Treatment of gastroduodenal Crohn's disease.
Symptomatic gastroduodenal manifestations of Crohn's disease (CD) are rare, with less than 4% of patients being clinically symptomatic. Gastroduodenal involvement may, however, be found endoscopically in 20% and in up to 40% of cases histologically, most frequently as Helicobacter pylori-negative focal gastritis, usually in patients with concomitant distal ileal disease. In practice, the activity of concomitant distal CD usually determines the indication for therapy, except in the presence of obstructive gastroduodenal symptoms. With the few data available, it seems correct to say that localized gastroduodenal disease should be treated with standard medical therapy used for more distal disease, with the exception of sulfasalazine and mesalanine with pH-dependent release. Presence of symptoms of obstruction needs aggressive therapy. If medical therapy with steroids and immunomodulatory drugs does not alleviate the symptoms, balloon dilation and surgery are the options to consider.
Mottet
Christian
C
Division of Gastroenterology and Hepatology, Lausanne University Medical Center, Lausanne, Switzerland. Christian.Mottet@hospvd.ch
Juillerat
Pascal
P
Gonvers
Jean-Jacques
JJ
Michetti
Pierre
P
Burnand
Bernard
B
Vader
John-Paul
JP
Felley
Christian
C
Froehlich
Florian
F
D002404:Catheterization; D003424:Crohn Disease / Q000150:complications / Q000628:therapy*; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007415:Intestinal Obstruction / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome
D005938:Glucocorticoids; D007155:Immunologic Factors