Öz
Giriş ve Amaç: Crohn hastalığı için üst
gastrointestinal sistem tutulumu sıklığı %0,5-4 arasında değişir. Bu hastaların
tedavi ve takipleri ileokolonik hastalıktan farklılık gösterir. Biz bu
çalışmada kliniğimizde Crohn hastalığının üst gastrointestinal sistemi
etkilediği hastalarımızı sunduk.
Gereç ve Yöntem:
Hastanemiz Gastroenteroloji Kliniğinde takip edilen ve üst gastrointestinal
sistem tutulumu olan Crohn hastaları çalışmaya alındı.
Bulgular: On hastada üst gastrointestinal
sistem tutulumu izlendi. Hastaların yaş ortancası 40,5 (31-53) olup 6 hasta
(%60) erkek 4 hasta (%40) ise kadındı. Ortanca takip süresi 29 (1-228) ay olup
hastaların 4 tanesinde (%40) izole üst gastrointestinal sistem tutulumu varken
geri kalan 6 hastanın (%60) beraberinde ileal veya ileokolonik hastalığı vardı.
Organ tutulumlarına bakıldığında 1 hastada (%10) özofagus, 2 hastada mide (%20)
ve 7 hastada (%70) duodenum tutulumu izlendi. Endoskopik görünümler hastadan
hastaya değişmekle beraber Crohn hastalığı için tipik sayılan kaldırım taşı
görünümü 2 hastada, ülserler 7 hastada ve nodülarite ise 4 hastada endoskopik
olarak tanımlandı. Biyopsilerde granülom 3 hastada izlendi (%30)
Sonuç: Crohn hastalığı tanısı
olan bir bireyde gelişen epigastrik ağrı, bulantı-kusma ve disfaji gibi
şikayetler üst gastrointestinal sistemin
endoskopik incelenmesini zorunlu hale getirmektedir. Erken tanı ve uygun tedavi
gelişebilecek komplikasyonların önüne geçebilir.
Anahtar Kelimeler
Kaynakça
- 1- Crohn BB, Ginzburg L, Oppenheimer GD. Regional ileitis. A pathologic and clinical entity. JAMA 1932;99:1323–9 2- Satsangi J, Silverberg MS; Vermeire S. The Montreal classification of inflammatory bowel disease: controversies, consensus and implications. Gut. 2006; 55 (6):749-53 3- Wagtmans MJ, van Hogezand RA, Griffioen G, et al. Crohn’s disease of the upper gastrointestinal tract. Neth J Med 1997;50(2):S2–7. 4- Ingle SB, Adgaonkar BD, Jamadar NP et al. Crohn’ disease with gastroduodenal involvement: Diagnostic approach. World J Clin Cases 2015,3:479-483 5- Van Assche G, Dignass A, Panes J et al. The second European evidence-based consensus on the diagnosis and management of Crohn’s disease: definition and diagnosis. J Crohn’s Colitis. 2010;4:7-27 6- Hisabe T, Hirai F, Matsui T et al. Evaluation of diagnostic criteria for Crohn’s disease in Japan. J Gastroenterol. 2014;49(1):93-9. 7- Fujiya M, Sakatani A, Dokoshi T. A Bamboo Joint-Like Appearance is a Characteristic Finding in the Upper Gastrointestinal Tract of Crohn's Disease Patients: A Case-Control Study. Medicine (Baltimore). 2015;94(37):e1500. 8- Diaz L, Hernandez-Oquet RE, Deshpande AR et al. Upper Gastrointestinal Involvement in Crohn’s Disease: Histopathologic and Endoscopic Findings. South Med J 2015;108(11):695-700. 9- Loftus EV Jr. Upper gastrointestinal tract Crohn’s disease. Clin Perspect Gastroenterol 2002;5:188-191 10- Van Hogezand RA, Witte AM, Veenendaal RA et al. Proximal Crohn’s disease. Review of the clinicopathologic features and therapy. Inflamm Bowel Dis 2001;7:328-337 11- Rutgeerts P, Onette E, Vantrappen G, et al. Crohn’s disease of the stomach and duodenum: a clinical study with emphasis on the value of endoscopy and endoscopic biopsies. Endoscopy 1980;12:288-94 12- Yamamoto T, Allan RN, Keighley MR. An audit of gastroduodenal Crohn disease; clinicopathologic features and management. Scand J Gastroenterol 1999;34:1019-1024. 13- Firth M, Prather C. Unusual gastric Crohn’s disease treated with infliximab–A case report. Am J Gastroenterol 2002;97:S190 14- Kim YL, Park YS, Park EK. Refractory duodenal Crohn's disease successfully treated with infliximab.Intest Res. 2014 ;12(1):66-9. 15- Shapiro M, Greenstein AJ, Byrn J. Surgical management and outcomes of patients with duodenal Crohn’s disease. J Am Coll Surg; 207(1):36-42
Öz
