Crohn's disease of the esophagus: Three cases and a literature review

Three cases of esophageal Crohn's disease (CD) are described, each with dys phagia and/or odynophagia caused by esophageal ulceration. All three patien ts had associated ileocolitis. One patient followed for a prolonged period responded to treatment with sulfasalazine and prednisone. A computer search hack to 1967 produced 72 additional cases of esophageal CD. Among these 75 patients (total), who were, on average, 34 years old, esophageal disease w as the presenting disease symptom in 41 patients (55%). The diagnosis was d ifficult in 13 patients, in whom no distal bowel disease was detected at th e time of initial esophageal presentation. The most common presentation was dysphagia associated with aphthous or deeper ulcerations (52 patients). In 11 of these patients, oral aphthous ulcerations were also present. Esophag eal stenosis or fistulas to surrounding structures were present in 27 patie nts and led to surgery in ii patients. Most of the unfavourable outcomes we re in this group of 27 patients with esophageal complications, including Av e deaths. Fourteen additional patients required surgery for CD of other are as. Responses of uncomplicated ulcerative disease of the esophagus tended t o be favourable if the medical regimen included prednisone. Clinical patter ns of esophageal CD were divided into three categories: ulcerative, stenosi ng and asymptomatic (acute disease in children).