Isolated oesophageal involvement of Crohn's disease

Abstract

A 31-year-old male was admitted with complaints of dysphagia and odynophagia. An upper gastrointestinal tract series revealed inflammatory changes in the mid and distal oesophagus with intramural extravasation of the barium. An upper endoscopy showed multiple ulcerations and inflammation. The patient developed a large stricture with no response to serial endoscopic dilations and a surgical resection of the oesophagus was required. Gross examination of the surgical specimen revealed transmural inflammation, deep ulcerations and non-necrotizing epithelioid cell granuloma. All these pathological findings were characteristic of Crohn's disease of the oesophagus. After 36 months of follow-up there has been no recurrence of symptoms or of other sites of involvement.

Oesophageal presentation of Crohn's disease

“…Dysphagia and odynophagia are the most common symptoms 2 6. Other symptoms include heartburn and chest pain 2.…”

“…Up to 30% of patients have oral aphthous ulcerations2 10 at the time of oesophageal CD symptom onset. Weight loss associated with these symptoms can be found 3 6 11. Extra intestinal manifestations of CD are often present, including arthritis, uveitis, and erythema nodosum 12…”

“…A small percentage of patients may complicate with fistulas to the stomach,14 respiratory tract,15–22 or have stricture formation 6 9 23…”

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

“…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].…”

“…However, these lesions are not specific to CD and must therefore be distinguished from other diseases, such as gastro-esophageal reflux disease, eosinophilic esophagitis, drug-induced esophagitis, viral and fungal infection, tuberculosis, vasculitis and malignancies [24]. Granuloma is detected in \25% of esophageal biopsy specimens (Table 2) [22,25,26]; thus, even in cases in which granulomas is not detected, it is important to treat the case as CD, because the diagnosis of CD can be made endoscopically.…”