Background and Aim: The frequency of upper gastrointestinal system involvement in Crohn’s disease is 0.5%–4%. Treatment and follow-up strategies of these patients differ from those of ileocolonic disease. Here we present our patients who had Crohn’s disease with upper gastrointestinal system involvement. Materials and Methods: We retrospectively investigated our patients who had Crohn’s disease with upper gastrointestinal system involvement. Results: Upper gastrointestinal system involvement was detected in 10 patients. The median age of patients was 40.5 years (31-53 years); 6 patients were male and 4 patients were female. The median follow-up period after diagnosis was 29 (1-228) months. Four patients had isolated upper gastrointestinal system involvement, while 6 patients had ileocolonic disease. The frequency of organ involvement was 10% (1 patient) for the esophagus, 20% (2 patients) for the stomach, and 70% (7 patient) for the duodenum. Endoscopic appearances varies among patients; cobble stone appearances were detected in 2 patients, ulcers were detected in 7 patients and nodulariy were detected in 4 patients. Granulomas were detected histopathologically in 3 patients (30%). Conclusion: Complaints like epigastric pain, nausea and vomiting, and/or dysphagia must warrant clinicians to investigate the upper gastrointestinal system in Crohn’s disease. Early diagnosis and appropriate treatment are necessary to prevent complications.
Anahtar Kelimeler
Kaynakça
- 1- Crohn BB, Ginzburg L, Oppenheimer GD. Regional ileitis. A pathologic and clinical entity. JAMA 1932;99:1323–9 2- Satsangi J, Silverberg MS; Vermeire S. The Montreal classification of inflammatory bowel disease: controversies, consensus and implications. Gut. 2006; 55 (6):749-53 3- Wagtmans MJ, van Hogezand RA, Griffioen G, et al. Crohn’s disease of the upper gastrointestinal tract. Neth J Med 1997;50(2):S2–7. 4- Ingle SB, Adgaonkar BD, Jamadar NP et al. Crohn’ disease with gastroduodenal involvement: Diagnostic approach. World J Clin Cases 2015,3:479-483 5- Van Assche G, Dignass A, Panes J et al. The second European evidence-based consensus on the diagnosis and management of Crohn’s disease: definition and diagnosis. J Crohn’s Colitis. 2010;4:7-27 6- Hisabe T, Hirai F, Matsui T et al. Evaluation of diagnostic criteria for Crohn’s disease in Japan. J Gastroenterol. 2014;49(1):93-9. 7- Fujiya M, Sakatani A, Dokoshi T. A Bamboo Joint-Like Appearance is a Characteristic Finding in the Upper Gastrointestinal Tract of Crohn's Disease Patients: A Case-Control Study. Medicine (Baltimore). 2015;94(37):e1500. 8- Diaz L, Hernandez-Oquet RE, Deshpande AR et al. Upper Gastrointestinal Involvement in Crohn’s Disease: Histopathologic and Endoscopic Findings. South Med J 2015;108(11):695-700. 9- Loftus EV Jr. Upper gastrointestinal tract Crohn’s disease. Clin Perspect Gastroenterol 2002;5:188-191 10- Van Hogezand RA, Witte AM, Veenendaal RA et al. Proximal Crohn’s disease. Review of the clinicopathologic features and therapy. Inflamm Bowel Dis 2001;7:328-337 11- Rutgeerts P, Onette E, Vantrappen G, et al. Crohn’s disease of the stomach and duodenum: a clinical study with emphasis on the value of endoscopy and endoscopic biopsies. Endoscopy 1980;12:288-94 12- Yamamoto T, Allan RN, Keighley MR. An audit of gastroduodenal Crohn disease; clinicopathologic features and management. Scand J Gastroenterol 1999;34:1019-1024. 13- Firth M, Prather C. Unusual gastric Crohn’s disease treated with infliximab–A case report. Am J Gastroenterol 2002;97:S190 14- Kim YL, Park YS, Park EK. Refractory duodenal Crohn's disease successfully treated with infliximab.Intest Res. 2014 ;12(1):66-9. 15- Shapiro M, Greenstein AJ, Byrn J. Surgical management and outcomes of patients with duodenal Crohn’s disease. J Am Coll Surg; 207(1):36-42
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 29 Ağustos 2017 |
| Yayımlandığı Sayı | Yıl 2017 Cilt: 25 Sayı: 2 |