Esophageal Crohn disease in children: a clinical spectrum.
BACKGROUND
The incidence of esophageal Crohn disease (ECD) in adults ranges from 0.2% to 11.2% and in children is up to 43%. The aim of the study was to determine the clinical and endoscopic spectrum of ECD and its prevalence in our patient population.


METHODS
Chart review of children with Crohn disease (CD). Esophageal Crohn disease was defined by accepted endoscopic and/or histologic findings.


RESULTS
210 children with CD were identified; 27 of those children had ECD. Nine children presented with specific upper GI symptoms; dysphagia, heartburn, nausea, vomiting, and odynophagia. Esophagoscopy in children with upper gastrointestinal symptoms revealed deep ulcers (n = 2), aphthous ulcers (n = l), erosions (n = l), edematous nodules, (n = l) and normal mucosa (n = 4). In asymptomatic children aphthous ulcers (n = 5), erosions (n = 3), deep ulcers (n = 3), and normal looking mucosa (n = 7) were seen. Twenty children also had gastric lesions, 3 children had duodenal lesions, and 3 children had both duodenal and gastric involvement. All 27 children had evidence of ileo-colonic or colonic disease. Acid suppressive medications were given only to children with upper GI symptoms and endoscopic esophageal lesions. The mean duration of follow-up from diagnosis of CD was 3.02 years (range 2 months-11.7 years). At last follow-up review, 7 children were receiving acid suppression and no children were receiving steroids. There were no complications related to ECD.


CONCLUSIONS
The prevalence of endoscopic ECD is 7.6% but as many as 17.6% of our patient population had histologic evidence of ECD. The clinical and endoscopic spectrum of ECD are highly variable and poorly correlate with each other.
Ramaswamy
Kannan
K
Division of Gastroenterology, British Columbia's Children's Hospital, 4480 Oak Street, Vancouver V6H 3V4, BC, Canada.
Jacobson
Kevan
K
Jevon
Gareth
G
Israel
David
D
D002648:Child; D002675:Child, Preschool; D003113:Colonoscopy; D003424:Crohn Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery; D016145:Endoscopy, Digestive System; D004941:Esophagitis / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D004947:Esophagus / Q000473:pathology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009853:Omeprazole / Q000627:therapeutic use; D011859:Radiography; D011899:Ranitidine / Q000627:therapeutic use
D011899:Ranitidine; D009853:Omeprazole