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Crohn’s disease of the esophagus

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Opinion statement

Esophageal damage is an uncommon manifestation of Crohn’s disease. The diagnosis should be considered in patients who have other intestinal manifestations of Crohn’s disease and present with esophageal symptoms. Diagnosis should be based on history, known extraesophageal Crohn’s disease, endoscopic evaluation with biopsy, and exclusion of gastroesophageal reflux disease. Mild disease should be treated with acid suppression and a short course of steroids. 5-amino-salicylates are not likely to be effective due to drug release characteristics. Patients who have moderate to severe disease should be treated aggressively with acid suppression, a longer course of steroids, and consideration of immunosuppressive therapy with 6-mercaptopurine or azathioprine. Infliximab or other anti-tumor necrosis factor therapy also can be considered in refractory patients to try to prevent the complications of stricturing and fistula formation. In those patients who develop strictures of the esophagus, treatment with balloon dilatation of the stricture followed by injection of a long-acting steroid such as triamcinolone will help to alleviate symptoms. Surgery may be required for severe, refractory symptoms, but it has a high morbidity in this population.

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References and Recommended Reading

  1. Crohn B, Ginzburg L, Oppenheimer G: Regional ileitis: a pathological and clinical entity. JAMA 1932, 99:1323–1329.

    Google Scholar 

  2. Eggers C: Resection of thoracic portion of oesophagus for chronic ulcer. Ann Surg 1934, 101:940–944.

    Google Scholar 

  3. Decker G, Loftus EJ, Pasha T, et al.: Crohn’s disease of the esophagus: clinical features and outcomes. Inflamm Bowel Dis 2001, 7:113–119.

    Article  PubMed  CAS  Google Scholar 

  4. Ramaswamy K, Jacobson K, Jevon G, Israel D: Esophageal Crohn disease in children: a clinical spectrum. J Pediatr Gastroenterol Nutr 2003, 36:454–458.

    Article  PubMed  Google Scholar 

  5. Remes-Troche J, Argote-Greene M, Rubio-Tapia A, et al.: Progressive dysphagia caused by isolated esophageal involvement of Crohn’s disease. Inflamm Bowel Dis 2005, 11:515–517.

    Article  PubMed  Google Scholar 

  6. Abdullah B, Gupta S, Croffie J, et al.: The role of esophago-gastroduodenoscopy in the initial evaluation of childhood inflammatory bowel disease: a 7-year study. J Pediatr Gastroenterol Nutr 2002, 35:636–640.

    Article  PubMed  Google Scholar 

  7. Naranjo-Rodriguez A, Solorzano-Peck G, Lopez-Rubio F, et al.: Isolated oesophageal involvement of Crohn’s disease. Eur J Gastroenterol Hepatol 2003, 15:1123–1126.

    Article  PubMed  Google Scholar 

  8. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 32-1995. A 78-year-old woman with increasing dysphagia and odynophagia. N Engl J Med 1995, 333:1066–1072.

  9. Knoblauch C, Netzer P, Scheurer U, Seibold F: Dysphagia in Crohn’s disease: a diagnostic challenge. Dig Liver Dis 2002, 34:660–664.

    Article  PubMed  CAS  Google Scholar 

  10. Brittenden J, Hosker HS, Healey C, Porter G: Oesophagobronchial fistula causing cough and recurrent lower respiratory tract infections in a patient with Crohn’s disease. Hosp Med 2005, 66:310–311.

    PubMed  CAS  Google Scholar 

  11. Locke G, Talley N, Fett S, et al.: Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota. Gastroenterology 1997, 112:1148–1156.

    Article  Google Scholar 

  12. Canavan C, Abrams KR, Hawthorne B, et al.: Long-term prognosis in Crohn’s disease: factors that affect quality of life. Aliment Pharmacol Ther 2006, 23:377–385.

    Article  PubMed  CAS  Google Scholar 

  13. Breuer-Katschinski BD, Hollander N, Goebell H: Effect of cigarette smoking on the course of Crohn’s disease. Eur J Gastroenterol Hepatol 1996, 8:225–228.

