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

Kara M. De Felice, David A. Katzka, Laura E. Raffals

Research output: Contribution to journalArticlepeer-review

30 Scopus citations


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
Issue number9
StatePublished - Jun 12 2015


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

ASJC Scopus subject areas

  • Immunology and Allergy
  • Gastroenterology


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