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Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Mar 7, 2019; 10(2): 35-49
Published online Mar 7, 2019. doi: 10.4292/wjgpt.v10.i2.35
Crohn’s disease of esophagus, stomach and duodenum
Andréa Maia Pimentel, Raquel Rocha, Genoile Oliveira Santana
Andréa Maia Pimentel, Genoile Oliveira Santana, Programa de Pós graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador 40110-060, Bahia, Brazil
Raquel Rocha, Departamento de Ciências da Nutrição, Universidade Federal da Bahia, Salvador 40110-060, Bahia, Brazil
Author contributions: Pimentel AM reviewed the literature and wrote the manuscript; Santana GO oversaw the essay writing and critically analyzed the article, giving an important intellectual contribution to the content of the article; Rocha R reviewed the article, contributing to its content.
Conflict-of-interest statement: No conflicts of interest associated with any of the authors or coauthors who contributed to the realization of this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Raquel Rocha, DSc, MSc, Assistant Professor, Departamento de Ciências da Nutrição, Universidade Federal da Bahia, Avenida Araújo Pinho, número 32, Salvador 40110-060, Bahia, Brazil. raquelrocha@yahoo.com.br
Telephone: +55-71-32837721 Fax: +55-71-32837721
Received: October 22, 2018
Peer-review started: October 22, 2018
First decision: November 29, 2018
Revised: January 31, 2019
Accepted: February 27, 2019
Article in press: February 27, 2019
Published online: March 7, 2019
Processing time: 138 Days and 7 Hours
Abstract

Crohn’s disease with involvement of the esophagus, stomach and duodenum has a prevalence of 0.5% to 4% in symptomatic adult patients, but some studies have shown that these results may be underestimated, since upper gastrointestinal endoscopy is not performed routinely in the initial evaluation of the disease in adult patients, as it is in the pediatric population. In general, involvement of the upper gastrointestinal tract in Crohn’s disease occurs concomitantly with involvement of the lower gastrointestinal tract. The diagnosis depends on clinical, endoscopic, histological and radiological evaluation. The presence of aphthoid ulcers, longitudinal ulcers, bamboo-joint-like appearance, stenoses and fistulas are endoscopic findings suggestive of the disease, and it is important to exclude the presence of Helicobacter pylori infection. The primary histological findings, which facilitate the diagnosis, are the presence of a chronic inflammatory process with a predominance of lymphoplasmacytic cells and active focal gastritis. The presence of epithelioid granuloma, although less frequent, is highly suggestive of the disease in the absence of chronic granulomatous disease. Treatment should include the use of proton pump inhibitors associated with corticosteroids, immunomodulators and biological therapy according to the severity of the disease.

Keywords: Crohn’s disease; Upper gastrointestinal tract; Upper digestive endoscopy; Esophagus; Stomach; Duodenum; Chronic gastritis; Focal gastritis; Epithelioid granuloma

Core tip: Crohn’s disease is a chronic inflammatory disease, which involves any segment of the mouth to the anus, but the involvement of the upper tract is less known, especially in the adult population, in which routine upper endoscopy is not indicated, as in the pediatric population. It is important to know the aspects related to Crohn’s disease with involvement of the esophagus, stomach and duodenum, in order to facilitate its diagnosis and treatment.