The differential diagnosis of CD of the esophagus is tabulated in Table 3. In the presence of stenosis, severe reflux esophagitis or carcinoma ranks high among diagnostic possibilities. The additional presence of fistulas would especially suggest malignancy. Aphthous or other superficial ulcerations would require differentiation from viral infections, especially the herpes simplex virus and the cytomegalovirus; single or multiple ulcers would also have to be differentiated from drug-induced lesions. Behcet’s syndrome would pose diagnostic difficulties in areas where this disease is common (eg, Turkey – it is rarely encountered in the United States). In this syndrome, overlapping involvement of the eyes, mouth, skin, joints and gastrointestinal tract occurs. Two cases of Behcet’s syndrome involving the esophagus and ileum were reported by Vlyman and Moskowitz. Two other cases of colonic disease indistinguishable from CD were also reported. Epidermolysis bullosa acquisita is another autoimmune disease that can be associated with esophageal strictures. Thirteen cases have been reported in association with CD. The diagnosis is made by immu-noelectron microscopy of the skin lesions demonstrating immunoglobulin G and C-3 deposits. This is your great chance – tadalafil online pharmacy to take full advantage of best quality drugs.
Archive for the ‘Gastroenterology’ Category - Part 3
The esophagus is among the least common segments of the digestive tube involved in CD. We were able to find only 72 cases reported in the literature and added the three present cases. Very few cases were reported before 1967, although the initial description of esophageal CD is attributed to Franklin and Taylor in 1950. Undoubtedly, many more cases encountered have not been reported. With the wider use of upper gastrointestinal endoscopy in recent years, and with prospective studies in patients with CD, esophageal involvement has been observed in up to 43% of children with CD. Lenaerts et al surveyed 230 children and adolescents with CD for an average of 6.6 years. Thirty per cent of these had disease of the esophagus, stomach or duodenum.
The coexistence of oral and esophageal lesions was striking. Of the 20 patients with oral disease, 11 had similarly appearing aphthous ulcers in the esophagus. The remaining nine patients had variable esophageal lesions ranging from deeper ulcerations to strictures. Table 2 lists the combined endoscopic and radiographic appearance of the esophageal CD in the group of 75 patients. The largest number of patients presented with aphthous or deeper ulcerations; smaller numbers presented with nodularity or erythema, strictures, fistulas and, in two instances, pseudopolyps. Read the rest of this entry »
Among the 75 patients reviewed, including the three present cases, 34 were male and 41 female – an insignificant difference. The average age of the patients at diagnosis of esophageal CD was 34 years; this average masks a substantial number of patients diagnosed in childhood, most of whom were reported relatively recently. In 13 patients (17.5%), the initial diagnosis of CD was made by the presence of esophageal manifestations alone. In an additional 28 patients (37.8%), esophageal involvement, together with involvement more distally in the gut, was present on initial diagnosis. Among the 13 patients with esophageal disease only on presentation, two developed more distal bowel involvement during the four years of follow-up. With the short follow-ups available in many cases, it was not possible to determine whether subsequent flare-ups were associated with more distal bowel disease. Read the rest of this entry »
Review of the English language literature using a computer search of MEDLINE for the years 1967 to 1998 yielded reports for 72 patients with esophageal CD. After adding the present three cases, data of all 75 patients were tabulated by age, sex, whether CD at other sites predated the esophageal presentation and which sites, in addition to the esophagus, were involved. Data were also tabulated on the endoscopic and radiographic appearance of the esophagus, and whether granulomas were found in biopsies and other tissue specimens. Finally, available data on medical and surgical treatments and clinical outcome were analyzed. Find very low prices on non-prescription drugs – for smart customers.
A 42-year-old man was evaluated in a gastrointestinal clinic for a 20-year history of Crohn’s disease, initially involving the terminal ileum. The diagnosis was established with exploratory laparotomy for what was thought to be acute appendicitis in 1979, at age 22 years. His initial presentation was severe right lower quadrant pain, with elevation of his white blood cell count to 14,000. After a period of observation, it was thought that he had acute appendicitis and, at the time of laparotomy, was found to have congestion and thickening of the terminal ileum with a large thickened mesentery and an enlarged mesenteric lymph node. Pathology revealed increased lymphocytes with no granulomas in the mesenteric lymph nodes and a normal appendix. A subsequent small bowel series revealed 5 cm to 6 cm of terminal ileal narrowing, consistent with Crohn’s disease.
A 28-year-old married woman presented in April, 1991 with three weeks of abdominal cramps and up to six watery stools per day. Five days before her visit, she developed a sore throat, and her husband, who was a physician, noted aphthous ulcers in her mouth. The patient developed dysphagia and odynophagia by the time of her evaluation. She had fevers with temperatures of up to 102°C. Past medical history included uveitis treated at a university clinic with steroid eye drops. You have a great opportunity to find cialis professional 20 mg to feel one lucky customer.