Endoscopic and Pathologic Changes of the Upper Gastrointestinal Tract in Crohn’s Disease

Abstract

Background. Crohn's disease (CD) may involve any part of the gastrointestinal tract. We assessed the prevalence and features of upper gastrointestinal (UGI) lesions in CD. Methods. This was a retrospective study that included 138 CD patients that underwent esophagogastroduodenoscopy (EGD). The rate of Crohn's specific endoscopic lesions in the esophagus, stomach, and duodenum was assessed, and immunohistochemical analysis was performed. Changes in the UGI lesions were assessed in those who had two or more EGD. Results. Of 138 patients, 51.3% had Crohn's specific UGI lesions. The rates of Crohn's specific lesion in the esophagus, upper-to-middle stomach, lower stomach, duodenal bulb, and 2nd portion of the duodenum were 6.5%, 47.8%, 24.6%, 31.9%, and 18.1%, respectively. Granulomas were detected in 6.1%, 25.0%, and 11.4% in the upper-to-middle stomach, lower stomach, and duodenal bulb, respectively, but none in the esophagus and 2nd portion of the duodenum. Thirty-seven were analyzed for Helicobacter pylori and 4 were positive (10.8%). Improvements of UGI lesions were seen in 14 out of 49 (28.5%) and were unchanged in 59.2% and worsened in 12.2%. Conclusions. The prevalence of Crohn's specific UGI lesions was common in our case series, and immunohistochemical studies suggested that the majority was unrelated to Helicobacter pylori infection. Worsening of UGI lesions over the course was rare.

The endoscopic findings of the upper gastrointestinal tract in patients with Crohn’s disease

“…The detection rate showed significant differences in each report [21,31,48]. Hirokawa et al reported that the prevalence of granuloma in histologic specimens obtained from lesions with the bamboo-joint-like appearance in the stomach of CD patients was 14.3% [34], which was less than the prevalence in our results (45.5%) [33].…”

“…According to previous reports, the frequency of esophageal lesions in CD patients ranges from 0.2 to 6% [18][19][20][21]. They are detected less frequently than gastric or duodenal lesions.…”

“…1a-c). In severe cases, longitudinally aligned ulcers, a cobblestone appearance and fistulas are observed [20][21][22][23]. Decker et al reported that the incidences of esophageal lesions, including ulcer, erosion, stricture and fistula, were 85, 40, 20 and 5%, respectively [20].…”

“…Regarding the frequency of duodenal lesions in CD patients, Cameron et al [15] reported that the frequency was 21%, while Sakuraba et al [21] reported that the frequency was 31.9% in the duodenal bulb and 18.1% in the second portion of the duodenum. We reported that the incidence of the notch-like appearance and erosion and/or ulcers in the duodenum of CD patients was 9.9 and 32.1%, respectively.…”

“…These two findings were observed in 6.2 and 22.2% of non-IBD patients and 1.5 and 4.5% of UC patients, respectively [36]. Meanwhile, Sakuraba et al suggested that the notch-like appearance in the second portion of the duodenum was CD-specific [21]. The frequency of duodenal lesions is relatively high, but minute lesions, such as the notch-like appearance and erosion, might be missed by white light endoscopy.…”