title: Upper Gastrointestinal Involvement in Crohn Disease: Histopathologic and Endoscopic Findings.
abstract: OBJECTIVE
  Studies describing the prevalence of upper gastrointestinal (GI) Crohn disease (CD) and its histopathologic changes have been inconsistent as a result of different definitions used for upper GI involvement, diverse populations, and varying indications for endoscopy. We reviewed the literature describing endoscopic findings and histologic lesions in gastric and duodenal mucosa of patients with established CD.
  
  
  METHODS
  PubMed, EMBASE, and the Cochrane Library were searched for gastroduodenal biopsy findings in patients with CD from 1970 to 2014. We included all retrospective and prospective studies in adults. We calculated the prevalence of the most common endoscopic and histopathological findings among patients with overall CD and upper GI CD.
  
  
  RESULTS
  Of the 385 articles identified, 20 eligible studies were included. A total of 2511 patients had CD and 815 had upper GI CD. In the CD group, the most common histopathological finding was nonspecific gastric inflammation in 32% of patients, followed by gastric granuloma in 7.9%. Focal gastritis was prevalent in 30.9% of patients. In the upper GI CD group, gastric inflammation was present in 84% of patients, followed by duodenal inflammation in 28.2% and gastric granuloma in 23.2%. The most common gastric endoscopic finding in patients with CD was erythema in 5.9%, followed by erosions in 3.7%. Duodenal endoscopic findings included ulcers and erythema in 5.3% and 3.0% of patients, respectively.
  
  
  CONCLUSIONS
  We found a prevalence of 34% for CD involving the upper GI tract across these 20 studies. Routine upper endoscopy with biopsies of the upper GI tract in the diagnostic workup of patients with CD can correctly classify the distribution and extent of the disease.
authors.affiliation: From the Department of Internal Medicine, University of Miami/Jackson Memorial Hospital, and the Division of Gastroenterology, University of Miami, Miami, Florida.
authors.forename: Liege
authors.initials: L
authors.lastname: Diaz
authors.affiliation: From the Department of Internal Medicine, University of Miami/Jackson Memorial Hospital, and the Division of Gastroenterology, University of Miami, Miami, Florida.
authors.forename: Rafael Enrique
authors.initials: RE
authors.lastname: Hernandez-Oquet
authors.affiliation: From the Department of Internal Medicine, University of Miami/Jackson Memorial Hospital, and the Division of Gastroenterology, University of Miami, Miami, Florida.
authors.forename: Amar R
authors.initials: AR
authors.lastname: Deshpande
authors.affiliation: From the Department of Internal Medicine, University of Miami/Jackson Memorial Hospital, and the Division of Gastroenterology, University of Miami, Miami, Florida.
authors.forename: Baharak
authors.initials: B
authors.lastname: Moshiree
mesh_terms: D001706:Biopsy; D003424:Crohn Disease / Q000453:epidemiology / Q000473:pathology*; D004386:Duodenum / Q000473:pathology*; D004947:Esophagus / Q000473:pathology*; D019317:Evidence-Based Medicine; D005753:Gastric Mucosa / Q000473:pathology*; D005773:Gastroscopy / Q000379:methods; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D011237:Predictive Value of Tests; D015995:Prevalence; D012680:Sensitivity and Specificity; D013270:Stomach / Q000473:pathology*; D014481:United States / Q000453:epidemiology; D041742:Upper Gastrointestinal Tract / Q000473:pathology