Tratamiento de la estomatitis aftosa recurrente en pacientes inmunocomprometidos. Revisión sistemática

Aislen Yanes Rojas, Ana Iris Gómez Martínez, Lester Celaya Palleiro, Vicente Eloy Fardales Macías

Texto completo:

PDF XML

Resumen

Fundamento: Aunque la estomatitis aftosa recurrente no tiene una etiología bien definida porque es una enfermedad multicausal, se ha reconocido que las interacciones o el debilitamiento del sistema inmunitario, contribuyen principalmente a la magnitud del proceso patológico. Las propuestas de tratamiento en pacientes inmunocomprometidos son diversas y por lo general se centran en alteraciones inmunológicas específicas.

Objetivo: Evaluar el efecto clínico de los tratamientos propuestos para la estomatitis aftosa recurrente en pacientes inmunocomprometidos.

Metodología: La búsqueda se realizó en las bases de datos PubMed/Medline y Cochrane. Se incluyeron ensayos clínicos que tuviesen entre sus variables de respuesta principales: Cicatrización de la úlcera aftosa, tiempo de cicatrización, de recurrencia e intensidad del dolor y entre las variables secundarias: Los efectos adversos y los síntomas. La extracción de datos se realizó de manera independiente por los autores. Se aplicó la metodología por la colaboración Cochrane para evaluar el riesgo de sesgo en cada uno de los estudios.

Resultados: Se incluyeron 11 ensayos clínicos (8 controlados) publicados entre 1995 y 2020 y que aportan resultados de la eficacia de varias intervenciones terapéuticas: talidomida (4), irsogladine (2), rebamipida (1), láser de diodo (1), cápsulas de Omega-3 (1), vitamina B 12 (1), Complejo B (1). Seis de estos estudios incluyeron pacientes con la forma menor de estomatitis aftosa recurrente. El periodo de seguimiento estuvo entre los 14 y 360 días.

Conclusiones: La talidomida puede ser eficaz en el alivio de los síntomas, la cicatrización y remisión de las lesiones, el diodo de láser y vitamina B12 en la disminución de la intensidad del dolor.

Referencias

Rodríguez-Archilla A, Raissouni T. Estudio clínico de 200 pacientes con estomatitis aftosa recurrente. Gac Med Mex. [Internet]. 2018 [citado 10 Ene 2021];154(2):165-71. Disponible en: Disponible en: https://www.gacetamedicademexico.com/files/gmm_154_2_165-171.pdf

Queiroz SIML, Silva MVA, Medeiros AMC, Oliveira PT, Gurgel BCV, Silveira EJD. Recurrent aphthous ulceration: an epidemiological study of etiological factors, treatment and differential diagnosis. An Bras Dermatol [Internet]. 2018 [cited 2021 Jan 10];93(3):341-6. Available from: Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6001102/pdf/abd-93-03-0341.pdf

Edgar NR, Saleh D, Miller RA. Recurrent Aphthous Stomatitis: A Review. J Clin Aesthet Dermatol [Internet]. 2017 [cited 2021 Jan 10];10(3):26-36. Available from: Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5367879/pdf/jcad_10_3_26.pdf

Ruan HH, Li GY, Duan N, Jiang HL, Fu YF, Song YF, et al. Frequencies of abnormal humoral and cellular immune component levels in peripheral blood of patients with recurrent aphthous ulceration. J Dent Sci. [Internet]. 2018 [cited 2021 Jan 10];13(2):124-130. Available from: Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6388805/pdf/main.pdf

Saikaly SK, Saikaly TS, Saikaly LE. Recurrent aphthous ulceration: a review of potential causes and novel treatments. J Dermatolog Treat [Internet]. 2018 [cited 2021 Sep 18];29(6):542-552. Available from: Available from: https://www.tandfonline.com/doi/full/10.1080/09546634.2017.1422079

