Crohn's disease of the esophagus: Clinical features and treatment outcomes in the biologic era

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background: Esophageal Crohn's disease (CD) is challenging and often a disabling phenotype of disease. We aimed to report the clinical, endoscopic, histologic features, and treatment outcomes of esophageal patients with CD. Methods: Esophageal patients with CD evaluated at the Mayo Clinic in Rochester, MN, between January, 1998, and December, 2012, were identified. Results: Twenty-four cases of esophageal CD were identified. The median age of diagnosis was 23 years (range, 12-60). Twenty-one patients (88%) had extraesophageal CD and 8 patients (33%) had oral ulcers at the time of esophageal CD symptom onset. The majority of patients had esophageal-specific symptoms. Mid (29%) or distal (29%) esophagus was the most common site of involvement. Inflammatory esophageal CD (75%) was marked by superficial ulcerations (58%), erythema and/or erosions (50%), deep ulcerations (13%), and pseudopolyps (4%) on endoscopy. Four patients (17%) were found to have esophageal strictures and 2 patients (8%) had fistulizing disease. Chronic inflammation (83%) was seen on biopsy in the majority of cases with 5 patients having associated granulomas. In our series, inflammatory esophageal CD responded to prednisone, topical budesonide, or biologics. Stricturing esophageal CD was successfully treated with a combination of biologic therapy, immunomodulators, and serial dilations with/without steroid injections. Aggressive medical therapy with biologics and endoscopic therapy was used for fistulizing esophageal CD, however, was not universally effective. Conclusions: Esophageal CD should be considered in all patients with CD with upper gastrointestinal symptoms. Early recognition, diagnosis, and aggressive medical and/or endoscopic treatment are needed for successful outcomes.

Original languageEnglish (US)
Pages (from-to)2106-2113
Number of pages8
JournalInflammatory Bowel Diseases
Volume21
Issue number9
DOIs
StatePublished - Jun 12 2015

Fingerprint

Crohn Disease
Esophageal Diseases
Esophagus
Biological Therapy
Oral Ulcer
Esophageal Stenosis
Budesonide
Immunologic Factors
Erythema
Prednisone
Granuloma
Biological Products
Endoscopy
Early Diagnosis
Dilatation
Steroids
Inflammation
Phenotype
Biopsy
Injections

Keywords

  • esophageal fistula
  • esophageal stricture
  • esophageal ulcers
  • oral ulcers

ASJC Scopus subject areas

  • Gastroenterology
  • Immunology and Allergy

Cite this

Crohn's disease of the esophagus : Clinical features and treatment outcomes in the biologic era. / De Felice, Kara M.; Katzka, David A; Raffals, Laura E. H.

In: Inflammatory Bowel Diseases, Vol. 21, No. 9, 12.06.2015, p. 2106-2113.

Research output: Contribution to journalArticle

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abstract = "Background: Esophageal Crohn's disease (CD) is challenging and often a disabling phenotype of disease. We aimed to report the clinical, endoscopic, histologic features, and treatment outcomes of esophageal patients with CD. Methods: Esophageal patients with CD evaluated at the Mayo Clinic in Rochester, MN, between January, 1998, and December, 2012, were identified. Results: Twenty-four cases of esophageal CD were identified. The median age of diagnosis was 23 years (range, 12-60). Twenty-one patients (88{\%}) had extraesophageal CD and 8 patients (33{\%}) had oral ulcers at the time of esophageal CD symptom onset. The majority of patients had esophageal-specific symptoms. Mid (29{\%}) or distal (29{\%}) esophagus was the most common site of involvement. Inflammatory esophageal CD (75{\%}) was marked by superficial ulcerations (58{\%}), erythema and/or erosions (50{\%}), deep ulcerations (13{\%}), and pseudopolyps (4{\%}) on endoscopy. Four patients (17{\%}) were found to have esophageal strictures and 2 patients (8{\%}) had fistulizing disease. Chronic inflammation (83{\%}) was seen on biopsy in the majority of cases with 5 patients having associated granulomas. In our series, inflammatory esophageal CD responded to prednisone, topical budesonide, or biologics. Stricturing esophageal CD was successfully treated with a combination of biologic therapy, immunomodulators, and serial dilations with/without steroid injections. Aggressive medical therapy with biologics and endoscopic therapy was used for fistulizing esophageal CD, however, was not universally effective. Conclusions: Esophageal CD should be considered in all patients with CD with upper gastrointestinal symptoms. Early recognition, diagnosis, and aggressive medical and/or endoscopic treatment are needed for successful outcomes.",
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