Abstract
Crohn's disease may affect any part of the GI tract but involvement proximal to the jejunum (UGI) is considered uncommon. Among 228 Crohn's disease patients diagnosed over the past 15 years, 73(32%) had UGI disease. Duodenal lesions were most commonly noted followed by gastric and esophageal. Although in 70% of cases, there was concordance between Xray and endoscopic findings, UGI Crohn's disease was endoscopically documented in 9/32 with normal Xrays. Epithelioid, multinucleated cells or granulomas were found in 30% of biopsies while chronic inflammatory changes were present in the others. A peptic disease type of pain or postprandial nausea or vomiting was present in 2/3 of cases. There was no increase in the incidence of extra-intestinal manifestations in those with UGI disease except for aphtous lesions of the mouth (50%). In only 5 patients was the disease limited to the UGI tract. Of 31 cases with terminal ileitis, less than 20% had UGI compared to an incidence of 30% in the 151 with ileocolitis and than 40% in colitis. Of interest was the fact that radiological and endoscopic findings pointed erroneously to a diagnosis of ulcerative colitis in 12.3% of the patients with UGI. This study demonstrates a high incidence of Crohn's disease proximal to the jejunum in children and suggests that an upper endoscopy should be carried out whenever chronic IBD is suspected.
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Lenaerts, C., Weber, A., Maurage, C. et al. 81. UPPER GI TRACT INVOLVEMENT IN CHILDREN WITH CROHN'S DISEASE. Pediatr Res 22, 109 (1987). https://doi.org/10.1203/00006450-198707000-00102
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DOI: https://doi.org/10.1203/00006450-198707000-00102