M. Crohn im oberen Gastrointestinaltrakt

Zusammenfassung

Zur weiteren Abklärung von Dysphagie und Gewichtsverlust war bei einer 29-jährigen Patientin mehrfach eine Gastroskopie durchgeführt worden. Hierbei waren kleinulzeröse Veränderungen im Ösophagus nachweisbar gewesen, die Histologie hieraus ergab zunächst keinen wegweisenden Befund. Eine Protonenpumpenhemmertherapie erbrachte keine Verbesserung der Symptomatik. In einer nochmaligen Gastroskopie konnte eine entzündliche Mitbeteiligung von Ösophagus und Magen bei Morbus Crohn nachgewiesen werden. Die daraufhin durchgeführte Ausbreitungsdiagnostik ergab auch im Ileum und Kolon M.-Crohn-Läsionen.

Abstract

For diagnostic evaluation of increasing dysphagia upper GI-endoscopy was performed several times in a 29-year-old patient. In the esophagus small ulcerations were found, histology revealed nonspecific changes. Under medication with PPI the symptoms remained. Upper GI-endoscopy was performed once more - Crohn's disease of the esophagus and stomach was diagnosed. Further gastrointestinal diagnostic procedures revealed an involvement of the ileum and colon of Crohn's disease.

Schlüsselwörter

M. Crohn - Crohn-Ösophagitis - gastroduodenaler M. Crohn

Key words

Crohn's disease - esophageal Crohn's disease - gastroduodenal Crohn's disease

Literatur

• 1 Farmer R G, Hawk W A, Turnbull R B. Clinical patterns in Crohn's disease: a statistical study of 615 cases.  Gastroenterology. 1975;  68 (4 Pt 1) 627-635
• 2 Mashako M N, Cezard J P, Navarro J, Mougenot J F, Sonsino E, Gargouri A, Maherzi A. Crohn's disease lesions in the upper gastrointestinal tract: correlation between clinical, radiological, endoscopic, and histological features in adolescents and children.  J Pediatr Gastroenterol Nutr. 1989;  8 442-446
• 3 Ruuska T, Vaajalahti P, Arajarvi P, Maki M. Prospective evaluation of upper gastrointestinal mucosal lesions in children with ulcerative colitis and Crohn's disease.  J Pediatr Gastroenterol Nutr. 1994;  19 181-186
• 4 Wagtmans M J, Verspaget H W, Lamers C B, van Hogezand R A. Clinical aspects of Crohn's disease of the upper gastrointestinal tract: a comparison with distal Crohn's disease.  Am J Gastroenterol. 1997;  92 1467-1471
• 5 Franklin R, Taylor S. Nonspecific granulomatous (regional) esophagitis.  J Thoracic Surg. 1950;  19 292-297
• 6 Lenaerts C, Roy C C, Vaillancourt M, Weber A M, Morin C L, Seidman E. High incidence of upper gastrointestinal tract involvement in children with Crohn disease.  Pediatrics. 1989;  83 777-781
• 7 Rudolph I, Goldstein F, DiMarino A J. Crohn's disease of the esophagus: Three cases and a literature review.  Can J Gastroenterol. 2001;  15 117-122
• 8 Freedman P G, Dieterich D T, Balthazar E J. Crohn's disease of the esophagus: case report and review of the literature.  Am J Gastroenterol. 1984;  79 835-838
• 9 Taskin V, Sohsten R, Singh B, Salzano L, Licht H. Crohn's disease of the esophagus.  Am J Gastroenterol. 1995;  90 1000-1001
• 10 Naranjo-Rodriguez A, Solorzano-Peck G, Lopez-Rubio F, Calanas-Continente A, Galvez-Calderon C, Gonzalez-Galilea A, Hervas-Molina A. Isolated oesophageal involvement of Crohn's disease.  Eur J Gastroenterol Hepatol. 2003;  15 1123-1126
• 11 Decker G A, Loftus E V, Pasha T M, Tremaine W J, Sandborn W J. Crohn's disease of the esophagus: clinical features and outcomes.  Inflamm Bowel Dis. 2001;  7 113-119
• 12 D'Haens G, Rutgeerts P, Geboes K, Vantrappen G. The natural history of esophageal Crohn's disease: three patterns of evolution.  Gastrointest Endosc. 1994;  40 296-300
• 13 Rholl J C, Yavorski R T, Cheney C P. et al . Esophagogastric fistula: a complication of Crohn's disease - case report and review of the literature.  Am J Gastroenterol. 1998;  93 1381-1383
• 14 Huchzermeyer H, Paul F, Seifert E, Frohlich H, Rasmussen C W. Endoscopic results in five patients with Crohn's disease of the esophagus.  Endoscopy. 1997;  8 75-81
• 15 Hanai H, Honda S, Sugimoto K. et al . Endoscopic therapy for multiple mucosal bridges in the esophagus of a patient with Crohn's disease.  Gastrointest Endosc. 1999;  50 715-717
• 16 Isaacs K L. Upper gastrointestinal tract endoscopy in inflammatory bowel disease.  Gastrointest Endosc Clin N Am. 2002;  12 451-462
• 17 Gschwantler M, Kogelbauer G, Klose W. et al . The pancreas as a site of granulomatous inflammation in Crohn's disease.  Gastroenterology. 1995;  108 1246-1249
• 18 Nugent F, Roy M. Duodenal Crohn's disease: an analysis of 89 cases.  Am J Gastroenterol. 1989;  84 249-254
• 19 Hokama A, Kinjo F, Sugama R, Kowashigawa R. Gastrointestinal: duodenal Crohn's disease.  J Gastroenterol Hepatol. 2003;  18 1425
• 20 Parente F, Cucino C, Bollani S, Imbesi V, Maconi G, Bonette S, Vago L, Porro G B. Focal gastric inflammatory infiltrates in inflammatory bowel diseases: prevalence, immunohistochemical characteristics, and diagnostic role.  Am J Gastroenterol. 2000;  95 705-711
• 21 Meining A, Bayerdorffer E, Bastlein E, Raudis N, Thiede C, Cyrus B, Kramer W, Klann H, Labenz J, Stolte M. Crohn's Disease Study Group, Germany . Focal inflammatory infiltrations in gastric biopsy specimens are suggestive of Crohn's disease.  Scand J Gastroenterol. 1997;  32 813-818