Proximal Crohn's disease: review of the clinicopathologic features and therapy.
Crohn's disease in the proximal region of the digestive tract is uncommon. Better diagnostically procedures and more careful histologic examination has led to a higher detection of proximal Crohn's disease. The diagnosis is based on symptoms, endoscopy with serial sections, or double contrast radiography. The most common histologic finding for this diagnosis are granulomas in the mucosa in Helicobacter pylori-negative patients, but the granulomas are not always frequently detected. Endoscopic lesions in the proximal regions look like the lesions that could be found in the distal regions. Notching in the duodenal folds could be a strong indication for Crohn's desease. Radiological lesions are not always characteristic, but should be used in combination with endoscopy. Stenosis is an important complication, but fistula formation and pseudodiverticular formation is possible. There is no uniform medical therapy, but the regular anti-inflammatory management for Crohn's disease is most often used. Sometimes surgery is needed.
van Hogezand
R A
RA
Department of Gastroenterology-Hepatology, Leiden University Medical Center, The Netherlands. R.A.van_hogezand.mdlz@lumc.nl
Witte
A M
AM
Veenendaal
R A
RA
Wagtmans
M J
MJ
Lamers
C B
CB
D003424:Crohn Disease / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D003937:Diagnosis, Differential; D004386:Duodenum / Q000473:pathology; D004947:Esophagus / Q000473:pathology; D006801:Humans; D007583:Jejunum / Q000473:pathology; D013270:Stomach / Q000473:pathology