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DOI: 10.1055/s-0030-1255788
© Georg Thieme Verlag KG Stuttgart · New York
Distal esophageal involvement in Crohn disease: short treatment with adalimumab
D. Musto
Seconda Università degli Studi di Napoli – Unit of Gastroenterology and Digestive Endoscopy, IBD Center
Piazza Miraglia
1 Naples 80138
Italy
Fax: +39-0815665112
Email: dario.musto@alice.it
Publication History
Publication Date:
26 November 2010 (online)
The proximal gastrointestinal tract is involved in Crohn disease in less than 4 % of cases [1]. Esophageal involvement occurs in between 0.3 % and 2 % of the total patient population [2]. Upper gastrointestinal involvement is symptomatic or, more rarely, can be asymptomatic, as described by Souza et al. [3].
We report the case of a 49-year-old Italian man who presented with epigastric pain, poor appetite, weight loss, abdominal pain, and diarrhoea. He had already undergone a colonoscopy with retrograde ileoscopy with biopsies, which led to the diagnosis of Crohn disease. Laboratory tests confirmed the active phase of the disease (erythrocyte sedimentation rate 40 mm/hour, C-reactive protein 27 mg/L). Esophagogastroduodenoscopy (EGDS) performed 1 month after the patient’s proximal symptoms were first treated with a proton pump inhibitor showed a lesion with a diameter of about 18 mm at the distal third of the esophageal mucosa ([Fig. 1]).
Histological examination of multiple biopsies showed features compatible with Crohn disease. The patient subsequently underwent pretreatment screening for biological drugs and was given a first injection of adalimumab (Humira) at a dose of 160 mg subcutaneously. A second injection (80 mg subcutaneously) was given 15 days later, with subsequent rapid improvement in his proximal symptoms as well as the symptoms related to the ileocecal location. At 3 months after his initial presentation, follow-up EGDS showed a hyperemic mucus lining with healing of the ulcer over a wide area in the distal third of the esophagus ([Fig. 2]).
Currently the patient’s disease is in remission.
Competing interests: None
Endoscopy_UCTN_Code_CCL_1AB_2AC_3AZ
#References
- 1 Mottet C, Juillerat P, Pittet V. et al . Upper gastrointestinal Crohn’s disease. Digestion. 2007; 76 Suppl 2 136-140
- 2 Lou G-C, Yang J M, Huang W. et al . Esophageal Crohn’s disease. Endoscopy. 2009; 41 E257
- 3 Souza J LS, da Silva J G, Sipahi A M. Crohn’s disease of the esophagus without inflammatory activity confirmed by the use of endoscopy with narrow-band imaging. Endoscopy. 2009; 41 E188
D. Musto
Seconda Università degli Studi di Napoli – Unit of Gastroenterology and Digestive Endoscopy, IBD Center
Piazza Miraglia
1 Naples 80138
Italy
Fax: +39-0815665112
Email: dario.musto@alice.it
References
- 1 Mottet C, Juillerat P, Pittet V. et al . Upper gastrointestinal Crohn’s disease. Digestion. 2007; 76 Suppl 2 136-140
- 2 Lou G-C, Yang J M, Huang W. et al . Esophageal Crohn’s disease. Endoscopy. 2009; 41 E257
- 3 Souza J LS, da Silva J G, Sipahi A M. Crohn’s disease of the esophagus without inflammatory activity confirmed by the use of endoscopy with narrow-band imaging. Endoscopy. 2009; 41 E188
D. Musto
Seconda Università degli Studi di Napoli – Unit of Gastroenterology and Digestive Endoscopy, IBD Center
Piazza Miraglia
1 Naples 80138
Italy
Fax: +39-0815665112
Email: dario.musto@alice.it