Gastroduodenal form of Crohn's disease
Abstract
The aim of review. To highlight modern aspects of clinical presentation, diagnostics and treatment of gastroduodenal variant of Crohn's disease (GDCD).
Key points. Gastroduodenal involvement at CD is a rare clinical variant of disease and develops in less than 5,5% of cases. By the present time association of GDCD with L1007P mutation of NOD2/CARD15 gene is detected. Epigastric pain, loss of body weight, nausea and — in some cases — vomiting are the most frequent symptoms of this pathology. Endoscopy of the stomach and duodenum with histological examination are the «gold» standard of GDCD diagnostics and quite often have crucial importance in the proof of diagnosis. In difficult cases test for antiSaccharomyces cerevisiae antibodies (ASCA) can be used as additional tool of differential diagnostics. Prescription of proton pump inhibitors in combination to system corticosteroids and azathioprine/6-mercaptopurine if required can be considered as the most successful therapy. Infliximab should be considered as alternati ve drug to other forms of treatment at nonresponding cases.
Conclusion. No matter that GDCD is not the common form of disease, knowledge of the clinical variant is important for its duly recognition.
About the Authors
I. V. MayevRussian Federation
Mayev Igor V. — MD, PhD, professor, honored doctor of the Russian Federation, honored scientist of the Russian Federation, corresponding member of the Russian Academy of Science, vice-rector for academic affairs, head of the chair of internal diseases propedeutics and gastroenterology
D. N. Andreev
Russian Federation
Andreyev Dmitry N. – assistant-professor, Chair of internal diseases propedeutics and gastroenterology
127473, Moscow, Delegatskaya street, 20, bld 1
Yu. A. Kucheryavy
Russian Federation
References
1. Vorob’yev G.I., Khalif I.L. Nonspecific inflammatory bowel diseases. M.: Miklosh, 2008.
2. Konovich Ye.A., Khalif I.L., Shapina M.V. Immunopathogenesis of inflammatory bowel diseases. Ros zhurn gastroenterol gepatol koloproktol 2013; 23(4):69-78.
3. Guidelines of the Russian gastroenterological association on treatment of Crohn's disease in adults (a draft). Ros zhurn gastroenterol gepatol koloproktol 2012; 22(6):66-82.
4. Banerjee S., Peppercorn M.A. Inflammatory bowel disease. Medical therapy of specific clinical presentations. Gastroenterol Clin North Am 2002; 31:185-202.
5. Barrett J.C., Hansoul S., Nicolae D.L., et al. Genomewide association defines more than 30 distinct susceptibility loci for Crohn’s disease. Nat Genet 2008; 40:955-62.
6. Burakoff R. Gastroduodenal Crohn’s disease. In: Bayless T.M., Hanauer S.B., eds. Advanced therapy of inflammatory bowel disease. Hamilton, Ontario: BC Decker, 2001:421-3.
7. Burisch J., Munkholm P. Inflammatory bowel disease epidemiology. Curr Opin Gastroenterol 2013; 29(4):357-62. 8. Cho J.H. The genetics and immunopathogenesis of inflammatory bowel disease. Nat Rev Immunol 2008; 8(6):458-66.
8. Danzi J.T., Farmer R.G., Sullivan B.H.Jr., Rankin G.B. Endoscopic features of gastroduodenal Crohn’s disease. Gastroenterology 1976; 70:9-13.
9. Fenoglio-Preiser C.M., Noffsinger A.E., Stemmermann O.N., et al. Gastrointestinal Pathology. 2nd ed. Philadelphia: Lippincott-Raven, 1999. The nonneoplastic stomach:153-236. 11. Fielding J.F., Toye D.K., Beton D.C., et al. Crohn’s disease of the stomach and duodenum Gut 1970; 11:1001-6.
10. Firth M., Prather C. Unusual gastric Crohn’s disease treated with infliximab - A case report. Am J Gastroenterol 2002; 97:190.
11. Gary E.R., Tremaine W.J., Banks P.M., Nagorney D.M. Isolated Crohn’s disease of the stomach. Mayo Clin Proc 1989; 64:776-9.
12. Grübel P., Choi Y., Schneider D., et al. Severe isolated Crohn’s-like disease of the gastroduodenal tract. Dig Dis Sci 2003; 48:1360-5.
13. Halme L., Karkkainen P., Rautelin H., et al. High frequency of helicobacter negative gastritis in patients with Crohn’s disease. Gut 1996; 38:379-83.
14. Ibrahim S.H., Smyrk T.C., Faubion W.A. Treatment of isolated gastric Crohn’s disease with inhaled corticosteroids. Case Rep Gastroenterol 2008; 2(3):363-8.
15. Ingle S.B., Hinge C.R., Dakhure S., Bhosale S.S. Isolated gastric Crohn’s disease. World J Clin Cases 2013; 1(2):71-3. 18. Isaacs K.L. Upper gastrointestinal tract endoscopy in inflammatory bowel disease. Gastrointest Endosc Clin North Am 2002; 12:451-62.
16. Jess T., Riis L., Vind I., et al. Changes in clinical characteristics, course, and prognosis of inflammatory bowel disease during the last 5 decades: A populationbased study from Copenhagen, Denmark. Inflamm Bowel Dis 2007; 13:481-9.
