Esophageal Crohn’s disease

Esophageal involvement in Crohn’s disease is uncommon event, especially solitary esophageal Crohn’s disease, with an incidence ranging from 0.3 % to 2 % [1] [2] [3]. We report a case of solitary esophageal Crohn’s disease.

A 46-year-old Chinese woman was admitted to hospital in April 2007, presenting with a history of continuous mouth ulcers, pain on swallowing, and chest pain; she had been unable to take solid food for 5 months. Gastroscopy revealed one huge ulcer in the esophagus, located 28 – 33 cm from the upper incisors and around two-thirds of the circumference, with its base of a cobblestone appearance ([Fig. 1 a]). Histological examination of biopsy specimens from the ulcer margin revealed chronic inflammation. Endoscopic ultrasonography showed a heterogeneous hypoechoic lesion with a thickened wall around 9 – 15 mm in the esophagus; all five layers of the esophageal wall were disordered, the adventitia was interrupted, and mediastinal lymphadenitis was present ([Fig. 1 b]). Colonoscopy and barium studies of the small intestine as well as capsule endoscopy revealed no abnormality. At first, antituberculosis treatment was applied as a diagnostic therapy, but 1 month later the esophageal ulcer expanded to the full circumference and became deeper ([Fig. 1 c]). Then esophageal Crohn’s disease was considered. Treatment started with prednisone (40 mg p. o., q. d.) and olsalazine (1000 mg p. o., t. i. d.). The prednisone was gradually withdrawn over 3 months and the olsalazine (500 mg t. i. d.) was maintained for 1 year. In the follow-up period, gastroscopy showed the ulcer disappearing gradually and the mucosal lesion being completely repaired piece by piece ([Fig. 1 d]).

Fig. 1 Endoscopic and endoscopic ultrasonographic appearance of esophageal Crohn’s disease. a Before treatment, an esophageal lesion with a central ulcer is seen that took up two-thirds of the circumference. The base of the ulcer exhibits a cobblestone-like appearance. b Endoscopic ultrasonography showed a heterogeneous echo in the esophageal wall with strand-like hyperechoic areas. Two enlarged lymph nodes 3–4 mm in diameter were observed as a low-echo signal. The thickness of the esophageal wall was 15.4 mm. c After antituberculosis therapy, the lesion spread to the whole circumference with a more obvious cobblestone-like ulcer base. d After appropriate treatment, the ulcer disappeared and the injured mucosa was repaired with only a scar left.

Endoscopy_UCTN_Code_CCL_1AB_2AC_3AZ

References

• 1 Naranio-Rodriguez A, Solorzano-Peck G, Lopez-Rubio F. et al . Isolated oesophageal involvement of Crohn’s disease.  Eur J Gastroenterol Hepatol. 2003;  15 1123-1126
• 2 Heller T, James S P, Drachenberg C. et al . Treatment of severe esophageal Crohn’s disease with infliximab.  Inflamm Bowel Dis. 1999;  5 279-282
• 3 Rudolph I, Goldstein F, DiMarino jr. A J. et al . Crohn’s disease of the esophagus: three cases and a literature review.  Can J Gastroenterol. 2001;  15 117-122