Colonic mucosa in patients with portal hypertension

BACKGROUND AND AIMS: To do a histomorphometric study of vascular changes in colonic mucosa of patients with portal hypertension (PHT) and to find their association with clinical and upper and lower gastrointestinal endoscopic observations. METHODS: Full length colonoscopy was carried out in 55 patients with portal hypertension and 25 controls. Hemorrhoids, anorectal varices and colopathy were carefully looked for and recorded. Two biopsies each were taken from the caecum, ascending colon, transverse colon, descending colon and rectum. Sections from all the five sites were examined for histopathological changes with special reference to changes in mucosal capillaries. Morphometric assessment of the diameter of the capillary and thickness of the capillary wall was performed. These histomorphometric changes were correlated with clinical parameters and findings of upper and lower gastrointestinal endoscopic findings. RESULTS: Dilated and congested capillaries as well as capillaries with irregular thickening of the wall were seen in a significantly higher number of sections from patients than controls in biopsies from all the five sites from caecum to rectum. On morphometry, the diameter of the capillaries and the thickness of the capillary wall in biopsies from all the five sites in patients was significantly higher than that in the control group. Apart from vascular changes, edema and inflammatory infiltrate in lamina propria were the other significant histological features noted. No significant association between clinical and endoscopic features and histomorphometric assessment was found. CONCLUSION: Dilated tortuous mucosal capillaries with irregular thickening of wall, edema of lamina propria and mild chronic inflammatory infiltrate are the major histopathological changes seen in colonic biopsies of patients with PHT, showing that PHT produces changes in the colonic mucosa similar to those seen in the mucosa of upper GI tract. However, the histological changes had no correlation with the clinical or endoscopic findings except that the thickness of the capillary wall was higher in patients who had undergone endoscopic sclerotherapy as opposed to those who had not received sclerotherapy.     

Duodenal compression caused by superior mesenteric artery: study of 10 patients.

BACKGROUND: the compression of the third portion of the duodenum by the superior mesenteric artery (aorto-mesenteric clamp) is a rare cause of abdominal pain. Its clinical appearance may range between an asymptomatic and accidental radiological finding and an acute duodenal ileus (superior mesenteric artery syndrome), which requires urgent surgical intervention. METHODS: we revised all of the reports of upper gastrointestinal tract contrast-medium study (which included the duodenum) made in our hospital between May 1999 and April 2002. We analysed the case history of those patients with a radiological image compatible with aorto-mesenteric clamp. RESULTS: of the 1280 studies analysed, 10 of them (0,78%) were compatible with an aorto-mesenteric clamp. The 10 patients were females whose mean age was 25,7 years (range 9-77) that consulted for different abdominal discomfort. The symptoms of the 9 youngest patients were not typical of duodenal obstruction and their evolution was favourable. In the eldest patient, the clinical data were compatible with a mesenteric superior artery syndrome, although a subsequent study showed the presence of a colon adenocarcinoma. CONCLUSIONS: the aorto-mesenteric clamp is a rare radiological finding (<1 %) which does not always justify the supported clinical data. In our series, 9 cases were considered non-obstructive aorto-mesenteric clamps, although some of them showed pathogenical factors (scoliosis and thinness). The superior mesenteric artery syndrome should be considered as a diagnosis of exclusion after performing an adequate clinical study when the situation of the patient requires it.     

