Upper gastrointestinal Crohn's disease.
Symptomatic gastroduodenal manifestations of Crohn's disease 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 Crohn's disease 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 the galenic formulation of sulfasalazine and mesalazine with pH-dependent release. The 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, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland. christian.mottet@chuv.ch
Juillerat
Pascal
P
Pittet
Valérie
V
Gonvers
Jean-Jacques
JJ
Michetti
Pierre
P
Vader
John-Paul
JP
Felley
Christian
C
Froehlich
Florian
F
D000911:Antibodies, Monoclonal / Q000627:therapeutic use; 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; D054328:Proton Pump Inhibitors; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D005938:Glucocorticoids; D007155:Immunologic Factors; D054328:Proton Pump Inhibitors