[Crohn's disease of the digestive tract proximal. A rare presentation of an uncommon disease in Mexico].
Although Crohn Disease (CD) can affect any part of the digestive tract its presentation in the upper digestive tract (UDT) is very uncommon. Recently we have seen some patients with CD in UDT. Because our Institute is a third level reference hospital in Mexico, we decided to review all patients with CD looking for those with UDT in order to know their clinical.


METHODS
[corrected] Clinical records of all patients with histological diagnosis of CD were reviewed. Clinical and biochemical analysis was done in each case. Location of CD was established by endoscopy or radiology methods. Statistical differences were evaluated by Student t test,Fisher exact test and X2 test.


RESULTS
The diagnosis of CD was established in 72 patients during the period of study (13 years). Sixty of them had distal CD while lesions in the upper digestive tract were detected in 12 (17%). Clinical parameters that showed statistical differences between patients with UDT and LDT-CD were: Age: 29.8+/-13.8 vs. 49.8+/-17 years (p=0.035), BMI: 19.6+/-3.6 vs. 22.6+/-4.9 kg/m2 (p=0.001) and platelets count: 561.4+/-242 vs. 408+/-165/mm3 (p=0.021), respectively. Patients with UDT-CD had more frequency of dysphagia, odinophagia and oral ulcers when compared with LDT affected patients. Six patients had esophageal involvement, three showed oral lesions,two pharyngeal ulcers and one duodenal ulcer. In all but one patient lesions in the distal part were concomitantly detected. Thus only in one case isolated UDT involvement was observed.


CONCLUSIONS
Mexicans patients with UDT-CD were younger, had a lower BMI and a higher platelets count when compared with LDT-CD patients. Solitary lesions in esophagus, stomach and duodenum are rare, occurring only in 1 of the 72 cases (3%). Dysphagia, odinophagia and oral ulcers must be a warning about the possibility of CD in the UDT portions.
Mejía-Rivas
M
M
Departamento de Gastroenterología, Dirección de Enseñanza, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Vasco de Quiroga #15, Colonia Sección XVI, C.P. 14000, Tlalpan, Mexico, D.F.
Yamamoto-Furusho
J
J
Remes-Troche
J M
JM
Uscanga
L
L
D000328:Adult; D003424:Crohn Disease / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008800:Mexico; D008875:Middle Aged; D041742:Upper Gastrointestinal Tract