The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.
SMJ // Article
Review Article
Upper Gastrointestinal Involvement in Crohn Disease: Histopathologic and Endoscopic Findings
Abstract
Objectives: Studies describing the prevalence of upper gastrointestinal (GI) Crohn disease (CD) and its histopathologic changes have been inconsistent as a result of different definitions used for upper GI involvement, diverse populations, and varying indications for endoscopy. We reviewed the literature describing endoscopic findings and histologic lesions in gastric and duodenal mucosa of patients with established CD.Methods: PubMed, EMBASE, and the Cochrane Library were searched for gastroduodenal biopsy findings in patients with CD from 1970 to 2014. We included all retrospective and prospective studies in adults. We calculated the prevalence of the most common endoscopic and histopathological findings among patients with overall CD and upper GI CD.
Results: Of the 385 articles identified, 20 eligible studies were included. A total of 2511 patients had CD and 815 had upper GI CD. In the CD group, the most common histopathological finding was nonspecific gastric inflammation in 32% of patients, followed by gastric granuloma in 7.9%. Focal gastritis was prevalent in 30.9% of patients. In the upper GI CD group, gastric inflammation was present in 84% of patients, followed by duodenal inflammation in 28.2% and gastric granuloma in 23.2%. The most common gastric endoscopic finding in patients with CD was erythema in 5.9%, followed by erosions in 3.7%. Duodenal endoscopic findings included ulcers and erythema in 5.3% and 3.0% of patients, respectively.
Conclusions: We found a prevalence of 34% for CD involving the upper GI tract across these 20 studies. Routine upper endoscopy with biopsies of the upper GI tract in the diagnostic workup of patients with CD can correctly classify the distribution and extent of the disease.
This content is limited to qualifying members.
Existing members, please login first
If you have an existing account please login now to access this article or view purchase options.
Purchase only this article ($25)
Create a free account, then purchase this article to download or access it online for 24 hours.
Purchase an SMJ online subscription ($75)
Create a free account, then purchase a subscription to get complete access to all articles for a full year.
Purchase a membership plan (fees vary)
Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.
References
1. Fielding JF, Toye DK, Beton DC, et al. Crohn’s disease of the stomach and duodenum. Gut 1970;11:1001-1006.
2. Haggitt RC, Meissner WA. Crohn’s disease of the upper gastrointestinal tract. Am J Clin Pathol 1973;59:613-622.
3. Thompson WM, Cockrill H Jr, Rice RP. Regional enteritis of the duodenum. Am J Roentgenol Radium Ther Nucl Med 1975;123:252-262.
4. Nugent FW, Roy MA. Duodenal Crohn’s disease: an analysis of 89 cases. Am J Gastroenterol 1989;84:249-254.
5. Annunziata ML, Caviglia R, Papparella LG, et al. Upper gastrointestinal involvement of Crohn’s disease: a prospective study on the role of upper endoscopy in the diagnostic work-up. Dig Dis Sci 2012;57:1618-1623.
6. Korelitz BI, Waye JD, Kreuning J, et al. Crohn’s disease in endoscopic biopsies of the gastric antrum and duodenum. Am J Gastroenterol 1981;76:103-109.
7. Oberhuber G, Puspok A, Oesterreicher C, et al. Focally enhanced gastritis: a frequent type of gastritis in patients with Crohn’s disease. Gastroenterology 1997;112:698-706.
8. Parente F, Cucino C, Bollani S, et al. Focal gastric inflammatory infiltrates in inflammatory bowel diseases: prevalence, immunohistochemical characteristics, and diagnostic role. Am J Gastroenterol 2000;95:705-711.
9. Sawczenko A, Sandhu BK. Presenting features of inflammatory bowel disease in Great Britain and Ireland. Arch Dis Child 2003;88:995-1000.
10. Kuriyama M, Kato J, Morimoto N, et al. Specific gastroduodenoscopic findings in Crohn’s disease: Comparison with findings in patients with ulcerative colitis and gastroesophageal reflux disease. Dig Liver Dis 2008;40:468-475.
11. Gad A. The diagnosis of gastroduodenal Crohn’s disease by endoscopic biopsy. Scand J Gastroenterol Suppl 1989;167:23-28.
