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

Abstract

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.

Surgical Treatment of Upper Gastrointestinal Tract Crohn Disease: A Long Way to Go to Identify the Optimal Method

“…Most patients achieved good outcomes after bypass surgery and/or primary repair. In contrast to previous studies that reported that the most common surgical indication for patients with CD was obstruction [10], 58.3% of the patients in the study by Moon et al [9] underwent surgery for penetrating fistula. Half of the patients with a fistula might have had penetration of distal CD such as the ileum or transverse colon.…”

“…However, information regarding surgery for UGI CD is sparse and has not been reported for patients with CD in Korea. Moon et al [9] analyzed the outcomes of adult patients who underwent surgery for UGI CD during a 20-year period at a single institution. The perioperative outcomes of 24 patients (2.96% of the total cohort) who underwent surgery for UGI CD were compared with those of 787 patients (97.04% of the total cohort) with only distal CD.…”

“…Thus, the recent European Crohn and Colitis Organization guidelines recommend the laparoscopic approach for CD surgery when feasible [15]. As UGI CD is frequently associated with ileal or colonic lesions and a history of previous surgery, Moon et al [9] only used the laparoscopic approach in one patient with UGI CD. Gastrojejunostomy bypass is the procedure that is best suited to the laparoscopic approach for UGI CD, and laparoscopic gastrojejunostomy for duodenal CD was first reported in 1996 [16].…”

Profiling non-coding RNA levels with clinical classifiers in pediatric Crohn’s disease

“…Individuals were clinically assigned according to the Montreal classification system, initially at baseline, for CD patients. Physician assessed Montreal classifiers were denoted by disease status such as B1 (inflammatory), B2 (stricturing), or B3 (penetrating); and inflammation location such as L1 (ileal), L2 (colonic), and L3 (ileal-colonic) [13]. Disease severity classifications, demographics, and clinical information were collected for each patient at time of enrollment and during follow-up, are provided in Table 1 along with other patient metrics included age, sex, disease type, disease behavior, inflammatory status and inflammation on disease location.…”

Profiling Non-Coding RNA Levels With Clinical Classifiers in Pediatric Crohn’s Disease

“…Individuals were clinically assigned according to the Montreal classi cation system, initially at baseline, for CD patients. Physician assessed Montreal classi ers were denoted by disease status such as B1 (in ammatory), B2 (stricturing), or B3 (penetrating); and in ammation location such as L1 (ileal), L2 (colonic), and L3 (ileal-colonic) 13 . Disease severity classi cations, demographics, and clinical information were collected for each patient at time of enrollment and during follow-up, are provided in Table 1 along with other patient metrics included age, gender, disease type, disease behavior, in ammatory status and in ammation on disease location.…”