Early esophageal Crohn's disease: an endoscopic view

Isolated oesophageal involvement of Crohn's disease

A 31-year-old male was admitted with complaints of dysphagia and odynophagia. An upper gastrointestinal tract series revealed inflammatory changes in the mid and distal oesophagus with intramural extravasation of the barium. An upper endoscopy showed multiple ulcerations and inflammation. The patient developed a large stricture with no response to serial endoscopic dilations and a surgical resection of the oesophagus was required. Gross examination of the surgical specimen revealed transmural inflammation, deep ulcerations and non-necrotizing epithelioid cell granuloma. All these pathological findings were characteristic of Crohn's disease of the oesophagus. After 36 months of follow-up there has been no recurrence of symptoms or of other sites of involvement.

[Presentation of Crohn's disease with esophageal involvement]

Inflammatory bowel disease basically consists of two entities: ulcerative colitis (UC) and Crohn's disease (CD). Both processes are characterized by chronic inflammation of the intestine, which in the case of CD may affect the entire digestive tract. We present the case of a young man who was diagnosed with esophageal CD after presenting dysphagia and odynophagia. Intestinal involvement was subsequently found. Esophageal involvement is infrequent and as the first manifestation of CD it is extremely rare. It should, however, be borne in mind in patients with esophageal ulcerations without symptoms or endoscopic signs compatible with peptic etiology, even though other indications of inflammatory disease are absent.

Crohn's disease of the esophagus: report of a case

We report herein the case of a 27-year-old man with Crohn's disease of the esophagus. The patient presented with large ulcers in the esophagus for which treatment based on a diagnosis of reflux esophagitis was commenced. Although his symptoms were initially resolved, the ulcers did not improve and he was readmitted to hospital 3 months later for progressive heartburn. An esophagoscopy revealed large ulcers in the esophagus, and a colonoscopy revealed a longitudinal ulcer in the terminal ileum. Histological examination of specimens from the terminal ileum showed severe inflammation without granuloma formation, which led to a diagnosis of Crohn's disease. The oral administration of prednisolone and salazosulfapyridine controlled his symptoms and the esophageal ulcers were observed to be healing 2 weeks after this treatment was initiated. A review of the English literature revealed only 77 cases of this disease. Isolated esophageal lesions were reported in ten patients (13.0%), none of which were able to be diagnosed as Crohn's disease preoperatively. Ileocolic lesions developed after esophageal lesions in only five patients (6.5%) including ours. In the remaining 62 patients (80.5%), ileocolic lesions had existed synchronous with or prior to the esophageal lesions. This suggests that ileocolic lesions may often coexist in Crohn's patients with esophageal lesions, and that examination of the terminal ileum must be performed to confirm a diagnosis of Crohn's disease of the esophagus.