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Crohn's Disease of the Esophagus: Clinical Features and Treatment Outcomes in the Biologic Era

De Felice, Kara M. MD; Katzka, David A. MD; Raffals, Laura E. MD

doi: 10.1097/MIB.0000000000000469
Original Clinical Articles

Background: Esophageal Crohn's disease (CD) is challenging and often a disabling phenotype of disease. We aimed to report the clinical, endoscopic, histologic features, and treatment outcomes of esophageal patients with CD.

Methods: Esophageal patients with CD evaluated at the Mayo Clinic in Rochester, MN, between January, 1998, and December, 2012, were identified.

Results: Twenty-four cases of esophageal CD were identified. The median age of diagnosis was 23 years (range, 12–60). Twenty-one patients (88%) had extraesophageal CD and 8 patients (33%) had oral ulcers at the time of esophageal CD symptom onset. The majority of patients had esophageal-specific symptoms. Mid (29%) or distal (29%) esophagus was the most common site of involvement. Inflammatory esophageal CD (75%) was marked by superficial ulcerations (58%), erythema and/or erosions (50%), deep ulcerations (13%), and pseudopolyps (4%) on endoscopy. Four patients (17%) were found to have esophageal strictures and 2 patients (8%) had fistulizing disease. Chronic inflammation (83%) was seen on biopsy in the majority of cases with 5 patients having associated granulomas. In our series, inflammatory esophageal CD responded to prednisone, topical budesonide, or biologics. Stricturing esophageal CD was successfully treated with a combination of biologic therapy, immunomodulators, and serial dilations with/without steroid injections. Aggressive medical therapy with biologics and endoscopic therapy was used for fistulizing esophageal CD, however, was not universally effective.

Conclusions: Esophageal CD should be considered in all patients with CD with upper gastrointestinal symptoms. Early recognition, diagnosis, and aggressive medical and/or endoscopic treatment are needed for successful outcomes.

Article first published online 16 June 2015.

Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.

Reprints: Laura E. Raffals, MD, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905 (e-mail: raffals.laura@mayo.edu).

Supported by CTSA Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH).

The contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH.

The authors have no conflicts of interest to disclose.

Received March 18, 2015

Accepted April 03, 2015

© Crohn's & Colitis Foundation of America, Inc.
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