Duodenal involvement of Crohn's disease

Poggioli, Gilberto; Stocchi, Luca; Laureti, Silvio; Selleri, S; Marra, Claudio; Salone, Mariacristina; Cavallari, A.

doi:10.1007/bf02054984

Cited by 55 publications

(18 citation statements)

References 19 publications

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“…There are no evidence-based data to guide therapy in duodenal CD, but the goal of treatment is to control active inflammation and maintain symptomatic remission for prolonged periods. Although some investigators (14) have advocated the use of acid suppression therapy for patients with duodenal mucosal ulceration from CD, and this alone appears to provide relief of symptoms for many patients (23), randomized, controlled trials are lacking. Along with acid suppression, a combined approach with anti-inflammatory agents and immunomodulators would be most appropriate to theoretically slow disease progression and maintain remission.…”

Section: Discussionmentioning

confidence: 97%

“…Mucosal ulcerations and/or fistulas documented on barium studies or endoscopy are also common (13). Twenty-five percent of patients with recurrent duodenal CD develop fistulas, usually arising in the third portion of the duodenum or at the ileocolonic anastomosis in patients with previous surgical resection (14). Duodenocutaneous fistulas from the bulb or the second part of the duodenum to the abdominal wall have also been described (13).…”

Section: Discussionmentioning

confidence: 98%

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Ampullary Stenosis with Biliary Obstruction in Duodenal Crohn’s Disease: A Case Report and Review of the Literature

et al. 2005

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KEY WORDS: ampullary stenosis; biliary obstruction; duodenal Crohn's disease; review.Gastroduodenal involvement in Crohn's disease (CD) is rare, with a reported incidence ranging between 0.5 and 4.0% (1-6). Since Gottlieb and Alpert (7) described the first case in 1937, CD of the duodenum is being increasingly recognized. We report an unusual case of duodenal CD involving the major ampulla resulting in biliary obstruction. CASE REPORTA 24-year-old male was admitted for closure of a loop ileostomy. Three months earlier, he had undergone a total colectomy with an ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC) refractory to medical therapy. UC was diagnosed in 1996 after the patient presented with bloody diarrhea. A colonoscopy shortly before the colectomy showed diffuse and continuous colitis from the rectum to the hepatic flexure. Biopsies revealed severe acute and chronic inflammation with gland branching and crypt abscesses consistent with chronic inflammatory bowel disease (IBD). No granulomas were seen. A UGI/SBFT follow-through was normal. The results of an IBD-antibody marker panel from Prometheus, Inc., San Diego, California ([+] PANCA and [−]ASC), were also suggestive of UC.Following the ileostomy closure, the patient developed sinus tachycardia and hypertension, with a heart rate in the 130s and a blood pressure of 200/100. Thyroid function tests were obtained. His thyroid stimulant hormone (TSH) was <0.01 µIU/ml (ref. range, 0.35-5.50 IU/ml) and his free thyroxine level (FT4) was 13.4 IU/ml (ref. range, 1.0-4.0 IU/ml), supporting a diagnosis Manuscript of hyperthyroidism. Therapy with methimazole and metoprolol, 25 mg po bid, was initiated. Several days after surgery, the patient developed postprandial right upper quadrant (RUQ) pain, nausea, and vomiting. Physical examination was significant for moderate RUQ tenderness without peritoneal signs. Further investigations included the following: total bilirubin, 1.6 mg/dl (ref. range, 0.3-1.2 mg/dl); serum aspartate aminotransferase, 231 U/L (ref. range, 5-40 U/L); serum alanine aminotransferase, 289 U/L (ref. range, 5-40 U/L); and alkaline phosphatase, 198 U/L (ref. range, 35-120 U/L).A RUQ ultrasound revealed a diffusely dilated common bile duct (CBD) measuring 1.3 cm in maximal diameter. The pancreatic duct also appeared prominent. The gallbladder was visualized without wall thickening, pericholecystic fluid, or gallstones. A subsequent MR cholangiopancreatogram (MRCP) confirmed the dilation of the CBD and showed a prominent pancreatic duct measuring 3-5 mm in maximum diameter. Soft tissue fullness was noted at the ampullary region, which was seen in all sequences and measured 7 × 6 mm in diameter, consistent with a prominent papilla. A small bowel through study showed an entirely normal course, caliber, and mucosal pattern.Endoscopic retrograde cholangiopancreatography (ERCP) was performed. Endoscopic views of the second and third portions of the duodenum revealed an abnormal granular appearance of the mucosa, with scattered superficial ...