Grimaux X, Leducq S, Goupille P, Aubourg A, Miquelestorena-Standley E, Samimi M. Aphthous mouth ulcers as an initial manifestation of sécukinumab-induced inflammatory bowel disease. Ann Dermatol Venereol [Internet]. 2018 Nov [cited 2021 Jan 15];145(11):676-682. Available from: Available from: https://www.sciencedirect.com/science/article/abs/pii/S015196381830499X?via%3Dihub

Tekcan A, Yigit S, Nursal AF, Tumer MK, Yerliyurt K, Kuruca N. Analysis Of İnterleukin-1 Receptor Antagonist Variable Number Tandem Repeat Variant in Recurrent Aphthous Stomatitis. Endocr Metab Immune Disord Drug Targets [Internet]. 2021 [cited 2021 Sep 18];21(1):139-44. Available from: Available from: https://pubmed.ncbi.nlm.nih.gov/32282310/

Ding X, Xu F, Zhang X. Clinical therapeutic effects of topical agents in adult patients with human immunodeficiency virus-related oral mucosa ulcers. Medicine (Baltimore) [Internet]. 2021 [cited 2021 Sep 18];100(6). Available from: Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7886410/pdf/medi-100-e23626.pdf

Samantha H, Shokrollah E. HIV Infection and Compromised Mucosal Immunity: Oral Manifestations and Systemic Inflammation. Front Immunol [Internet]. 2017 [cited 2021 Jan 10];8(241). Available from: Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5339276/pdf/fimmu-08-00241.pdf

Nur'aeny N, Gurnida DA, Suwarsa O, Sufiawati I. The Impact of DNA Methylation on IL6 mRNA Levels in Hematinic Deficiency and Atopy-Associated Recurrent Aphthous Stomatitis Patients. Int J Dent [Internet]. 2021 [cited 2021 Sep 18];2021:1-11. Available from: Available from: https://downloads.hindawi.com/journals/ijd/2021/5560695.pdf

Yang Z, Cui Q, An R, Wang J, Song X, Shen Y, et al. Comparison of microbiomes in ulcerative and normal mucosa of recurrent aphthous stomatitis (RAS)-affected patients. BMC Oral Health [Internet]. 2020 [cited 2021 Jan 10];20(1):128. Available from: Available from: https://bmcoralhealth.biomedcentral.com/articles/10.1186/s12903-020-01115-5

Cabras M, Carrozzo M, Gambino A, et al. Value of colchicine as treatment for recurrent oral ulcers: A systematic review. J Oral Pathol Med [Internet]. 2020 [cited 2021 Jan 10];49(8):731-740. Available from: Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/jop.13020

Kuteyi T, Okwundu CI. Topical treatments for HIV-related oral ulcers. Cochrane Database Syst Rev [Internet]. 2012 [2021 Jan 10];(1). Available from: Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007975.pub2/full

Paterson DL, Georghiou PR, Allworth AM, Kemp RJ. Thalidomide as treatment of refractory aphthous ulceration related to human immunodeficiency virus infection. Clin Infect Dis [Internet].1995 Feb [cited 2021 Jan 10];20(2):250-4. Available from: Available from: https://academic.oup.com/cid/article-abstract/20/2/250/376713?redirectedFrom=fulltext

Jacobson JM, Greenspan JS, Spritzler J, Ketter N, Fahey JL, Jackson JB, et al. Thalidomide for the treatment of oral aphthous ulcers in patients with human immunodeficiency virus infection. National Institute of Allergy and Infectious Diseases AIDS Clinical Trials Group. N Engl J Med. [Internet].1997 [cited 2021 Jan 10];336(21):1487-93. Available from: Available from: https://www.nejm.org/doi/10.1056/NEJM199705223362103?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0www.ncbi.nlm.nih.gov

Jacobson JM, Greenspan JS, Spritzler J, Fox L, Fahey JL, Jackson JB. Thalidomide in low intermittent doses does not prevent recurrence of human immunodeficiency virus-associated aphthous ulcers. J Infect Dis. [Internet]. 2001 [cited 2021 Jan 10];183(2):343-346. Available from: Available from: https://academic.oup.com/jid/article/183/2/343/850304

