van Hogezand R A, Witte A M, Veenendaal R A, Wagtmans M J, Lamers C B
Department of Gastroenterology-Hepatology, Leiden University Medical Center, The Netherlands.
Inflamm Bowel Dis. 2001 Nov;7(4):328-37. doi: 10.1097/00054725-200111000-00010.
Crohn's disease in the proximal region of the digestive tract is uncommon. Better diagnostically procedures and more careful histologic examination has led to a higher detection of proximal Crohn's disease. The diagnosis is based on symptoms, endoscopy with serial sections, or double contrast radiography. The most common histologic finding for this diagnosis are granulomas in the mucosa in Helicobacter pylori-negative patients, but the granulomas are not always frequently detected. Endoscopic lesions in the proximal regions look like the lesions that could be found in the distal regions. Notching in the duodenal folds could be a strong indication for Crohn's desease. Radiological lesions are not always characteristic, but should be used in combination with endoscopy. Stenosis is an important complication, but fistula formation and pseudodiverticular formation is possible. There is no uniform medical therapy, but the regular anti-inflammatory management for Crohn's disease is most often used. Sometimes surgery is needed.
消化道近端的克罗恩病并不常见。更好的诊断程序和更仔细的组织学检查使得近端克罗恩病的检出率更高。诊断基于症状、连续切片的内镜检查或双重对比造影。对于这种诊断，最常见的组织学发现是幽门螺杆菌阴性患者黏膜中的肉芽肿，但肉芽肿并不总是经常被检测到。近端区域的内镜病变看起来与远端区域可能发现的病变相似。十二指肠皱襞的切迹可能是克罗恩病的有力指征。放射学病变并不总是具有特征性，但应与内镜检查结合使用。狭窄是一种重要的并发症，但也可能形成瘘管和假性憩室。目前没有统一的药物治疗方法，但最常采用的是针对克罗恩病的常规抗炎治疗。有时需要进行手术。
