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J Gastroenterol Hepatol. 2018 Feb;33(2):355-364. doi: 10.1111/jgh.13866.

Oral and upper gastrointestinal Crohn's disease.

Author information

1
Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.
2
Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.
3
Department of Oral Medicine, Westmead Hospital, Sydney, New South Wales, Australia.
4
Faculty of Dentistry, Sydney University, Sydney, New South Wales, Australia.
5
Department of Radiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.
6
Department of Colorectal Surgery, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.

Abstract

Crohn's disease is a heterogeneous, inflammatory condition that can affect any location of the gastrointestinal tract. Proximal gastrointestinal involvement occurs in 0.5-16% of patients, and it is usually diagnosed after recognition of intestinal disease. Symptoms are often mild and nonspecific; however, upper gastrointestinal disease predicts a more severe Crohn's phenotype with a greater frequency of complications such as obstruction and perforation. Gastroscopy and biopsy is the most sensitive diagnostic investigation. There is a paucity of data examining the treatment of this condition. Management principles are similar to those for intestinal disease, commencing with topical therapy where appropriate, progressing to systemic therapy such as glucocorticoids, 5-aminosalicylic acid, immunomodulators, and biologics. Acid suppression therapy has symptomatic but no anti-inflammatory benefit for gastroduodenal and esophageal involvement. Surgical intervention with bypass, strictureplasty, or less frequently, endoscopic balloon dilation may be required for complications or failed medical therapy.

KEYWORDS:

Crohn's disease; esophageal diseases; oral pathology; stomach diseases; upper gastrointestinal tract

PMID:
28708248
DOI:
10.1111/jgh.13866
[Indexed for MEDLINE]

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