Crohn's Disease of the Esophagus: Clinical Features and Treatment Outcomes in the Biologic Era
Crohn's Disease of the Esophagus: Clinical Features and Treatment Outcomes in the Biologic Era
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DOI：
10.1097/mib.0000000000000469
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发表时间：
2015-09-01
影响因子：
4.9
通讯作者：
Raffals, Laura E.
中科院分区：
文献类型：
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作者：
De Felice, Kara M.;Katzka, David A.;Raffals, Laura E.
背景：食管克罗恩病（CD）是一种具有挑战性的疾病，通常是一种致残性疾病。我们的目的是报告食管CD患者的临床、内窥镜、组织学特征和治疗结果。方法：1998年1月至2012年12月期间，在明尼苏达州罗切斯特的马约诊所评估了食管CD患者。结果：确定了24例食管CD病例。诊断的中位年龄为23岁（范围，12-60岁）。在食管CD症状发作时，21例患者（88%）患有食管外CD，8例患者（33%）患有口腔溃疡。大多数患者有泌尿系特异性症状。食管中段（29%）或远端（29%）是最常见的受累部位。炎症性食管CD（75%）在内镜检查中表现为浅表溃疡（58%）、红斑和/或糜烂（50%）、深部溃疡（13%）和假性息肉（4%）。发现4例（17%）患者有食管狭窄，2例（8%）患者有瘘管病。在大多数病例的活检中观察到慢性炎症（83%），其中5例患者有相关肉芽肿。在我们的研究中，炎症性食管CD对泼尼松、局部布地奈德或生物制剂有反应。通过联合生物治疗、免疫调节剂和连续扩张（伴/不伴类固醇注射）成功治疗了食管CD梗阻。积极的药物治疗与生物制剂和内镜治疗用于瘘食管CD，但是，并不普遍effectived.Conclusions：食管CD应考虑在所有患者CD上消化道症状。早期识别，诊断和积极的医疗和/或内窥镜治疗是成功的结果所必需的。
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.