Wagtmans M J, van Hogezand R A, Griffioen G, Verspaget H W, Lamers C B
Department of Gastroenterology and Hepatology, University Hospital Leiden, Netherlands.
Neth J Med. 1997 Feb;50(2):S2-7. doi: 10.1016/s0300-2977(96)00063-0.
Although Crohn's disease (CD) is generally found in the ileum and/or colon, since the 1960s it has become evident that this chronic inflammatory disorder of unknown aetiology can affect the whole gastrointestinal tract from mouth to anus. In 0.5-13% of patients with ileocolonic CD the disease occurs in the upper gastrointestinal tract as well (i.e., from mouth through jejunum). With the radiological double-contrast technique, however, early signs of upper gastrointestinal CD may be detected in 20-40% of patients with ileocolitis. On the other hand, histologically evaluated biopsies from the lower oesophagus, body of the stomach, gastric antrum and the duodenal bulb of patients with Crohn's disease from whom the upper gastrointestinal tract is normal, according to X-ray or endoscopy may reveal lesions, which are considered to be pathologically diagnostic. Jejunal involvement occurs in 4-10% of patients with ileitis, ileocolitis or colitis. In early studies biopsies of apparently normal buccal mucosa from patients with Crohn's disease showed a significant correlation between the activity of the disease, as defined by the Crohn's Disease Activity Index, and the number of plasma cells containing IgM, suggesting a generalized activated humoral defence system during relapse. A diagnosis of Crohn's disease of the upper gastrointestinal tract can be achieved by combining recognition of clinical, roentgenographic, and endoscopic features. Provided that other causes of granulomatous involvement of the gastrointestinal tract can be excluded, non-caseating granulomas are generally accepted as the histological proof of Crohn's disease. When Crohn's disease does involve the upper gastrointestinal tract, there is nearly always concomitant disease in the small bowel or colon. Compared to patients with an ileocolonic localization, patients with Crohn's disease in the upper gastrointestinal tract more frequently have colic-like abdominal pain and/or cramps, nausea and anorexia as presenting symptoms and are younger at onset of the disease. Medical therapeutic principles are the same as for Crohn's disease elsewhere in the gastrointestinal tract. Absolute indications for surgical treatment are massive bleeding, progressive stenosis, and extensive fistula formation.
尽管克罗恩病（CD）通常发生在回肠和/或结肠，但自20世纪60年代以来，已明显发现这种病因不明的慢性炎症性疾病可累及从口腔到肛门的整个胃肠道。在0.5%至13%的回结肠型CD患者中，疾病也发生在上消化道（即从口腔至空肠）。然而，采用放射学双对比技术，在20%至40%的回肠炎患者中可检测到上消化道CD的早期征象。另一方面，根据X线或内镜检查，上消化道正常的克罗恩病患者，其经组织学评估的来自食管下段、胃体、胃窦和十二指肠球部的活检标本可能显示病变，这些病变被认为具有病理诊断意义。空肠受累见于4%至10%的回肠炎、回结肠型肠炎或结肠炎患者。在早期研究中，克罗恩病患者外观正常的颊黏膜活检显示，以克罗恩病活动指数定义的疾病活动度与含IgM浆细胞数量之间存在显著相关性，提示复发期间存在全身性激活的体液防御系统。结合临床、放射学和内镜特征的识别可实现上消化道克罗恩病的诊断。如果能排除胃肠道肉芽肿性病变的其他病因，非干酪样肉芽肿通常被视为克罗恩病的组织学证据。当克罗恩病确实累及上消化道时，小肠或结肠几乎总是同时存在病变。与回结肠型定位的患者相比，上消化道克罗恩病患者更常出现绞痛样腹痛和/或痉挛、恶心和厌食等症状，且发病年龄较轻。药物治疗原则与胃肠道其他部位的克罗恩病相同。手术治疗的绝对指征是大量出血、进行性狭窄和广泛的瘘管形成。
