Intest Res.  2020 Apr;18(2):210-218. 10.5217/ir.2019.00091.

Histologically confirmed upper gastrointestinal Crohn’s disease: is it rare or are we just not searching hard enough?

• Saadah OI
• Fallatah K
• Baumann C
• Elbaradie
• Howladar F
• Daiwali MT
• Alshuaibi
• Alsahafi M
• Bokhary RY
• Qari YA
• Peyrin-Biroulet L
• Mosli MH

• KMID: 2501386
• DOI: http://doi.org/10.5217/ir.2019.00091

Abstract

Background/Aims
Crohn’s disease (CD) may involve the upper parts of the gastrointestinal (GI) tract including the esophagus, stomach, and duodenum. Clinical features of upper GI CD (UGICD) are not well characterized in the Gulf region. We therefore aimed to assess the prevalence and clinical characteristics of patients diagnosed with UGICD.
Methods
We performed a retrospective analysis of all patients diagnosed with CD who underwent upper GI endoscopy between 2012 and 2017 at King Abdulaziz University Hospital, irrespective of age. Patients who had endoscopy of the upper GI tract at baseline and had histologically confirmed UGICD were included. Data on patients’ demographics, clinical characteristics, extraintestinal manifestations and complications were reviewed.
Results
We identified 78 CD patients who underwent upper GI endoscopy from our medical records. The mean age was 17.2±8.7 years and 55.1% were males. Of the total, 19 out of 78 patients (24.4%) had histologically confirmed UGICD (3 esophageal, 16 gastric, and 9 duodenal), of which 52.6% were symptomatic. Disease distribution was ileal in 57.8%, colonic in 21.1% and ileo-colonic in 21.1%. A non-stricturing and non-penetrating phenotype was reported in 89.4%, stricturing in 5.3%, and penetrating in 5.3%. Perianal disease was found in 10.5%. UGICD was complicated by stricture formation in 2 patients (esophageal and gastric).
Conclusions
The prevalence of UGICD is considered high among CD Saudi patients who undergo upper GI endoscopy at baseline, and is asymptomatic in 47.4% of patients. This reported prevalence is not dissimilar from reports originating from Western countries.

Keyword

Crohn disease; Inflammatory bowel disease; Esophagitis; Gastro-duodenal; Saudi Arabia

Figure

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  Fig. 1. Focally enhanced gastritis. (A) Low power view of gastric body-type mucosa with patchy chronic gastritis (H&E, ×100). (B) High detail showing dense collection of chronic inflammatory cells around some antral glands with neutrophils infiltrating the glandular epithelium (H&E, ×200).

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  Fig. 2. Non-caseating granuloma in duodenal biopsy. (A) Low power view (H&E, ×40) and (B) high power view (H&E, ×200).

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