Abstract
BackgroundFew studies have described patients with foregut dysmotility in inflammatory bowel disease. The aim of this case series was to evaluate clinical characteristics of 5 patients with inflammatory bowel disease and symptoms and signs of upper gut dysmotility.Case presentationsWe describe a series of four patients with Crohn's disease and one with indeterminate colitis who presented with severe symptoms and signs of gastroparesis. We reviewed medical records of all cases. Gastric emptying of a solid meal was assessed by scintigraphy. Small bowel enteroclysis, gastroduodenoscopy and colonoscopy with biopsies were performed to estimate the activity of the disease and to exclude organic obstruction. None of the patients had any signs of active inflammation or stricture. All of the patients had markedly delayed gastric emptying with a mean t 1/2 of 234 minutes (range 110–380 minutes; normal values 54–94 minutes).ConclusionClinicians should consider impaired gastric emptying when evaluating patients with Crohn's disease and severe symptoms of upper gut dysmotility, which cannot be attributed to active inflammation or organic obstruction of the digestive tract. Symptoms in these patients are refractory to various therapeutic interventions including tube feeding and gastric surgery.
Highlights
Few studies have described patients with foregut dysmotility in inflammatory bowel disease
Clinicians should consider impaired gastric emptying when evaluating patients with Crohn's disease and severe symptoms of upper gut dysmotility, which cannot be attributed to active inflammation or organic obstruction of the digestive tract
Some reports indicate that upper gut motility can be impaired in patients with inactive Crohn's disease [1,3]. The aim of this case series is to describe clinical characteristics of five patients who had severe symptoms of gastroparesis which could not be attributed to mechanical obstruction or active inflammation, but who all had impaired gastric emptying of solid food
Summary
We describe five patients with Crohn's disease who had no signs of active inflammation but developed severe symptoms of gastroparesis. It remains to be elucidated why some patients with inactive Crohn's disease develop upper gut motor disturbances. According to our experience these patient will develop persistent symptoms despite medical treatment. Tube feeding is most often necessary and even bypassing of the stomach seems to be the only therapeutic possibility in the most extreme cases
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