Crohn Disease of the Esophagus

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Crohn disease may affect the entire gastrointestinal tract, including the esophagus. Involvement of the esophagus alone is rare, however.

Endoscopic diagnostic criteria (Fig. 3.44)

- Erythema, diffuse or focal edema, blistering

- Bleeding

- Pseudomembrane, ulcer, slough

- Stricture

- Fistula

- Squamous cell carcinoma (caustic ingestion)

Differential diagnosis

► Endoscopic findings are easy to interpret in patients with a typical history.

Checklist for endoscopic evaluation

► Location of the injury

► Extent of the injury

Endoscopic diagnostic criteria (Fig. 3.45)

► Mucosal edema and erythema

► Nodular mucosa

► Ulceration and strictures

Differential diagnosis

► Viral esophagitis

Checklist for endoscopic evaluation

► Morphology of the individual lesions

► Number and size of the lesions

Additional Studies

► Further standard tests for evaluating Crohn disease

Additional Studies after Endoscopy

► No tube placement

► Radiographic follow-up: Perforation?

Comments

The patient should be reexamined at three to four weeks, first with radiographs and then endoscopically.

Because caustic (alkaline) injuries are classified as premalignant lesions, endo-scopic follow-ups should be scheduled once a year.

Fig. 3.45 a, b Esophageal involvement by Crohn disease b

Fig. 3.45 a, b Esophageal involvement by Crohn disease b

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