Upper Gastrointestinal Involvement of Crohn's Disease: A Prospective Study on the Role of Upper Endoscopy in the Diagnostic Work-Up
Upper Gastrointestinal Involvement of Crohn's Disease: A Prospective Study on the Role of Upper Endoscopy in the Diagnostic Work-Up
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DOI：
10.1007/s10620-012-2072-0
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发表时间：
2012-06-01
影响因子：
3.1
通讯作者：
Cicala, Michele
中科院分区：
文献类型：
--
作者：
Annunziata, Maria Laura;Caviglia, Renato;Cicala, Michele
据报道，成人克罗恩病 (CD) 上胃肠道 (GI) 受累的患病率非常低 (0.3-5%)。在常规实践中，仅建议对有上消化道症状的克罗恩病患者进行上消化道内镜检查。关于克罗恩病患者无症状上消化道病变患病率的现有数据存在争议。本研究的目的是前瞻性评估 CD 患者中上消化道 CD 受累的患病率，无论上消化道症状如何。连续 119 名 CD 患者接受了临床评估，包括上消化道症状的发生和评分，以及上消化道内窥镜检查和活检样本，以进行组织学评估和幽门螺杆菌 (Hp) 感染检测。为了进一步将上消化道病变识别为 CD 或其他形式的炎症，在 CD 患者亚组中，在接受 12 周抗 TNF-α 或与质子泵抑制剂相关的其他治疗后，重复进行组织学和内窥镜评估。19/119 (16%) 患者发现上消化道受累。 10/119 (8.4%) CD 患者中检测到 Hp 感染。 34/119 (28.6%) CD 患者中发现 Hp 阴性局灶性活动性慢性胃炎。目前，12/19 例（63%）显示上消化道受累的患者无症状，7 例（37%）有症状。在 CD 患者中观察到上消化道受累的患病率很高，无论上消化道症状如何。这一发现表明常规上消化道内窥镜检查在克罗恩病患者的诊断检查中很有用，可以正确分类疾病的分布和程度。
Prevalence of upper gastrointestinal (GI) tract involvement in adult Crohn's disease (CD) has been reported to be very low (0.3-5%). In routine practice, upper endoscopy is recommended only in CD patients with upper GI symptoms. Available data concerning the prevalence of asymptomatic upper GI lesions in CD patients are controversial. The aim of this study was to prospectively evaluate the prevalence of upper GI CD involvement in CD patients, irrespective of upper GI symptoms.A series of 119 consecutive CD patients underwent clinical assessment, including occurrence and score of upper GI symptoms, and upper endoscopy with biopsy samples for histological assessment and Helicobacter pylori (Hp) infection detection. In an attempt to further recognize the upper GI tract lesions as CD or other form of inflammation, in a subgroup of CD patients, the histological and endoscopic evaluation was repeated following 12 weeks of anti-TNF-alpha or other treatments in association with proton-pump inhibitors.Upper CD involvement was found in 19/119 (16%) patients. Hp infection was detected in 10/119 (8.4%) CD patients. Hp-negative focally active chronic gastritis was found in 34/119 (28.6%) CD patients. At presentation, 12/19 patients (63%) showing upper CD involvement were asymptomatic and 7 (37%) symptomatic.A high prevalence of upper GI tract involvement has been observed in CD patients, irrespective of upper symptoms. This finding suggests the usefulness of routine upper endoscopy in the diagnostic work-up of CD patients in order to correctly classify the distribution and extent of the disease.