Crohn's disease of the duodenum (transmural duodenitis): Clinical manifestations

Farmer, Richard G.; Hawk, William A.; Turnbull, Rupert B.

doi:10.1007/bf02232289

Cited by 37 publications

(6 citation statements)

References 18 publications

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“…This high number may be an underestimation of the actual prevalence since only patients with symptoms suggestive of upper GI disease and/ or those with abnormalities on upper GI x-ray studies underwent endoscopic and bioptic evaluation. In contrast to the findings in earlier reports on adult patients (1)(2)(3)(4)(5), only one of their pediatric patients had changes severe enough to require surgical intervention (8). In the report by Griffiths et al (9), the frequency of upper GI involvement with CD in 196 children and adolescents was 5.1%, whereas The predictive values of abnormal and normal endoscopic findings are given in parentheses.…”

Section: Histology Versus Endoscopymentioning

confidence: 80%

Endoscopic and Histologic Findings in the Upper Gastrointestinal Tract of Children with Crohn's Disease

Schmidt‐Sommerfeld,

Kirschner,

Stephens

1990

J. pediatr. gastroenterol. nutr.

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In an attempt to define endoscopic and histologic changes suggestive of upper gastrointestinal Crohn's disease (CD), the medical histories, endoscopic reports, and biopsies were reviewed from 24 pediatric patients with CD and 28 age‐matched patients without CD in whom esophagogastroduodenoscopies were performed because of upper GI symptoms. No differences in the overall frequency of endoscopic abnormalities were found between the two groups. However, gastric erosions and ulcerations were more frequent in CD patients. Histological abnormalities in the stomach and duodenum were also more frequent in CD patients. Noncaseating granulomas were found in five patients with CD and in one patient without clinical, radiologic, or endoscopic evidence of CD. Focal inflammation in the stomach and duodenum occurred more frequently in CD patients. Two patients with CD had focal and deep chronic inflammatory infiltrates in the esophagus, which reached the submucosa. Abnormal histology was often seen in CD patients with normal endoscopic appearances. We conclude that superficial ulcerations seen during endoscopy and the histological finding of focal inflammation may represent upper GI CD in pediatric patients. Histological changes can be missed if biopsies are not taken from normal‐appearing mucosa during endoscopy.

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Section: Histology Versus Endoscopymentioning

confidence: 80%

Endoscopic and Histologic Findings in the Upper Gastrointestinal Tract of Children with Crohn's Disease

Schmidt‐Sommerfeld,

Kirschner,

Stephens

1990

J. pediatr. gastroenterol. nutr.

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“…The symptoms are those of peptic ulcer disease with pain, nausea, anorexia, weight loss, bleeding and vomiting. Operation is required for obstruction or incapacitating symptoms and all series show excellent long term results following bypass (Nugent et al , 1977; Fielding et al , 1970; Farmer et al , 1972). The operation of gastroenterostomy and vagotomy may be adequate for disease limited to the duodenum; partial gastrectomy with Bilroth II reconnection may be indicated for associated gastric disease.…”

Section: Specific Surgical Proceduresmentioning

confidence: 99%

The Surgical Treatment of Crohn's Disease

Holmes

Richter

Garberoglio

et al. 1981

Int J Clinical Practice

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“…Indications for surgery of gastroduodenal disease have been reviewed by Reynolds and Stellato [35], who summarized 6 series [16,36,37,38,39] with a total of 108 patients: 90 (83%) underwent surgery for obstruction, 12 (11%) for refractory pain and 5 (5%) for massive bleeding.…”

Section: Treatmentmentioning

confidence: 99%

Upper Gastrointestinal Crohn’s Disease

et al. 2007

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Symptomatic gastroduodenal manifestations of Crohn’s disease are rare, with less than 4% of patients being clinically symptomatic. Gastroduodenal involvement may, however, be found endoscopically in 20% and in up to 40% of cases histologically, most frequently as Helicobacter pylori-negative focal gastritis, usually in patients with concomitant distal ileal disease. In practice, the activity of concomitant distal Crohn’s disease usually determines the indication for therapy, except in the presence of obstructive gastroduodenal symptoms. With the few data available, it seems correct to say that localized gastroduodenal disease should be treated with standard medical therapy used for more distal disease, with the exception of the galenic formulation of sulfasalazine and mesalazine with pH-dependent release. The presence of symptoms of obstruction needs aggressive therapy. If medical therapy with steroids and immunomodulatory drugs does not alleviate the symptoms, balloon dilation and surgery are the options to consider.

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Crohn's disease of the duodenum (transmural duodenitis): Clinical manifestations

Cited by 37 publications

References 18 publications

Endoscopic and Histologic Findings in the Upper Gastrointestinal Tract of Children with Crohn's Disease

Endoscopic and Histologic Findings in the Upper Gastrointestinal Tract of Children with Crohn's Disease

The Surgical Treatment of Crohn's Disease

Upper Gastrointestinal Crohn’s Disease

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