Crohn’s disease of the esophagus: DISCUSSION Part 1

Crohn’s disease of the esophagus

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.

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Crohn’s disease of the esophagus: LITERATURE REVIEW

Crohn’s disease of the esophagus

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.

Crohn’s disease of the esophagus: CASE 3

Crohn’s disease of the esophagus

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.

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Crohn’s disease of the esophagus: CASE 2

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.

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Crohn’s disease of the esophagus: CASE 1

A 24-year-old married woman was seen in February 1998; her chief complaint was odynophagia. She had suffered from prolonged heartburn. Treatment with H2-receptor blockers, and later with proton pump inhibitors, produced only minor symptom relief. Subsequently, odynophagia developed, brought on by swallowing any food or even saliva. Avoidance of spicy foods produced minimal benefit. Past medical history recalled by the patient included ‘functional’ gastrointestinal problems in 1986, when the patient was 12 years old. Unrelated events also recalled included bouts of cystitis, and asthma treated with oral prednisone and an albuterol inhaler. On physical examination, the patient appeared well developed and nourished, vital signs were normal and general examination failed to show any abnormalities. Because of the odynophagia, EGD was performed. EGD revealed three distinct esophageal ulcers, each appearing as a sharply demarcated, red, approximately 5 mm round area in the lower esophagus surrounded by normal-appearing mucosa (Figure 1). The Z-line was distinct without clinically apparent esophagitis or stricture. The stomach and duodenum appeared normal. Biopsies from the lower esophagus revealed dense lymphocytic infiltrates in several areas and ulcerations in others. Granulomas were not found. Read the rest of this entry »

Pouchitis-associated iritis following total proctocolectomy and ileal pouch-to-anal anastomosis in ulcerative colitis: DISCUSSION

DISCUSSION

The late complications attributed to pouchitis developing after creation of an ileal pouch-to-anal anastomosis have been enumerated in detail elsewhere. Conversely, the presence of extraintestinal manifestations of inflammatory bowel disease before proctocolectomy appears to be a prognostic factor for the subsequent development of pouchitis. In one study, for example, the presence of preoperative extraintestinal manifestations was reported to be 100% predictive of postoperative extraintestinal manifestations. It has been previously thought that some of the extra-intestinal manifestations of chronic ulcerative colitis may be totally cured by proctocolectomy. Indeed, in some patients, severe extraintestinal manifestations have even been considered to be the main indication for surgical intervention. These manifestations have included eye changes that could lead to blindness, incapacitation from arthritis or intractable skin lesions, particularly pyoderma gangrenosum; these may prompt a proctocolectomy even if the colitis is quiescent. In contrast, other extraintestinal manifestations, including ankylosing spondylitis or primary sclerosing cholangitis, may progress in spite of colonic resection or initially appear after the colonic resection has been performed for severe colonic disease. This suggested approach to treatment for the serious ocular complications of ulcerative colitis probably relates to earlier observational studies. Korelitz and Coles, for example, described 13 patients with uveitis (iritis) complicating inflammatory colonic disease. Three of these patients with ulcerative colitis had proctocolectomies.
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Crohn’s Disease – PSYCHOSOCIAL CONSIDERATIONS

Although there is no evidence to support the concept that psychologic factors are etiologic in Crohn’s disease, there is no question that psychosocial pressures can influence the course of the patient’s illness and have to be addressed. The caring physician who is willing to answer questions and be available at all times is often all that is needed. At other times, mild psychotropic agents in conjunction with behavior modification and support groups are of enormous benefit. In this regard, the Crohn’s and Colitis Foundation of America can be extremely helpful in providing patients with emotional support and educational materials.

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