Soft, bland, non-acidic foods (without spices or salt) may lessen irritation. Sucking on ice chips may relieve some pain. Other treatments, such as applying milk of magnesia to the sores or rinsing with salt water, diluted hydrogen peroxide, or Benadryl may be helpful in some cases. Pain killers are also sometimes used, but remember that NSAIDs may cause a flare-up of IBD in some people.
Because AS may also be worsened by trauma, it is important to take care to not bite or injure the inside of the mouth. Any dental problems (jagged teeth, ill-fitting appliances) that may be causing or contributing to the ulcers should be addressed by a dentist.
In cases of AS that are due to a flare-up of IBD, the ulcers typically resolve when the flare is under control.
