Crohn’s disease presenting as gastric outlet obstruction: a therapeutic challenge?

Inayat, Faisal; Ullah, Waqas; Hussain, Qulsoom; Shafique, Khurram

doi:10.1136/bcr-2016-218181

Cited by 7 publications

(10 citation statements)

References 14 publications

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“…7 UGI-CD is relatively rare disease, thus other possible etiologies of gastric outlet obstruction such as peptic ulcer disease, Menetrier disease, collagen vascular disease, various infections like Helicobacter pylori, cytomegalovirus and Mycobacterium tuberculosis, nonsteroidal anti-inflammatory drug use, malignant and infiltrative disease should be ruled out through imaging or upper endoscopy. 10 One-third of patients with isolated UGI-CD do not have small or large intestine disease at the time of diagnosis of CD but develop distal disease over time. Also, only 4% to 11% of patients with UGI-CD have granulomas in biopsies, making the diagnosis of atypical isolated gastric CD more challenging.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Crohn’s disease with severe morbidity manifested by gastric outlet obstruction: two cases report and review of the literature

et al. 2021

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1 ileal), and stricturing or penetrating disease (B2 or B3 phenotype) are bad prognostic factors over 15 years of CD. 4 Therefore, in pediatric CD patients, it is important to clarify disease phenotype and stratified the risk level and prognostic factors. According to risk stratification of GETAID cohort, pediatric CD presenting as gastric outlet obstruction is important clinical presentation of CD causing morbidity despite of its rarity. Most patients with gastroduodenal CD are asymptomatic, but the most common symptom is epigastric pain, which is often alleviated by food and proton pump inhibitors. About 30% of symptomatic patients with gastroduodenal CD undergo surgery mainly due to gastroduodenal obstruction. Endoscopic intervention, such as endoscopic balloon dilation (EBD), can be performed in selected patients. 5 Here, we report 2 cases of pediatric CD patient who present gastroduodenal obstructing symptom as an initial symptom of CD and treated with medication and EBD without surgery. This case report may contribute towards elucidating the bene

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Section: Discussionmentioning

confidence: 99%

Pediatric Crohn’s disease with severe morbidity manifested by gastric outlet obstruction: two cases report and review of the literature

et al. 2021

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“…Crohn's disease isolated to the stomach usually causes non-specific symptoms, such as nausea, epigastric pain, vomiting and weight loss. duodenal stricture are very unlikely to be the first symptoms of the disease (36) . Proton pump inhibitors, glucocorticoids, biological therapy and endoscopic balloon dilation are used in the treatment (35) .…”

Section: Crohn's Diseasementioning

confidence: 99%

Causes of upper gastrointestinal tract obstruction

Kurowski¹,

Ostrowski²,

Hartleb³

2021

Pediatr Med Rodz

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Obstruction of the upper gastrointestinal tract, caused by blocked passage in the oesophagus, stomach or duodenum, is an important clinical and diagnostic problem in gastroenterological practice. The typical symptoms are dysphagia, postprandial vomiting, epigastric pain and weight loss. Post-inflammatory oesophageal lesions associated with reflux oesophagitis are the most common cause of obstruction. Other common causes include foreign bodies, neoplasms, chemical burns of the oesophagus and radiation-induced stenosis. In more than 2/3 cases, foreign bodies are localised in the proximal part of the oesophagus, but anatomical abnormalities, such as a Schatzki ring or post-inflammatory stenosis, increase the risk of food bolus impaction in the distal part of the oesophagus. Radiotherapy of head and neck tumours may cause stenosis, which affects more than 7% of patients treated this way. For the stomach and duodenum, 50–80% of obstruction cases are associated with neoplastic processes, with gastric cancer and pancreatic adenocarcinoma accounting for 35% and 15–25% of these cases, respectively. Mild causes of peripyloric obstruction include gastric and duodenal peptic ulcer, peritoneal adhesions, gastric polyps and Crohn’s disease. Symptoms of temporary pylorus obstruction can be caused by large, gastric hyperplastic pedunculated polyps. Therapeutic endoscopy is the most commonly used method for upper gastrointestinal tract obstruction. Depending on the cause, it involves foreign body removal, balloon enteroscopy, stenting with self-expanding metallic stents, and, in the case of treatment failure, surgical resection or palliative gastrojejunostomy.

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“…полагают, что иногда при БК ВО ЖКТ выявляются неспецифические признаки, например, язвы во рту, или нехарактерные для данной патологии -может наблюдаться задержка роста и/или полового созревания у детей, перианальное заболевание [24]. Отмечаются также внекишечные проявления, предшествующие желудочным или желудочно-кишечным симптомам, главным образом, появление артрита или артралгий [25]. Некоторые авторы подчеркивают, что хотя гематемезис и мелена возникают редко, заболевание может проявляться хронической железодефицитной анемией [26].…”

Section: рис 4 результаты повторного гистологического исследованияunclassified

“…Чаще всего выявляется поражение антрального отдела желудка, проксимальный отдел обычно не изменен. Эрозии могут быть круглыми или продольно выровненными, обычно расположены в антральном отделе и трудно дифференцируются от других типов гастрита, не связанных с БК [25,31]. Подобные визуальные изменения неспецифичны и могут наблюдаться при других состояниях, таких как гастрит, ассоциированный с H. pylori, туберкулез, гастропатии, индуцированные нестероидными противовоспалительными препаратами, болезнь Менетрие, злокачественные новообразования, лимфомы, сосудистые заболевания, коллагеновые болезни [6,32].…”

Section: рис 4 результаты повторного гистологического исследованияunclassified

Crohn’s disease with isolated gastric involvement as an example of a rare disease phenotype: a clinical case

et al. 2019

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Crohn's disease (CD), along with ulcerative colitis, is one of the predominant nosological forms of inflammatory bowel diseases. In CD, any part of the gastrointestinal tract can be affected; however, the process is commonly associated with terminal ileum or colon involvement. CD cases with isolated or mixed involvement of upper gastrointestinal tract (esophagus, stomach, and duodenum) are rare and least studied types of the disease. In isolated stomach involvement, the complaints are non-specific and include epigastric pain, gastric dyspepsia, early satiety, decreased appetite, and nausea. Isolated CD of upper gastrointestinal tract can be diagnosed after comprehensive work-up and always requires a high diagnostic level, including clinical, endoscopic and morphological one. We present a clinical case of CD with isolated stomach involvement in a 62-year-old woman. The diagnosis was confirmed by the histopathological findings of an epithelioid cell granuloma in the gastric antrum. Treatment with systemic corticosteroids reduced the disease clinical activity and improved the histological characteristics of the gastric biopsy sampled obtained by endoscopy. In this clinical case, there were specific macroscopic gastric lesions found at endoscopy in CD patients with upper gastrointestinal tract involvement, which is characterized by thickened longitudinal folding and linear grooves. This type of lesion has been described in the literature as “bamboo joint-like appearance”.Conclusion: Comprehensive assessment of clinical manifestations, endoscopic and histopathological specific features is crucial for the timely diagnosis and treatment of inflammatory bowel diseases.

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Crohn’s disease presenting as gastric outlet obstruction: a therapeutic challenge?

Cited by 7 publications

References 14 publications

Pediatric Crohn’s disease with severe morbidity manifested by gastric outlet obstruction: two cases report and review of the literature

Pediatric Crohn’s disease with severe morbidity manifested by gastric outlet obstruction: two cases report and review of the literature

Causes of upper gastrointestinal tract obstruction

Crohn’s disease with isolated gastric involvement as an example of a rare disease phenotype: a clinical case

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