Background: Prevalence of upper GI involvement in CD has been reported to be low. This can be due to difficulties encountered in establishing a clear diagnosis. The aim of the study was to evaluate the rate of upper GI involvement in CD patients based on the data coming from a regional, population-based romanian registry, and to identify their chracteristics on diagnosis and during follow-up.
Methods: In order to study the characteristics of patients with upper GI Crohn's disease, we used data from EPIROM- a regional, population-based registry. Data was collected between 2014–2016. Upper GI tract involvement was considered when endoscopy described erythema, edema, linear or aphtoid erosions or deep ulcers, combined with a histologic report describing nonspecific chronic inflammation, focally enhanced gastritis or granuloma.
Results: Out of 113 patients with CD, fourteen (12.38%) were considered to have upper GI tract involvement: 10 had gastroduodenal lesions, 3 had only gastric lesions and one patient had only duodenal lesions. None of the patients had esophageal CD. Apthoid erosions and deep ulcers were the most common endoscopic findings (64.28%). Chronic active gastritis was the most common histologic finding (71.42%). Only one patient was found to have gastric granuloma.
Two thirds of patients with upper GI tract involvement were considered to have severe disease, based on the endoscopical and histological scores.
Upper GI tract disease was most commonly found in association with ileocolonic disease (50%), followed by ileal disease (28.57%) and colonic disease (21.42%) No cases with exclusive involvement of the upper GI tract were registered.
Intestinal stenosis was the most common complication of CD in these patients and it was found to be significantly associated with upper GI tract involvement (p=0.021). Intestinal stenosis was found in 9 patients with upper GI tract involvement (64.28%), 7 of these associated ileal disease, and 2 associated ileocolonic disease.
Conclusions: The rate of upper GI involvement in CD is low. Most of the patients had gastroduodenal lesions combined with ileocolonic involvement. The disease is more severe in these cases and the development of intestinal stenosis occurs more frequently.
These patients usually associate a poor prognosis, thus a prompt and highly efficient therapeutic method is needed early in the course of the disease.