Crohn's disease of the esophagus: clinical features and outcomes.
OBJECTIVE
Crohn's disease of the esophagus is rare. We sought to determine the clinical features and outcome of patients with esophageal Crohn's disease seen at our institution.


METHODS
Patients with esophageal Crohn's disease evaluated at Mayo Clinic Rochester between 1976 and 1998 were identified.


RESULTS
Twenty patients (0.2%) with esophageal involvement were identified. Median age at diagnosis was 31 years (range, 7-77 years). Eleven patients (55%) were female. Extraesophageal Crohn's disease preceded or was found at the same time as the diagnosis of esophageal Crohn's in all cases. Sixteen patients (80%) had symptoms referable to the esophagus. Endoscopic findings included ulcers in 17 (85%), erythema or erosions in 8 (40%), and strictures in 4 patients (20%). One patient had a fistula. The most common histological findings were active chronic inflammation (75%) and ulcer (30%). No granulomata were identified. Approximately one-half of our patients improved with first-line therapy. Eleven patients (55%) received immune modifier therapy. Six showed significant improvement on azathioprine, 6-mercaptopurine, or cyclosporine. Esophageal dilatation was required in six patients, and three patients required surgery.


CONCLUSIONS
Esophageal Crohn's disease may be underdiagnosed. Patients with Crohn's disease complaining of esophageal symptoms should undergo upper endoscopy with biopsies, and the diagnosis of esophageal Crohn's disease should be entertained if aphthous or deep ulcers or strictures are present. Immune modifier therapy should be considered for steroid-dependent and steroid-resistant cases.
Decker
G A
GA
Inflammatory Bowel Disease Clinic, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Loftus
E V
EV
Pasha
T M
TM
Tremaine
W J
WJ
Sandborn
W J
WJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D003424:Crohn Disease / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D003627:Data Interpretation, Statistical; D004106:Dilatation; D004935:Esophageal Diseases / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D015122:Mercaptopurine / Q000627:therapeutic use; D019804:Mesalamine / Q000627:therapeutic use; D008875:Middle Aged; D013256:Steroids / Q000627:therapeutic use
D000894:Anti-Inflammatory Agents, Non-Steroidal; D007166:Immunosuppressive Agents; D013256:Steroids; D019804:Mesalamine; D015122:Mercaptopurine