Esophageal Crohn's disease: Medical management and correlation between clinical, endoscopic, and histologic features

Abstract

: Esophageal involvement in patients with Crohn's disease, initially thought to be rare, has been documented with increasing frequency in both retrospective and prospective studies. However, there is no documented standardized medical regimen for treatment of these patients. We report five cases of esophageal Crohn's disease as well as a review of the literature emphasizing therapeutic approach and increased incidence of corticosteroid dependence in these patients. In the past, patients with significant esophageal disease and symptoms have been surgical candidates. We recommend that all patients with symptoms of dysphagia, odynophagia, chest pain, or dyspepsia with documented esophageal Crohn's disease should receive H2 receptor antagonists as part of their medical regimen. In addition, immunosuppressant agents should be considered as adjuvant therapy in steroid-dependent patients with esophageal disease involvement.