Barrett's mucosa of distal esophagus with concomitant isolated Crohn's disease and intramucosal adenocarcinoma

Delpre, G; C, Mor; Avidor, I; Gutman, Haim; A, Leisser; Kött, I; Kadish, U

doi:10.1007/bf01536067

Cited by 4 publications

(2 citation statements)

References 28 publications

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“…Furthermore, it must be realized that when characteristic features of CD are present more distally in the digestive tract, the diagnosis is more secure. Other possible diagnoses such as adenocarcinoma, linitis plastica, lymphoma, scirrhous carcinoma of the stomach, benign peptic ulcer, carcinoma of the duodenum pancreatitis, pancreatic carcinoma, and annular pancreas must be considered in the differential diagnosis (64,98,99).…”

Section: Differential Diagnosismentioning

confidence: 99%

Proximal Crohn's Disease: Review of the Clinicopathologic Features and Therapy

Hogezand

Witte

Veenendaal

et al. 2001

Inflammatory Bowel Diseases

102

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Crohn's disease in the proximal region of the digestive tract is uncommon. Better diagnostically procedures and more careful histologic examination has led to a higher detection of proximal Crohn's disease. The diagnosis is based on symptoms, endoscopy with serial sections, or double contrast radiography. The most common histologic finding for this diagnosis are granulomas in the mucosa in Helicobacter pylori-negative patients, but the granulomas are not always frequently detected. Endoscopic lesions in the proximal regions look like the lesions that could be found in the distal regions. Notching in the duodenal folds could be a strong indication for Crohn's desease. Radiological lesions are not always characteristic, but should be used in combination with endoscopy. Stenosis is an important complication, but fistula formation and pseudodiverticular formation is possible. There is no uniform medical therapy, but the regular anti-inflammatory management for Crohn's disease is most often used. Sometimes surgery is needed.

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Section: Differential Diagnosismentioning

confidence: 99%

Proximal Crohn's Disease: Review of the Clinicopathologic Features and Therapy

Hogezand

Witte

Veenendaal

et al. 2001

Inflammatory Bowel Diseases

102

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“…25 Adenocarcinoma has been reported as a complication of Crohn's disease of the esophagus. 26 The most likely diagnosis in this case is chronic Crohn's esophagitis, manifested by a thickened esophageal wall, a narrowed esophageal lumen, and dysphagia with odynophagia during a period of three years. Although there was no evidence of gastrointestinal inflammation elsewhere, perhaps the chronic gastrointestinal symptoms that were ascribed to irritable bowel disease resulted from mild Crohn's ileitis or colitis.…”

Section: P Resentation Of C Asementioning

confidence: 88%

Case 32-1995

Brugge¹,

Mark²

1995

N Engl J Med

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A 78-year-old woman was admitted to the hospital because of worsening dysphagia and odynophagia.For three years, she had had dysphagia, with a sensation of solid food catching in the upper esophagus, which had worsened during the six months before admission. The dysphagia was followed by the coughing up of mucus for as long as an hour and by painful "spasms" in the neck that were provoked by swallowing medication or food. She had lost 4 to 7 kg in weight during the two years before admission. A barium-swallow examination performed elsewhere 26 months before admission showed a hiatal hernia and esophageal spasm. A barium-swallow study performed at this hospital 17 months before admission (Fig. 1) showed a large paraesophageal hiatal hernia, with reflux during the examination. The esophagus did not distend well, especially in the upper portion. A 13-mm barium pill, administered with a large volume of water, did not move below the level of the aortic arch. No evidence of active ulceration was observed at that point or elsewhere. Three weeks before admission an esophagealmotility study revealed that the tone of the lower esophageal sphincter was in the low-normal range. An examination with a pH probe disclosed abnormal gastroesophageal reflux in both the proximal and the distal ports of the probe, with delayed clearance of acid. The patient was admitted to the hospital.She had a lifelong history of the irritable bowel syndrome, which was well controlled by increased dietary fiber. A barium-enema examination and a sigmoidoscopic examination 10 years before admission had been normal. Mild asthma, induced by exercise and exposure to cold air, had been present for two years and was managed by infrequent use of inhaled medications. The patient took levothyroxine for primary hypothyroidism. An appendectomy had been performed many years ear-lier, and a biopsy of a benign breast lesion had been performed four years before admission. The patient did not smoke and drank little alcohol. There was no history of vomiting, hematemesis, hematochezia, melena, or jaundice. Her medications included a transdermal estrogen preparation, medroxyprogesterone acetate, levothyroxine, and an albuterol inhaler.The temperature was 37.6 ° C, the pulse was 78, and the respirations were 18. The blood pressure was 130/65 mm Hg.Physical examination was normal; a stool specimen was negative for occult blood.The urine was normal, as were a complete blood count and the values for urea nitrogen, creatinine, glucose, bilirubin, calcium, phosphorus, sodium, potassium, aspartate aminotransferase, amylase, and alkaline phosphatase. An electrocardiogram showed sinus bradycardia at a rate of 56, with a left anterior hemiblock and an intraventricular conduction defect. Radiographs of the chest revealed a retrocardiac opacity consistent Figure 1. Film from the Barium-Swallow Examination Performed 17 Months before Admission, Demonstrating an Area of Esophageal Narrowing, 5 cm Long, at the Level of the Aortic Arch and above It. No ulceration is evident. A hiatal ...

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