Upper Gastrointestinal Involvement in Crohn Disease: Histopathologic and Endoscopic Findings

Diaz, Liege; Hernandez-Oquet, Rafael Enrique; Deshpande, Amar R.; Moshiree, Baharak

doi:10.14423/smj.0000000000000373

Cited by 67 publications

(47 citation statements)

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“…Although the previous prospective studies found quite high prevalence (~56%) from endoscopy and endoscopic biopsy [17,18], the current study showed that the rate of patients who needed surgery was just around 3%. The majority of patients in our study experienced frequent stool passage or diarrhea related to penetrating fistula, especially those related to previous anastomosis (29.2%), followed by symptoms reported in other studies [17,20] such as nausea, vomiting, and indigestion. We found that patients with upper GI CD were significantly more likely to be male and to have a history of perianal surgery and smoking than patients with CD at other sites.…”

Section: Discussionsupporting

confidence: 53%

Clinical Characteristics and Postoperative Outcomes of Patients Presenting With Upper Gastrointestinal Tract Crohn Disease

Moon

Lee

et al. 2020

Ann Coloproctol

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Purpose: Upper gastrointestinal (GI) tract involvement in Crohn disease (CD) is rare and effectiveness of surgical treatment is limited. The aim of this study was to evaluate characteristics and surgical outcomes of upper GI CD.Methods: Medical records of 811 patients who underwent intestinal surgery for CD between January 2006 and December 2015 at a single institution were reviewed. Upper GI CD was defined by involvement of the stomach to the fourth portion of duodenum, with or without concomitant small/large bowel CD involvement according to a modification of the Montreal classification.Results: We identified 24 patients (21 males, 3 females) who underwent surgery for upper GI CD. The mean age at diagnosis was 27 ± 12 years, the mean age at surgery was 33 ± 11 years, and the mean duration of CD was 73.6 ± 56.6 months. Fifteen patients (62.5%) had history of previous perianal surgery. Ten patients (41.7%) had duodenal or gastric stricture and 14 patients (58.3%) had penetrating fistula; patients with fistula were significantly more likely to develop complications (57.1% vs. 20.0%, P = 0.035). One patient with stricture had surgical recurrence. In seven patients with fistula, fistula was related to previous anastomosis. Patients with fistula had significantly longer hospital stays than those with stricture (16 days vs. 11 days, P = 0.01).Conclusion: Upper GI CD is rare among CD types (2.96%). In patients with upper GI CD, penetrating fistula was associated with longer hospital stay and more complications.

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Section: Discussionsupporting

confidence: 53%

Clinical Characteristics and Postoperative Outcomes of Patients Presenting With Upper Gastrointestinal Tract Crohn Disease

Moon

Lee

et al. 2020

Ann Coloproctol

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“…Ulcerative colitis and Crohn’s disease are the two most common phenotypic manifestations of inflammatory bowel disease. In particular, Crohn’s disease may involve the entire gastrointestinal system, and a duodenal localization has been reported in 28.2% of patients [62]. In this subset of patients, the macroscopic appearance of the mucosa shows ulcers or erythema.…”

Section: Origin Of Mementioning

confidence: 99%

Lymphocytic duodenitis or microscopic enteritis and gluten-related conditions: what needs to be explored?

Ierardi¹,

Losurdo²,

Iannone³

et al. 2017

aog

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Microscopic enteritis (ME) is characterized by abnormal infiltration of intraepithelial lymphocytes in intestinal mucosa. It was described as duodenal lymphocytosis or lymphocytic duodenitis until the dedicated Consensus Conference of 2015. ME represents a common feature of several gluten-mediated and non-gluten related diseases; therefore, it is an umbrella term embracing several conditions. The most frequent causes of ME are gluten-related disorders (celiac disease, non-celiac gluten sensitivity, wheat allergy), Helicobacter pylori infection and drug-related damages. Less frequently, ME may be secondary to inflammatory bowel disease, some autoimmune conditions, immunoglobulin deficiencies, blood malignancies, infections and irritable bowel syndrome. Therefore, the differential diagnosis of ME may be challenging. The diagnosis of ME needs to be driven by predominant symptoms and patient history. However, it is often difficult to achieve an immediate identification of the underlying condition, and a broad variety of diagnostic tests may be required. Ultimately, long-term surveillance is needed for a final diagnosis in many cases, since a hidden or quiescent condition may be disclosed after a period of latency. In any case, strict collaboration between the clinician and the pathologist is pivotal. The treatment of ME should be personalized, depending on the underlying disease. For gluten-related conditions (celiac disease, gluten sensitivity, wheat allergy, dermatitis herpetiformis), a gluten-free diet may be proposed. For other conditions, a targeted etiologic treatment is necessary. In conclusion, ME represents a novel entity that is attracting increasing interest. The growing epidemiologic trend confirms that it will become a common condition in clinical practice.

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“…Diaz et al in a review of 20 articles reporting 2511 patients with CD (CD group) reported involvement of UGI tract in 815 (34%) patients (UGI group). [55] The endoscopic features in the CD group were gastric erythema in 5.9%, gastric erosions in 3.7%, duodenal ulcers in 5.3%, and erythema in the duodenum in 3% of patients. [55] The most common histopathological features in the CD group was nonspecific gastric inflammation in 32%, gastric granuloma in 7.9%, and focal gastritis in 30.9% of patients.…”

Section: Endoscopic Features In Patients With Gastrointestinal Tubercmentioning

confidence: 87%

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2017

Journal of Digestive Endoscopy

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Upper Gastrointestinal Involvement in Crohn Disease: Histopathologic and Endoscopic Findings

Cited by 67 publications

References 1 publication

Clinical Characteristics and Postoperative Outcomes of Patients Presenting With Upper Gastrointestinal Tract Crohn Disease

Clinical Characteristics and Postoperative Outcomes of Patients Presenting With Upper Gastrointestinal Tract Crohn Disease

Lymphocytic duodenitis or microscopic enteritis and gluten-related conditions: what needs to be explored?

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