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 98%

Ampullary Stenosis with Biliary Obstruction in Duodenal Crohn’s Disease: A Case Report and Review of the Literature

et al. 2005

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“…The ideal sites for strictureplasty are short fibrotic strictures secondary to Crohn's Disease, although strictureplasty can be safely done at short, uncomplicated, active disease sites [14]. It is also suitable for recurrent stricture at ileocolic or ileorectal anastomosis, restricture of previously performed strictureplasties [17], and for duodenal strictures [18][19][20]. A certain number of techniques have been proposed to quantify the caliber of the stenoses that must be treated surgically [21,22•].…”

Section: Strictureplastymentioning

confidence: 99%

Obstruction in Crohn’s disease: Strictureplasty versus resection

Laureti

Fazio

2000

Curr Treat Options Gastro

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Although the long-term outcome of patients undergoing strictureplasty is still to be determined, safety and effectiveness of this technique have been widely demonstrated in several reports during the past decade, with follow-up up to 10 years. However, since contraindications exist, careful selection of patients is needed. Thus, strictureplasty does not replace resection, but must be considered as a valid adjunct to conventional excisions surgery for obstructive small bowel Crohn's disease, expecially when the patient is vulnerable to short bowel syndrome. Further studies with longer follow-up are needed to determine whether or not nonresective techniques should be used with the view of sparing bowel length, in cases where resection can be done without an actual risk of short bowel syndrome (eg, terminal ileitis, where resection of terminal ileum and cecum has always been considered the "gold standard").

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“…Indications for surgery of gastroduodenal disease have been reviewed by Reynolds and Stellato [35], who summarized 6 series [16,36,37,38,39] with a total of 108 patients: 90 (83%) underwent surgery for obstruction, 12 (11%) for refractory pain and 5 (5%) for massive bleeding.…”

Section: Treatmentmentioning

confidence: 99%

Upper Gastrointestinal Crohn’s Disease

et al. 2007

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Symptomatic gastroduodenal manifestations of Crohn’s disease are rare, with less than 4% of patients being clinically symptomatic. Gastroduodenal involvement may, however, be found endoscopically in 20% and in up to 40% of cases histologically, most frequently as Helicobacter pylori-negative focal gastritis, usually in patients with concomitant distal ileal disease. In practice, the activity of concomitant distal Crohn’s disease usually determines the indication for therapy, except in the presence of obstructive gastroduodenal symptoms. With the few data available, it seems correct to say that localized gastroduodenal disease should be treated with standard medical therapy used for more distal disease, with the exception of the galenic formulation of sulfasalazine and mesalazine with pH-dependent release. The presence of symptoms of obstruction needs aggressive therapy. If medical therapy with steroids and immunomodulatory drugs does not alleviate the symptoms, balloon dilation and surgery are the options to consider.

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Duodenal involvement of Crohn's disease

Cited by 55 publications

References 19 publications

Ampullary Stenosis with Biliary Obstruction in Duodenal Crohn’s Disease: A Case Report and Review of the Literature

Ampullary Stenosis with Biliary Obstruction in Duodenal Crohn’s Disease: A Case Report and Review of the Literature

Obstruction in Crohn’s disease: Strictureplasty versus resection

Upper Gastrointestinal Crohn’s Disease

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