title: Treatment of gastroduodenal Crohn's disease.
abstract: 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.
authors.affiliation: Division of Gastroenterology and Hepatology, Lausanne University Medical Center, Lausanne, Switzerland. Christian.Mottet@hospvd.ch
authors.forename: Christian
authors.initials: C
authors.lastname: Mottet
authors.forename: Pascal
authors.initials: P
authors.lastname: Juillerat
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Gonvers
authors.forename: Pierre
authors.initials: P
authors.lastname: Michetti
authors.forename: Bernard
authors.initials: B
authors.lastname: Burnand
authors.forename: John-Paul
authors.initials: JP
authors.lastname: Vader
authors.forename: Christian
authors.initials: C
authors.lastname: Felley
authors.forename: Florian
authors.initials: F
authors.lastname: Froehlich
mesh_terms: 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
chemical_list: D005938:Glucocorticoids; D007155:Immunologic Factors