12. Ando T, Nobata K, Watanabe O, et al. Abnormalities in the upper gastrointestinal tract in inflammatory bowel disease. Inflammopharmacology 2007;15:101-104.
13. Ando T, Watanabe O, Ishiguro K, et al. Relationships between Helicobacter pylori infection status, endoscopic, histopathological findings, and cytokine production in the duodenum of Crohn’s disease patients. J Gastroenterol Hepatol 2008;23(Suppl 2):S193-S197.
14. Alcantara M, Rodriguez R, Potenciano JL, et al. Endoscopic and bioptic findings in the upper gastrointestinal tract in patients with Crohn’s disease. Endoscopy 1993;25:282-286.
15. Parente F, Molteni P, Bollani S, et al. Prevalence of Helicobacter pylori infection and related upper gastrointestinal lesions in patients with inflammatory bowel diseases. A cross-sectional study with matching. Scand J Gastroenterol 1997;32:1140-1146.
16. Yardley JH, Hendrix TR. Gastroduodenal Crohn’s disease: the focus is on focality. Gastroenterology 1997;112:1031-1033.
16a. Ariyama J, Wehlin L, Lindstrom CG, et al. Gastroduodenal erosions in Crohn’s disease. Gastrointest Radiol 1980;5:121-125.
16b. D’Inca R, Sturniolo G, Cassaro M, et al. Prevalence of upper gastrointestinal lesions and Helicobacter pylori infection in Crohn’s disease. Dig Dis Sci 1998;43:988-992.
16c. Halme L, Sipponen PI, von Smitten KAJ. Involvement of gastroduodenal mucosa in Crohn’s disease. Eur J Gastroenterol Hepatol 1992;4:23-28.
16d. Hirokawa M, Shimizu M, Terayama K, et al. Bamboo-joint-like appearance of the stomach: a histopathological study. Acta Pathol Microbiol Immunol Scand 1999;107:951-956.
16e. Jaskiewicz K, Lemmer E. Histological findings in gastroduodenal mucosa in patients with Crohn’s disease. Any diagnostic significance? Pol J Pathol 1996;47:115-118.
16f. Oberhuber G, Hirsch M, Stolte M. High incidence of upper gastrointestinal tract involvement in Crohn’s disease. Virchows Arch 1998;432:49-52.
16g. Schmitz-Moormann P, Malchow H, Pittner PM. Endoscopic and bioptic study of the upper gastrointestinal tract in Crohn’s disease patients. Pathol Res Pract 1985;179:377-387.
16h. Tanaka M, Kimura K, Sakai H, et al. Long-term follow-up for minute gastroduodenal lesions in Crohn’s disease. Gastrointest Endosc 1986;32:206-209.
16i. Wright CL, Riddell RH. Histology of the stomach and duodenum in Crohn’s disease. Am J Surg Pathol 1998;22:383-390.
17. Sonnenberg A, Melton SD, Genta RM. Frequent occurrence of gastritis and duodenitis in patients with inflammatory bowel disease. Inflamm Bowel Dis 2011;17:39-44.
18. Halme L, Karkkainen P, Rautelin H, et al. High frequency of helicobacter negative gastritis in patients with Crohn’s disease. Gut 1996;38:379-383.
19. Yamamoto T, Allan RN, Keighley MR. An audit of gastroduodenal Crohn disease: clinicopathologic features and management. Scand J Gastroenterol 1999;34:1019-1024.
20. Rutgeerts P, Onette E, Vantrappen G, et al. Crohn’s disease of the stomach and duodenum: a clinical study with emphasis on the value of endoscopy and endoscopic biopsies. Endoscopy 1980;12:288-294.
21. Xin W, Greenson JK. The clinical significance of focally enhanced gastritis. Am J Surg Pathol 2004;28:1347-1351.
22. Meining A, Bayerdorffer E, Bastlein E, et al. Focal inflammatory infiltrations in gastric biopsy specimens are suggestive of Crohn’s disease. Crohn’s Disease Study Group, Germany. Scand J Gastroenterol 1997;32:813-818.
23. Danzi JT, Farmer RG, Sullivan BH Jr, et al. Endoscopic features of gastroduodenal Crohn’s disease. Gastroenterology 1976;70:9-13.
