Endoscopic Results in Five Patients with Crohn's Disease of the Esophagus

Abstract

In our experience with five cases of Crohn's disease of the esophagus, the endoscopic appearance has been demonstrated. Corresponding to the basic pathological changes, the findings are very different, but two stages may be differentiated: Stage I in which inflammatory changes predominate as a mild or more often erosive-ulcerative esophagitis. Stage II is a stenosing form similar to a peptic stenosis or to a stenosing tumor. The morphological changes are predominantly limited to the lower part of the esopha.gus with a tendency to extend to the proximal regions. The diagnosis may be established endoscopically only in special cases with shallow ulcerations within a normal mucosa or with cobble-stone relief whidi is usually seen in the colon. In all other cases, a specific macroscopical appearance of Crohn's disease of the esophagus does not exist and no specific differentiation is possible from other forms of esophagitis. Only by a combination of endoscopy, radiology and histology can the diagnosis be suspected. Guided biopsies are not able to confirm the diagnosis histologically. The exact diagnosis of Crohn's disease of the esophagus is only possible by histological examination of the resected esophagus.

Crohn's disease of the esophagus

“…These lesions closely mimic reflux-induced or malignant stenoses, and rnisdiagnosis is possible because guided biopsy in patients with ECD rarely yields typical histologic features of Crohn's disease [10]. In most cases described so far, the diagnosis was presumptive: suggested by the typical history and intestinal localization of the disease, or made based on the findings from an operative specimen.…”

Crohn’s disease of the esophagus: Report of a case

“…Isolated esophageal lesions were reported in ten patients (13.0%, 10/77), 2,6,7,11,13,37 which were difficult to diagnose as Crohn's disease. In fact, none of these patients were able to be diagnosed before surgery and all underwent surgery for suspected esophageal carcinoma or for severe symptoms induced by the extensive ulcers.…”

Aphthoid esophageal ulcers in Crohn's disease of ileum and colon

“…Even specimens from guided biopsies of the lesions are not able to confirm the diagnosis of Crohn's disease of the esophagus. The exact diagnosis can only be made by histologic examination of the resected esophagus [7]. Superficial esophageal erosions are also seen with reflux and with herpetic and mycotic esophagitis [11].…”