Department of Digestive Disease, University Campus Bio Medico of Rome, Rome, Italy.
Dig Dis Sci. 2012 Jun;57(6):1618-23. doi: 10.1007/s10620-012-2072-0. Epub 2012 Feb 11.
Prevalence of upper gastrointestinal (GI) tract involvement in adult Crohn's disease (CD) has been reported to be very low (0.3-5%). In routine practice, upper endoscopy is recommended only in CD patients with upper GI symptoms. Available data concerning the prevalence of asymptomatic upper GI lesions in CD patients are controversial. The aim of this study was to prospectively evaluate the prevalence of upper GI CD involvement in CD patients, irrespective of upper GI symptoms.
A series of 119 consecutive CD patients underwent clinical assessment, including occurrence and score of upper GI symptoms, and upper endoscopy with biopsy samples for histological assessment and Helicobacter pylori (Hp) infection detection. In an attempt to further recognize the upper GI tract lesions as CD or other form of inflammation, in a subgroup of CD patients, the histological and endoscopic evaluation was repeated following 12 weeks of anti-TNF-α or other treatments in association with proton-pump inhibitors.
Upper CD involvement was found in 19/119 (16%) patients. Hp infection was detected in 10/119 (8.4%) CD patients. Hp-negative focally active chronic gastritis was found in 34/119 (28.6%) CD patients. At presentation, 12/19 patients (63%) showing upper CD involvement were asymptomatic and 7 (37%) symptomatic.
A high prevalence of upper GI tract involvement has been observed in CD patients, irrespective of upper symptoms. This finding suggests the usefulness of routine upper endoscopy in the diagnostic work-up of CD patients in order to correctly classify the distribution and extent of the disease.
成人克罗恩病（CD）上消化道（GI）受累的患病率报道很低（0.3-5%）。在常规实践中，仅建议有上 GI 症状的 CD 患者进行上内窥镜检查。关于 CD 患者无症状上 GI 病变的患病率，现有数据存在争议。本研究旨在前瞻性评估无论上 GI 症状如何，CD 患者上 GI CD 受累的患病率。
对 119 例连续 CD 患者进行临床评估，包括上 GI 症状的发生和评分，以及上内窥镜检查和活检样本进行组织学评估和幽门螺杆菌（Hp）感染检测。为了进一步识别上 GI 道病变是 CD 还是其他形式的炎症，在 CD 患者亚组中，在使用质子泵抑制剂联合抗 TNF-α 或其他治疗 12 周后，重复进行组织学和内镜评估。
19/119（16%）患者发现上 CD 受累。119 例 CD 患者中有 10 例（8.4%）检测到 Hp 感染。在 119 例 CD 患者中发现 34 例（28.6%） Hp 阴性局灶性活动性慢性胃炎。在出现上 CD 受累的 19 例患者中，12 例（63%）在出现时无症状，7 例（37%）有症状。
无论上 GI 症状如何，CD 患者均存在较高的上 GI 道受累患病率。这一发现提示在 CD 患者的诊断工作中常规进行上内窥镜检查的有效性，以便正确分类疾病的分布和程度。
