Crohn's disease of the esophagus: Clinical features and outcomes

Objectives: Crohn's disease of the esophagus is rare. We sought to determin e the clinical features and outcome of patients with esophageal Crohn's dis ease seen at our institution. Methods: Patients with esophageal Crohn's dis ease evaluated at Mayo Clinic Rochester between 1976 and 1998 were identifi ed. Results; Twenty patients (0.2%) with esophageal involvement were identi fied. Median age at diagnosis was 31 years (range, 7-77 years). Eleven pati ents (55%) were female. Extraesophageal Crohn's disease preceded or was fou nd at the same time as the diagnosis of esophageal Crohn's in all cases. Si xteen patients (80%) had symptoms referable to the esophagus. Endoscopic fi ndings included ulcers in 17 (85%), erythema or erosions in 8 (40%), and st rictures in 4 patients (20%). One patient had a fistula, The most common hi stological findings were active chronic inflammation (75%) and ulcer (30%). No granulomata were identified. Approximately one half of our patients imp roved with first-line therapy. Eleven patients (55%) received immune modifi er therapy. Six showed significant improvement on azathioprine, 6-mercaptop urine. or cyclosporine. Esophageal dilatation was required in six patients, and three patients required surgery. Conclusion: Esophageal Crohn's diseas e may be underdiagnosed. Patients with Crohn's disease complaining of esoph ageal symptoms should undergo upper endoscopy with biopsies, and the diagno sis of esophageal Crohn's disease should be entertained if aphthous or deep ulcers or strictures are present. Immune modifier therapy should be consid ered for steroid-dependent and steroid-resistant cases.