    Article  PubMed  CAS  Google Scholar 

  14. O’sullivan M, O’Morain C: Nutrition in inflammatory bowel disease. Best Pract Res Clin Gastroenterol 2006, 20:561–573.

    Article  PubMed  CAS  Google Scholar 

  15. Berni Canani R, Terrin G, Borrelli O, et al.: Short-and long-term therapeutic efficacy of nutritional therapy and corticosteroids in paediatric Crohn’s disease. Dig Liver Dis 2006, 38:381–387.

    Article  PubMed  CAS  Google Scholar 

  16. Thomas TS, Berto E, Scribano ML, et al.: Treatment of esophageal Crohn’s disease by enteral feeding via percutaneous endoscopic gastrostomy. JPEN J Parenter Enteral Nutr 2000, 24:176–179.

    PubMed  CAS  Google Scholar 

  17. Meyer A, Ramzan N, Heigh R, Leighton J: Relapse of inflammatory bowel disease associated with use of nonsteroidal anti-inflammatory drugs. Dig Dis Sci 2006, 51:168–172.

    Article  PubMed  CAS  Google Scholar 

  18. Huang JQ, Hunt RH: Pharmacological and pharmacodynamic essentials of H(2)-receptor antagonists and proton pump inhibitors for the practising physician. Best Pract Res Clin Gastroenterol 2001, 15:355–370.

    Article  PubMed  CAS  Google Scholar 

  19. Moayyedi P, Talley N: Gastro-oesophageal reflux disease. Lancet 2006, 367:2086–2100.

    Article  PubMed  Google Scholar 

  20. Guslandi M, Tittobello A: Symptomatic response to omeprazole in inflammatory bowel disease. J Clin Gastroenterol 1996, 22:159–160.

    Article  PubMed  CAS  Google Scholar 

  21. Miehsler W, Puspok A, Oberhuber G, Vogelsang H: Impact of different therapeutic regimens on the outcome of patients with Crohn’s disease of the upper gastrointestinal tract. Inflamm Bowel Dis 2001, 7:99–105.

    Article  PubMed  CAS  Google Scholar 

  22. Domenech E: Inflammatory bowel disease: current therapeutic options. Digestion 2006, 73(Suppl 1):67–76.

    PubMed  CAS  Google Scholar 

  23. Rutgeerts PJ: Review article: the limitations of corticosteroid therapy in Crohn’s disease. Aliment Pharmacol Ther 2001, 15:1515–1525.

    Article  PubMed  CAS  Google Scholar 

  24. Decker A, Loftus E, Pasha T, et al.: Crohn’s disease of the esophagus: clinical features and outcomes. Inflamm Bowel Dis 2001, 7:113–119.

    Article  PubMed  CAS  Google Scholar 

  25. McKeage K, Goa KL: Budesonide (Entocort EC Capsules): a review of its therapeutic use in the management of active Crohn’s disease in adults. Drugs 2002, 62:2263–2282.

    Article  PubMed  CAS  Google Scholar 

  26. Weigand K, Wagner-Thiessen E, Stolte M: Esophagitis in an adolescent patient with Crohn’s disease after changing treatment from prednisolone to budesonide. Z Gastroenterol 2004, 42:1179–1181.

    Article  PubMed  CAS  Google Scholar 

  27. ACP’s PIER: The Physicians’ Information and Education Resource w/ AHFS Dl Essentials. Philadelphia: American College of Physicians; 2006.

  28. Dubinsky M: Azathioprine, 6-mercaptopurine in inflammatory bowel disease: pharmacology, efficacy and safety. Clin Gastroenterol Hepatol 2004, 2:731–743.

    Article  PubMed  CAS  Google Scholar 

  29. Sandborn WJ, Tremaine WJ, Wolf DC, et al.: Lack of effect of intravenous administration on time to respond to azathioprine for steroid-treated Crohn’s disease. North American Azathioprine Study Group. Gastroenterology 1999, 117:527–535.

    Article  PubMed  CAS  Google Scholar 

  30. Feagan BG, Rochon J, Fedorak RN, et al.: Methotrexate for the treatment of Crohn’s disease. N Engl J Med 1995, 332:292–297.

