Periodontitis and Inflammatory Bowel Disease

A Meta-analysis

Yang-yang She; Xiang-bo Kong; Ya-ping Ge; Zhi-yong Liu; Jie-yu Chen; Jing-wei Jiang; Hong-bo Jiang; Si-lian Fang


BMC Oral Health. 2020;20(67) 

In This Article


Inflammatory bowel disease (IBD) is a chronic relapsing and remitting intestinal inflammatory disease with an increasing prevalence worldwide.[1,2] Crohn' s disease (CD) and ulcerative colitis (UC) are two forms of IBD.[3] While UC is limited to the colon, CD can affect anywhere along the gastrointestinal tract, most frequently in the distal ileum. The main clinical manifestations are abdominal pain, diarrhea and bloody stool. Besides the intestinal inflammatory involvement and complications that characterize the disease, extraintestinal manifestations (EIMs) occur in up to 40% of IBD patients,[4] involving the eyes, mouth, nerve system, skin, joints, and liver.[5] Oral lesions precede, coincide with or follow the onset of the intestinal symptoms.[6] However, the prevalence of oral lesions in IBD varied substantially in previous studies.[7,8] Due to poorly understood etiology, there is currently no cure but only temporary relief for IBD patients.[9]

While many potential causes that play a major role in the disease pathogenesis have been identified. These fall into three specific categories: genetic predisposition, the host immune system, as well as environmental factors, such as the gut microbiota dominated by intestinal bacteria.[10,11] An emerging theory is that IBD is the result of an abnormal reaction of T-lymphocytes to specific bacterial flora in genetically vulnerable populations.[12] Compared with healthy individuals, the composition of intestinal bacterial microbiota of IBD patients were imbalance.[13] The dynamic crosstalk between intestinal epithelial cells (IECs), intestinal microbes and local immune cells reflects one of the essential features of intestinal homeostasis.[13]

Earlier studies documented a high prevalence of periodontitis in patients with IBD.[14,15] However, with regard to the markedly different features between CD and UC,[16] information would be lost when they are combined as IBD. Hence, they should be measured separately. Periodontitis is a polymicrobial, biofilm-mediated disease resulting in inflammatory resorption of alveolar bones.[17] Periodontitis and IBD share the inflammatory processes in its progression, in which the key mediators involved in tissue damage are common, such as some cytokines.[12,18] In addition, a high frequency of periodontopathic bacteria such as Campylobacter rectus, Porphyromonas gingivalis and Tannerella forsythia have been found among patients with CD.[19] The periodontal pathogens induced changes of the composition of intestinal microorganisms, and their inflammatory response could cause IECs barrier dysfunction, accentuating the disease.[20]

At present, the relationship between periodontitis and IBD has not been firmly established. Confirming this correlation is critical and would inspire future research on understanding IBD etiology, elucidating the underlying mechanisms, and might lead to novel treatment strategies. Therefore, we conducted a meta-analysis on the association between periodontitis and IBD.