The incidence of inflammatory bowel diseases (IBD) - Crohn’s disease (CD) and ulcerative colitis (UC) - has been increasing on a global scale, and progressively, more gastroenterologists will be included in the diagnosis and treatment of IBD. Although IBD primarily affects the intestinal tract, extraintestinal manifestations of the disease are often apparent, including in the oral cavity, especially in CD. Specific oral manifestations in patients with CD are as follows: indurate mucosal tags, cobblestoning and mucogingivitis, deep linear ulcerations and lip swelling with vertical fissures. The most common non-specific manifestations, such as aphthous stomatitis and angular cheilitis, occur in both diseases, while pyostomatitis vegetans is more pronounced in patients with UC. Non-specific lesions in the oral cavity can also be the result of malnutrition and drugs. Malnutrition, followed by anemia and mineral and vitamin deficiency, affects the oral cavity and teeth. Furthermore, all of the drug classes that are applied to the treatment of inflammatory bowel diseases can lead to alterations in the oral cavity due to the direct toxic effects of the drugs on oral tissues, as well as indirect immunosuppressive effects with a risk of developing opportunistic infections or bone marrow suppression. There is a higher occurrence of malignant diseases in patients with IBD, which is related to the disease itself and to the IBD-related therapy with a possible oral pathology. Treatment of oral lesions includes treatment of the alterations in the oral cavity according to the etiology together with treatment of the primary intestinal disease, which requires adequate knowledge and a strong cooperation between gastroenterologists and specialists in oral medicine.

Objective. It has been suggested that the incidence of inflammatory bowel disease (IBD), which includes ulcerative colitis (UC) and Crohn's disease (CD), is higher in northern than in southern Europe. Recent epidemiological studies showed the loss of the previously described geographical north–south gradient. The aim of this study was to investigate the incidence of UC and CD in Primorsko-goranska County, Croatia. Material and methods. In the period 1 January 2000 to 31 December 2004 (5 years) all new patients diagnosed with IBD were prospectively identified according to a standard protocol for case ascertainment and definition. A total of 178 residents (81 F, 97 M) were newly diagnosed as having IBD during the study period. Of these, 70 had UC and 100 CD. Eight patients had indeterminate IBD. The data on patients were collected using a data form completed by gastroenterologists. Results. Annual age-standardized incidence rates were 4.3/10⁵ (95% CI 2.6–6.0) for UC and 7.0/10⁵ (95% CI 3.4–10.6) for CD. The highest incidence rate was observed in the age group 35–44 years for UC and the 25–34 years age group for CD. The incidence of IBD was higher in the urban than in the rural population, with the exception of on the islands. Conclusions. The incidence of IBD was higher than previously observed in Croatia. Our results suggest that CD incidence rates in the northern coastal part of Croatia are currently comparable with those reported in northern Europe.

We describe an 81-year old man presenting with ileus and two rare, pathologically distinct entities: gastrointestinal stromal tumor (GIST) and Crohn's disease. Within Meckel's diverticulum a polypous tumor, 3 cm in diameter, with preserved lumen was found. In the area of the terminal ileum, coecum and colon ascendens inflamed bowel loops were fixed together with fibrous adhesions. Partial resection of the ileum with end-to-end anastomosis and right hemicolectomy with resection of the terminal ileum and end-to-end ileotransverse anastomosis were performed. Pathohistological and immunohistochemical examination revealed the polypous tumor as GIST. Changes in terminal ileum, coecum and colon ascendens were referred as Crohn's disease. Although adenocarcinoma is well known in chronic, long-standing inflammatory bowel disease, other primary intestinal tumors are rare in those patients. Furthermore, Crohn's disease can be a part of differential diagnosis of ileus, also in such an old man. Wir beschreiben einen 81-jährigen Patienten mit Ileus und 2 seltenen pathologischen Befunden: einem gastrointestinalen Stromatumor und einem Morbus Crohn. Bei der Operation fand sich in einem Meckel'schem Divertikel ein polypöser Tumor von 3 cm Durchmesser, der sich als gastrointestinaler Stromatumor herausstellte und das Darmlumen nicht kompromittierte. Zusätzlich imponierten im terminalen Ileum, Zökum und Kolon ascendens entzündete Darmschlingen, die fibröse Adhäsionen bildeten und für den Ileus verantwortlich waren. Es wurde das Meckel'sche Divertikel mit dem Ileum reseziert und eine End-zu-End-Anastomose durchgeführt, zusätzlich erfolgte eine rechtsseitige Hemikolektomie. Die pathohistologische Untersuchung bestätigte den gastrointestinalen Stromatumor im Meckel'schen Divertikel. Die Veränderungen im terminalen Ileum, Zökum und Kolon ascendens waren dem Morbus Crohn zuzuschreiben. Obwohl die Koinzidenz von einem Adenokarzinom bei lang dauerndem Morbus Crohn bekannt ist, werden bei diesen Patienten nur selten intestinale Tumore anderer Genese gefunden. Unser Fall zeigt des Weiteren, dass auch ein Morbus Crohn in die Differentialdiagnose „Ileus” beim sehr alten Patienten einbezogen werden muss.