Crohn’s disease with gastroduodenal involvement: Diagnostic approach

Abstract

Crohn's disease (CD) is a chronic idiopathic inflammatory disease of gastrointestinal tract characterized by segmental and transmural involvement of gastrointestinal tract. Ileocolonic and colonic/anorectal is a most common and account for 40% of cases and involvement of small intestine is about 30%. Isolated involvement of stomach is an extremely unusual presentation of the disease accounting for less than 0.07% of all gastrointestinal CD. To date there are only a few documented case reports of adults with isolated gastric CD and no reports in the pediatric population. The diagnosis is difficult to establish in such cases with atypical presentation. In the absence of any other source of disease and in the presence of nonspecific upper gastrointestinal endoscopy and histological findings, serological testing can play a vital role in the diagnosis of atypical CD. Recent studies have suggested that perinuclear anti-neutrophil cytoplasmic antibody and anti-Saccharomycescervisia antibody may be used as additional diagnostic tools. The effectiveness of infliximab in isolated gastric CD is limited to only a few case reports of adult patients and the long-term outcome is unknown.

Crohn’s disease of esophagus, stomach and duodenum

“…Gastroduodenal CD has a prevalence of 0.5% to 4%. The isolated involvement of the stomach and duodenum occurs in less than 0.07% of all cases of CD[ 13 , 49 - 52 ]. A higher frequency of findings is reported in more recent studies, though with different diagnostic criteria.…”

“…Gastroduodenal involvement usually manifests itself through insidious, gastritis-like symptoms, but there are reports of atypical conditions, with rapid progression to obstructive forms[ 52 , 54 ]. Less frequent presentations are upper gastrointestinal bleeding, delayed puberty, and chronic iron-deficiency anemia[ 49 , 55 ]. Perforation, a frequent complication in peptic ulcer disease, is rare in gastroduodenal CD[ 56 ].…”

“…Endoscopic findings are similar to those described in other segments of the gastrointestinal tract, such as edema, enanthem, longitudinal or irregular erosions, ulcers that may be superficial or deep or aphthoid, linear or serpentine (Figure 2 ); nodularity of the mucosa and thickening or narrowing of the antrum, with reduction of distensibility; “cobblestone” appearance, duodenal stenosis, “notching” of the duodenal folds (Figure 3 ), protruding lesions in the bulb and second duodenal portion and a “bamboo-joint-like (BJL)” appearance[ 4 , 38 , 49 , 65 , 66 ]. The protruding lesions may have a longitudinal arrangement described as “rosary-like protuberant lesions”.…”

FKBP11 protects intestinal epithelial cells against inflammation‑induced apoptosis via the JNK‑caspase pathway in Crohn's disease

“…Prior to sample collection, all patients provided written informed consent. Patients with CD had been diagnosed according to standard clinical manifestations, endoscopy examination and histological criteria ( 26 ). The inclusion criteria included focal inflammation, irregular crypts and granuloma ( 27 ).…”

Peripheral Blood Inflammatory Markers and Crohn’s Disease: Lymphocytes Counts Could Predict Stricture Lesions 

“…Crohn´s disease (CD) is a type of chronic in ammatory bowel disease characterized by segmental and transmural involvement of any portion of the gastrointestinal tract [1]. The terminal ileum is most commonly involved in CD patients [2], and approximately one-third of CD patients develop intestinal strictures, which cause obstructive symptoms and require surgical resection [3].…”