title: Crohn's Disease of the Esophagus: Clinical Features and Treatment Outcomes in the Biologic Era.
abstract: BACKGROUND
  Esophageal Crohn's disease (CD) is challenging and often a disabling phenotype of disease. We aimed to report the clinical, endoscopic, histologic features, and treatment outcomes of esophageal patients with CD.
  
  
  METHODS
  Esophageal patients with CD evaluated at the Mayo Clinic in Rochester, MN, between January, 1998, and December, 2012, were identified.
  
  
  RESULTS
  Twenty-four cases of esophageal CD were identified. The median age of diagnosis was 23 years (range, 12-60). Twenty-one patients (88%) had extraesophageal CD and 8 patients (33%) had oral ulcers at the time of esophageal CD symptom onset. The majority of patients had esophageal-specific symptoms. Mid (29%) or distal (29%) esophagus was the most common site of involvement. Inflammatory esophageal CD (75%) was marked by superficial ulcerations (58%), erythema and/or erosions (50%), deep ulcerations (13%), and pseudopolyps (4%) on endoscopy. Four patients (17%) were found to have esophageal strictures and 2 patients (8%) had fistulizing disease. Chronic inflammation (83%) was seen on biopsy in the majority of cases with 5 patients having associated granulomas. In our series, inflammatory esophageal CD responded to prednisone, topical budesonide, or biologics. Stricturing esophageal CD was successfully treated with a combination of biologic therapy, immunomodulators, and serial dilations with/without steroid injections. Aggressive medical therapy with biologics and endoscopic therapy was used for fistulizing esophageal CD, however, was not universally effective.
  
  
  CONCLUSIONS
  Esophageal CD should be considered in all patients with CD with upper gastrointestinal symptoms. Early recognition, diagnosis, and aggressive medical and/or endoscopic treatment are needed for successful outcomes.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Kara M
authors.initials: KM
authors.lastname: De Felice
authors.forename: David A
authors.initials: DA
authors.lastname: Katzka
authors.forename: Laura E
authors.initials: LE
authors.lastname: Raffals
mesh_terms: D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001688:Biological Products / Q000627:therapeutic use; D019819:Budesonide / Q000627:therapeutic use; D002648:Child; D003131:Combined Modality Therapy; D003424:Crohn Disease / Q000473:pathology* / Q000628:therapy*; D004106:Dilatation; D004359:Drug Therapy, Combination; D004935:Esophageal Diseases / Q000473:pathology* / Q000628:therapy*; D004945:Esophagoscopy / Q000379:methods; D004947:Esophagus / Q000473:pathology; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D001688:Biological Products; D007155:Immunologic Factors; D019819:Budesonide; D011241:Prednisone