CROHNS-DISEASE OF THE UPPER GASTROINTESTINAL-TRACT - THE VALUE OF ENDOSCOPIC EXAMINATION

The involvement of the upper gastrointestinal (GI) tract has been cons idered to be a rare manifestation of Crohn's disease (CD). Retrospecti ve studies have reported prevalence figures of 0.5-13%. The diagnosis of CD of the upper GI tract is based on clinical, radiological, endosc opic and histologic features. In contrast to the retrospective studies , prospective studies, in which patients with CD underwent routine end oscopic evaluation with biopsies, revealed a much higher frequency of endoscopic and histologic abnormalities. Since Helicobacter pylori is the most frequent cause of gastritis and the most important etiologic factor in peptic ulcer disease, it is important to assess the contribu tion of H. pylori in the interpretation of the abnormalities observed in the upper GI tract in patients with CD. Therapy for CD of the upper GI tract consists of drug therapy and endoscopic or surgical interven tions and is in fact similar to that for distal CD. Corticosteroids ar e still the most important drugs in the treatment of CD of the upper G I tract. Sometimes adjunctive therapy, e.g. gastric antisecretory drug s and mucosa protective agents, is beneficial. Endoscopic evaluation o f the upper GI tract with biopsies should be part of the work-up of CD patients.