Mimura MA, Hirota SK, Sugaya NN, Sanches JA Jr, Migliari DA. Systemic treatment in severe cases of recurrent aphthous stomatitis: an open trial. Clinics (Sao Paulo). [Internet]. 2009 [cited 2021 Jan 10];64(3):193-8. Available from: Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2666466/pdf/cln64_3p0193.pdf

Nanke Y, Kamatani N, Okamoto T, Ogiuchi H, Kotake S. Irsogladine is effective for recurrent oral ulcers in patients with Behçet's disease: an open-label, single-centre study. Drugs R D. [Internet]. 2008 [cited 2021 Jan 10];9(6):455-9. Available from: Available from: https://pubmed.ncbi.nlm.nih.gov/18989994/

Hayashi N, George J, Shiroeda H, Saito T, Toshikuni N, Tsuchishima M, et al. Irsogladine maleate for the treatment of recurrent aphthous stomatitis in hepatitis C virus patients on pegylated-interferon and ribavirin: a pilot study. J Gastroenterol Hepatol [Internet]. 2013 Jun [cited 2021 Jan 10];28(6):1015-8. Available from: Available from: https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.12137

Matsuda T, Ohno S, Hirohata S, Miyanaga Y, Ujihara H, Inaba G, Nakamura S, Tanaka S, Kogure M, Mizushima Y. Efficacy of rebamipide as adjunctive therapy in the treatment of recurrent oral aphthous ulcers in patients with Behçet's disease: a randomised, double-blind, placebo-controlled study. Drugs R D [Internet]. 2003 [cited 2021 Jan 10];4(1):19-28. Available from: Available from: https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgh.12137

Huo X, Han N, Liu L. Effect of different treatments on recurrent aphthous stomatitis: laser versus medication. Lasers Med Sci [Internet]. 2021 [cited 2021 Sep 18];36:1095-1100. Available from: Available from: https://pubmed.ncbi.nlm.nih.gov/33140267/

Hadian Z, Moghadamnia AA, Kazemi S, Shirzad A. Effect of Omega-3 on Recurrent Aphthous Stomatitis and Improvement Quality of Life. Int J Dent [Internet]. 2021 [cited 2021 Sep 18];2021. Available from: Available from: https://downloads.hindawi.com/journals/ijd/2021/6617575.pdf

Golestannejad Z, Ghalayani P, Mojthaedi N, Foroughi A. The effectiveness of submucosal injection bioactive vitamine b12 in comparision to triancinolone in pain and frecuency of apthous ulcer. Ann Dent Spec [Internet]. 2017 [cited 2021 Jan 10];5(3):122-125. Available from: Available from: https://annalsofdentalspecialty.net.in/storage/models/article/IEpxGJAby2yL8vE6iP8V13lM8Y2XUZEKpuvp7BT316R8D1rgodDjQGGIdewo/9-the-effectiveness-of-submucosal-injection-bioactive-vitamin-b12-in-comparison-to-triaminolone-in.pdf

Rasi A, Zamanian A, Mehran G, Ezati A, Rastin V, Karimi S. Comparing the Effect of Injectable Vitamin B With Conventional Oral Treatment on Aphthous Stomatitis. J Skin Stem Cell [Internet]. 2018 [cited 2021 Jan 10];5(1-2):e69052. Available from: Available from: https://sites.kowsarpub.com/jssc/articles/69052.html

Taleb R, Hafez B, El Kassir N, El Achkar H, Mourad M. Role of vitamin B12 in treating recurrent aphthous stomatitis: A review. Int J Vitam Nutr Res [Internet]. 2020 [cited 2021 Jul 18]:1-8. Available from: Available from: https://econtent.hogrefe.com/doi/pdf/10.1024/0300-9831/a000684



Licencia de Creative Commons
Esta obra está bajo una licencia de Creative Commons Reconocimiento-NoComercial 4.0 Internacional.