    Article  PubMed  CAS  Google Scholar 

  31. Feagan BG, Fedorak RN, Irvine EJ, et al.: A comparison of methotrexate with placebo for the maintenance of remission in Crohn’s disease. N Engl J Med 2000, 342:1627–1632.

    Article  PubMed  CAS  Google Scholar 

  32. Present D, Rutgeerts P, Targan S, et al.: Infliximab for the treatment of fistulas in patients with Crohn’s disease. N Engl J Med 1999, 340:1398–1405.

    Article  PubMed  CAS  Google Scholar 

  33. Rutgeerts P, D’Haens G, Targan S, et al.: Efficacy and safety of retreatment with anti-tumor necrosis factor antibody (infliximab) to maintain remission in Crohn’s disease. Gastroenterology 1999, 117:761–769.

    Article  PubMed  CAS  Google Scholar 

  34. Targan S, Hanauer S, van Deventer S, et al.: A short-term study of chimeric monoclonal antibody cA2 to tumor necrosis factor alpha for Crohn’s disease. N Engl J Med 1997, 337:1029–1035.

    Article  PubMed  CAS  Google Scholar 

  35. Ho I, Guarino D, Pertsovskiy Y, Cerulli M: Infliximab treatment of an esophagobronchial fistula in a patient with extensive Crohn’s disease of the esophagus [letter]. J Clin Gastroenterol 2002, 34:488–489.

    Article  PubMed  Google Scholar 

  36. Heller T, James S, Drachenberg C, et al.: Treatment of severe esophageal Crohn’s disease with infliximab. Inflamm Bowel Dis 1999, 5:279–282.

    Article  PubMed  CAS  Google Scholar 

  37. Fefferman D, Shah S, Alsahlil M, et al.: Successful treatment of refractory esophageal Crohn’s disease with infliximab. Dig Dis Sci 2001, 46:1733–1735.

    Article  PubMed  CAS  Google Scholar 

  38. Theodoropoulou A, Koutroubakis I, Kouroumalis E: Treatment of oesophageal Crohn’s disease with infliximab. Eur J Gastroenterol Hepatol 2004, 16:431–432.

    Article  PubMed  Google Scholar 

  39. Filippi J, Mambrini P, Arab K, et al.: Treatment of oesophageal Crohn’s disease by infliximab [in French]. Gastroenterol Clin Biol 2005, 29:84–85.

    Article  PubMed  Google Scholar 

  40. Schreiber S, Rutgeerts P, Fedorak R, et al.: A randomized, placebo-controlled trial of certolizumab pegol (CDP870) for treatment of Crohn’s disease. Gastroenterology 2005, 129:807–818. [Published erratum appears in Gastroenterology 2005, 129:1808.]

    Article  PubMed  CAS  Google Scholar 

  41. Hanauer SB, Sandborn WJ, Rutgeerts P, et al.: Human antitumor necrosis factor monoclonal antibody (adalimumab) in Crohn’s disease: the CLASSIC-I trial. Gastroenterology 2006, 130:323–333.

    Article  PubMed  CAS  Google Scholar 

  42. Sandborn WJ, Hanauer SB, Katz S, et al.: Etanercept for active Crohn’s disease: a randomized, double-blind, placebo-controlled trial. Gastroenterology 2001, 121:1088–1094.

    Article  PubMed  CAS  Google Scholar 

  43. Rutgeerts P, Sandborn W, Fedorak R, et al.: Onercept for moderate-to-severe Crohn’s disease: a randomized, double-blind, placebo-controlled trial. Clin Gastroenterol Hepatol 2006, 4:888–893.

    Article  PubMed  CAS  Google Scholar 

  44. Bariol C, Meagher A, Vickers C, et al.: Early studies on the safety and efficacy of thalidomide for symptomatic inflammatory bowel disease. J Gastroenterol Hepatol 2002, 17:135–139.

