Endoscopic findings in the upper gastrointestinal tract in patients with Crohn’s disease are common, highly specific, and associated with chronic gastritis

Abstract

Crohn’s disease (CD) may affect the entire gastrointestinal tract including its upper part. However, this aspect is poorly addressed in scientific literature and considered a rare finding. Here we aimed to prospectively investigate the prevalence, characteristics and clinical significance of upper gastrointestinal tract involvement in patients with CD, with particular focus on stomach bamboo joint-like appearance (BJA), Helicobacterpylori status and presence of microscopic changes. 375 prospectively recruited patients were included. In CD patients the prevalence of gastric and duodenal, but not esophageal, mucosal lesions, such as gastric mucosal inflammation, duodenal edema, ulcerations, and duodenal bulb deformation was significantly higher (at least p < 0.01 for all). Similar results were found when only H.pylori negative individuals were analyzed. Moreover, BJA of the stomach and in case of H.pylori negative patients also duodenal bulb deformation were detected exclusively in CD patients. Presence of BJA lesion was not significantly associated with neither duration of the disease nor use/history of biologic treatment. Despite absence of H.pylori infection microscopic features of chronic gastritis were found in almost all (93.5%) patients, and in 31% of controls (p < 0.00001). Our analysis outlines that upper gastrointestinal tract involvement in CD is a very common event and frequently manifests with a highly specific BJA lesion. Furthermore, our study reveals that in almost all CD patients features of H.pylori negative gastritis are present.

Poorly Cohesive Carcinoma of the Nonampullary Small Bowel: A Rare Cause of Recurrent Small Bowel Obstruction

“… 3 Therefore, the patient underwent antegrade and retrograde single balloon-assisted enteroscopy, which yielded nonspecific pathology results and inconclusive findings to explain symptoms. In Crohn's disease, one would expect to find notable endoscopic and histologic findings of the mucosa, 6 which our patient did not have despite suggestive CT findings. Furthermore, normal villi in the duodenum and negative tissue transglutaminase made celiac disease less likely.…”

Duodenal Crohn’s disease: Case report and systematic review

“…Serpiginous or linear ulcers distinguish DCD ulcers from peptic ulcers[ 80 ]. Graca-Pakulsa et al [ 81 ] reported a higher likelihood of duodenal abnormalities in DCD patients through endoscopy, including aphthous lesions, duodenal bulb deformation, duodenal ulceration, and mucosal swelling.…”