Oral and upper gastrointestinal Crohn's disease

Abstract

Crohn's disease is a heterogeneous, inflammatory condition that can affect any location of the gastrointestinal tract. Proximal gastrointestinal involvement occurs in 0.5-16% of patients, and it is usually diagnosed after recognition of intestinal disease. Symptoms are often mild and nonspecific; however, upper gastrointestinal disease predicts a more severe Crohn's phenotype with a greater frequency of complications such as obstruction and perforation. Gastroscopy and biopsy is the most sensitive diagnostic investigation. There is a paucity of data examining the treatment of this condition. Management principles are similar to those for intestinal disease, commencing with topical therapy where appropriate, progressing to systemic therapy such as glucocorticoids, 5-aminosalicylic acid, immunomodulators, and biologics. Acid suppression therapy has symptomatic but no anti-inflammatory benefit for gastroduodenal and esophageal involvement. Surgical intervention with bypass, strictureplasty, or less frequently, endoscopic balloon dilation may be required for complications or failed medical therapy.

Oral manifestations of autoinflammatory and autoimmune diseases

“…Histologically non-caseous granulomas can typically be visible in specific lesions along with chronic inflammatory infiltrate (38,39). To confirm the disease, radiographic examination, endoscopy, and histopathology are the standard approach.…”

Another Case of Reflux Esophagitis?

“…2 Histopathology typically demonstrates chronic inflammation, although noncaseating granulomas are seen in the minority (7%-39%) of patients. 3 Multiple deep biopsies are recommended to improve diagnostic yield, 3 and our case demonstrates the value of repeat endoscopic evaluation.…”

“…Oral prednisolone, topical budesonide, and immunomodulators including thiopurines have been used in case series, but biological therapy (typically antitumor necrosis factor) is likely to be required for severe disease. 2,3 There are no data on the use of more novel biologics. Critically, almost all reported cases of esophageal Crohn's disease have concomitant intestinal disease, and the presence of upper gastrointestinal Crohn's predicts a more severe disease phenotype, supporting the use of more aggressive medical therapy in this instance.…”

“…Critically, almost all reported cases of esophageal Crohn's disease have concomitant intestinal disease, and the presence of upper gastrointestinal Crohn's predicts a more severe disease phenotype, supporting the use of more aggressive medical therapy in this instance. 3…”

Use of lumen apposing metal stent for pyloric stenosis refractory to balloon dilatation

“…However, upper GI tract involvement in CD is relatively rare, with an incidence of 0.5%-16%. 2 It occasionally presents as pyloric stenosis, which has mainly been reported in case reports. 3,4 Here we report our experience of a case of gastroduodenal CD presenting with pyloric stenosis refractory to balloon dilatation.…”