17. Kefalas C.H. Gastroduodenal Crohn’s disease. Proc (Bayl Univ Med Cent) 2003; 16(2):147-51.
18. Korelitz B.I., Adler D.J., Mendelsohn R.A., Sacknoff A.L. Long-term experience with 6-mercaptopurine in the treatment of Crohn’s disease. Am J Gastroenterol 1993; 88:1198-205.
19. Kuna A.T. Serological markers of inflammatory bowel disease. Biochem Med (Zagreb) 2013; 23(1):28-42.
20. Lee E.L., Feldman M. Gastritis and gastropathies. In: Feldman M., Friedman L.S., Brandt L.J., eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier, 2010:chap 51.
21. Lee Y.H., Song G.G. Pathway analysis of a genome-wide association study of ileal Crohn’s disease. DNA Cell Biol 2012; 31(10):1549-54.
22. Levine M.S. Crohn’s disease of the upper gastrointestinal tract. Radiol Clin North Am 1987; 25:79-91.
23. Li X., Conklin L., Alex P. New serological biomarkers of inflammatory bowel disease. World J Gastroenterol 2008; 14(33):5115-24.
24. Loftus E.V.Jr. Upper gastrointestinal tract Crohn’s disease. Clin Perspect Gastroenterol 2002; 5:188-91.
25. Marcello P.W., Schoetz D.J.Jr. Gastroduodenal Crohn’s disease: Surgical management. In: Bayless T.M., Hanauer S.B., eds. Advanced therapy of inflammatory bowel disease. Hamilton, Ontario: BC Decker, 2001:461-3.
26. Marcuzzi A., Bianco A.M., Girardelli M., et al. Genetic and functional profiling of Crohn’s disease: Autophagy mechanism and susceptibility to infectious diseases. Biomed Res Int 2013; 2013:ID297501.
27. Mardini H.E., Gregory K.J., Nasser M., et al. Gastroduodenal Crohn’s disease is associated with NOD2/ CARD15 gene polymorphisms, particularly L1007P homozygosity. Dig Dis Sci 2005; 50(12):2316-22.
28. Miehsler W., Puspok A., Oberhuber T., Vogelsang H. Impact of different therapeutic regimens on the outcome of patients with Crohn’s disease of the upper gastrointestinal tract. Inflamm Bowel Dis 2001; 7:99-105.
29. Murray J.J., Schoetz D.J.Jr., Nugent F.W., et al. Surgical management of Crohn’s disease involving the duodenum. Am J Surg 1984; 147:58-65.
30. Nugent F.W., Richmond M., Park S.K. Crohn’s disease of the duodenum. Gut 1977; 18:115-20.
31. Nugent F.W., Roy M.A. Duodenal Crohn’s disease: An analysis of 89 cases. Am J Gastroenterol 1989; 84:249-54.
32. Ott C., Schölmerich J. Extraintestinal manifestations and complications in IBD. Nat Rev Gastroenterol Hepatol 2013; 10(10):585-95.
33. Pichney L.S., Fantry G.T., Graham S.M. Gastrocolic and duodenocolic fistulas in Crohn’s disease. J Clin Gastroenterol 1992; 15:205-11.
34. Reynolds H.L.Jr., Stellate T.A. Crohn’s disease of the foregut. Surg Clin North Am 2001; 81:117-35.
35. Ruffolo C., Angriman I., Scarpa M., et al. A gastrocolic fistula in Crohn’s disease. Dig Dis Sci 2005; 50(5):933-34.
36. Rutgeerts P., Onette E., Vantrappen G., et al. Crohn’s disease of the stomach and duodenum: A clinical study with emphasis on the value of endoscopy and endoscopic biopsies. Endoscopy 1980; 12:288-94.
37. Sandborn W.J. Preliminary report on the use of oral tacrolimus (FK506) in the treatment of complicated proximal small bowel and fistulizing Crohn’s disease. Am J Gastroenterol 1997; 92:876-9.
38. Sands B.E., Siegel C.A. Crohn’s disease. In: Feldman M., Friedman L.S., Brandt L.J., eds. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier, 2010: chap 111.
39. Travis S.P., Stange E.F., Lémann M., et al. European evidence based consensus on the diagnosis and management of Crohn’s disease: Current management. Gut 2006; 55 (Suppl. 1):16-35.
40. Tremaine W.J. Gastroduodenal Crohn’s disease: Medical management. Inflamm. Bowel Dis 2003; 9(2):127-8.
41. Valori R.M., Cockel R. Omeprazole for duodenal ulceration in Crohn’s disease. BMJ 1990; 300:438-9.
42. Van Hogezand R.A., Witte A.M., Veenendaal R.A., et al. Proximal Crohn’s disease: Review of the clinicopathologic features and therapy. Inflamm Bowel Dis 2001; 7:328-37.
43. Wagtmans M.J., Verspaget H.W., Lamers C.B., et al. Clinical aspects of Crohn’s disease of the upper gastrointestinal tract: A comparison with distal Crohn’s disease. Am J Gastroenterol 1997; 92:1467-71.
Review
For citations:
Mayev I.V., Andreev D.N., Kucheryavy Yu.A. Gastroduodenal form of Crohn's disease. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2015;25(5):5-9. (In Russ.)