Schmidt-Sommerfeld E, Kirschner B S, Stephens J K
Department of Pediatrics, University of Chicago, Illinois 60637.
J Pediatr Gastroenterol Nutr. 1990 Nov;11(4):448-54. doi: 10.1097/00005176-199011000-00004.
In an attempt to define endoscopic and histologic changes suggestive of upper gastrointestinal Crohn's disease (CD), the medical histories, endoscopic reports, and biopsies were reviewed from 24 pediatric patients with CD and 28 age-matched patients without CD in whom esophagogastroduodenoscopies were performed because of upper GI symptoms. No differences in the overall frequency of endoscopic abnormalities were found between the two groups. However, gastric erosions and ulcerations were more frequent in CD patients. Histological abnormalities in the stomach and duodenum were also more frequent in CD patients. Noncaseating granulomas were found in five patients with CD and in one patient without clinical, radiologic, or endoscopic evidence of CD. Focal inflammation in the stomach and duodenum occurred more frequently in CD patients. Two patients with CD had focal and deep chronic inflammatory infiltrates in the esophagus, which reached the submucosa. Abnormal histology was often seen in CD patients with normal endoscopic appearances. We conclude that superficial ulcerations seen during endoscopy and the histological finding of focal inflammation may represent upper GI CD in pediatric patients. Histological changes can be missed if biopsies are not taken from normal-appearing mucosa during endoscopy.
为了明确提示上消化道克罗恩病（CD）的内镜及组织学改变，我们回顾了24例患CD的儿科患者以及28例因上消化道症状而行食管胃十二指肠镜检查、年龄匹配的非CD患者的病史、内镜报告及活检结果。两组在内镜异常的总体发生率上未发现差异。然而，CD患者中胃糜烂和溃疡更为常见。CD患者胃和十二指肠的组织学异常也更常见。在5例CD患者及1例无CD临床、影像学或内镜证据的患者中发现了非干酪样肉芽肿。CD患者胃和十二指肠的局灶性炎症更为频繁。2例CD患者食管出现局灶性及深部慢性炎症浸润，累及黏膜下层。内镜表现正常的CD患者常可见组织学异常。我们得出结论，内镜检查时发现的浅表溃疡以及局灶性炎症的组织学表现可能代表儿科患者的上消化道CD。如果在内镜检查时未从外观正常的黏膜取材活检，可能会漏诊组织学改变。