    Article  PubMed  CAS  Google Scholar 

  45. Farrell R, Alsahli M, Jeen Y, et al.: Intravenous hydrocortisone premedication reduces antibodies to infliximab in Crohn’s disease: a randomized controlled trial. Gastroenterology 2003, 124:917–924.

    Article  PubMed  CAS  Google Scholar 

  46. Cynn WS, Chon H, Gureghian PH, Levin BL: Crohn’s disease of the esophagus. Am J Roentgenol Radium Ther Nucl Med 1975, 125:359–364.

    PubMed  CAS  Google Scholar 

  47. Giaffer MH, Tindale WB, Holdsworth D: Value of technetium-99m HMPAO-labelled leucocyte scintigraphy as an initial screening test in patients suspected of having inflammatory bowel disease. Eur J Gastroenterol Hepatol 1996, 8:1195–1200.

    Article  PubMed  CAS  Google Scholar 

  48. DeVault KR, Castell DO: Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol 2005, 100:190–200.

    Article  PubMed  Google Scholar 

  49. Honda S, Sugimoto K, Iwasaki H, et al.: Multiple mucosal bridge formation in the esophagus in a patient with Crohn’s disease. Endoscopy 1998, 30:S37–S38.

    Article  PubMed  CAS  Google Scholar 

  50. Abid S, Jafri W, Hamid S, et al.: Endoscopic features of esophageal tuberculosis. Gastrointest Endosc 2003, 57:759–762.

    Article  PubMed  Google Scholar 

  51. Kahrilas PJ, Quigley EM: Clinical esophageal pH recording: a technical review for practice guideline development. Gastroenterology 1996, 110:1982–1996.

    Article  PubMed  CAS  Google Scholar 

  52. Chotiprashidi P, Liu J, Carpenter S, et al.: ASGE Technology Status Evaluation Report: wireless esophageal pH monitoring system. Gastrointest Endosc 2005, 62:485–487.

    Article  PubMed  Google Scholar 

  53. Ferguson DD: Evaluation and management of benign esophageal strictures. Dis Esophagus 2005, 18:359–364.

    Article  PubMed  CAS  Google Scholar 

  54. Ferlitsch A, Reinisch W, Puspok A, et al.: Safety and efficacy of endoscopic balloon dilation for treatment of Crohn’s disease strictures. Endoscopy 2006, 38:483–487.

    Article  PubMed  CAS  Google Scholar 

  55. Singh V, Draganov P, Valentine J: Efficacy and safety of endoscopic balloon dilation of symptomatic upper and lower gastrointestinal Crohn’s disease strictures. J Clin Gastroenterol 2005, 39:284–290.

    Article  PubMed  Google Scholar 

  56. Ohta M, Konno H, Kamiya K, et al.: Crohn’s disease of the esophagus: report of a case. Surg Today 2000, 30:262–267.

    Article  PubMed  CAS  Google Scholar 

  57. D’Haens G, Rutgeerts P, Geboes K, Vantrappen G: The natural history of esophageal Crohn’s disease: three patterns of evolution. Gastrointest Endosc 1994, 40:296–300.

    Article  PubMed  CAS  Google Scholar 

  58. Ardizzone S, Porro G: Biologic therapy for inflammatory bowel disease. Drugs 2005, 65:2253–2286.

    Article  PubMed  CAS  Google Scholar 

  59. Macdonald JK, McDonald JW: Natalizumab for induction of remission in Crohn’s disease. Cochrane Database Syst Rev 2006, 3:CD006097.

  60. Van Assche G, Van Ranst M, Sciot R, et al.: Progressive multifocal leukoencephalopathy after natalizumab therapy for Crohn’s disease. N Engl J Med 2005, 353:362–368.

    Article  PubMed  Google Scholar 

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  1. Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, CB# 7032, Room 7200 MBRB, Chapel Hill, NC, 27599-7032, USA

    Kim L. Isaacs

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  1. Kim L. Isaacs
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Correspondence to Kim L. Isaacs.

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Isaacs, K.L. Crohn’s disease of the esophagus. Curr Treat Options Gastro 10, 61–70 (2007). https://doi.org/10.1007/s11938-007-0058-3

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