Gastroduodenal Crohn's disease - report of 4 cases and review of the literature

BACKGROUND: Crohn's disease can affect all the gastrointestinal tract, but gastroduodenal involvement is rarely seen (0.5 to 13%). OBJECTIVES: Report clinical, radiological and endoscopic findings and treatment of four patients with gastroduodenal Crohn's disease and review the literature. PATIENTS AND METHODS: Four patients (one male of 24 years old three females of 37, 66 and 74 years old) with epigastric pain, weight loss and low grade fever were referred to the University Hospitals of Federal University of Rio de Janeiro and Fluminese Federal University. Two had also mild intermittent diarrhea and arthritis/arthralgia and the third developed pyloric obstruction and received surgical treatment. Anemia was observed in only one (the young female). Barium x-ray studies showed aphthous ulcers in stomach and duodenum with distal ileum lesions and deformity in both. Upper gastrointestinal endoscopy revealed aphthous ulcers in stomach and geographic duodenal ulcers. Polypoid lesions and serpiginous ulcers within gastric antrum were observed in the young female. Colonoscopy was performed in two patients and disclosed an ulcerated ileitis in one and ulcerated pancolitis in other. Histopathology findings of biopsy specimens were inconclusive (granulomas were not found) and other causes of granulomatous disease were ruled out. Corticosteroids and proton pump inhibitors were started and two patients had their disease controlled. The other patient developed pyloric obstruction and had to be operated. CONCLUSIONS: Gastroduodenal Crohn's disease has distinct clinical, therapeutic and prognostic features. Advances in endoscopic methods and recognition of new histopathologic criteria for diagnosis have revealed an incidence higher than previously reported.     

Crohn's disease of esophagus,stomach and duodenum

Crohn's disease with involvement of the esophagus, stomach and duodenum has a prevalence of 0.5% to 4% in symptomatic adult patients, but some studies have shown that these results may be underestimated, since upper gastrointestinal endoscopy is not performed routinely in the initial evaluation of the disease in adult patients, as it is in the pediatric population. In general, involvement of the upper gastrointestinal tract in Crohn's disease occurs concomitantly with involvement of the lower gastrointestinal tract. The diagnosis depends on clinical,endoscopic, histological and radiological evaluation. The presence of aphthoid ulcers, longitudinal ulcers, bamboo-joint-like appearance, stenoses and fistulas are endoscopic findings suggestive of the disease, and it is important to exclude the presence of Helicobacter pylori infection. The primary histological findings,which facilitate the diagnosis, are the presence of a chronic inflammatory process with a predominance of lymphoplasmacytic cells and active focal gastritis. The presence of epithelioid granuloma, although less frequent, is highly suggestive of the disease in the absence of chronic granulomatous disease. Treatment should include the use of proton pump inhibitors associated with corticosteroids,immunomodulators and biological therapy according to the severity of the disease.     

The significance of serum transforming growth factor beta 1 in detecting of gastric and colon cancers

BACKGROUND/AIMS: TGF-beta1 is a growth factor with wide ranging effects on proliferation, differentiation, immune suppression, apoptosis and matrix remodeling. We aimed to clarify the clinical significance of circulating levels of TGF-beta1 as a tumor marker in gastrointestinal tract cancers by comparing it to CEA across a range of parameters such as cancer type and severity. METHODOLOGY: Sera collected from patients with gastrointestinal tract cancers (32 gastric, 36 colon) and from 25 healthy volunteers were analyzed for TGF-beta1 and CEA. Relations between serum TGF-beta1 levels and tumor stage and tumor grade were also evaluated. RESULTS: Mean serum TGF-beta1 levels were higher in patients with gastric or colon cancer compared to the control group (p = 0.001). In both types of cancer there were no differences in TGF-beta1 levels associated with serosal involvement, lymph node involvement, vascular invasion, distant metastasis or tumor size. Mean serum TGF-beta1 levels were also not statistically different across histopathological tumor grades in either type of cancer. The sensitivity of TGF-beta1 was higher in patients with gastric cancer than in patients with colon cancer. TGF-beta1 had greater sensitivity than CEA in gastric cancer patients. CONCLUSIONS: TGF-beta1 has higher sensitivity in gastric and colon cancers. Since it may be increased even in cancer without closed and distant metastasis, TGF-beta1 may be used as a tumor marker and combined with CEA particularly in gastric cancers.     

Crohn's disease of the upper gastrointestinal tract

Although Crohn's disease (CD) is generally found in the ileum and/or colon, since the 1960s it has become evident that this chronic inflammatory disorder of unknown aetiology can affect the whole gastrointestinal tract from mouth to anus. In 0.5–13% of patients with ileocolonic CD the disease occurs in the upper gastrointestinal tract as well (i.e., from mouth through jejunum). With the radiological double-contrast technique, however, early signs of upper gastrointestinal CD may be detected in 20–40% of patients with ileocolitis. On the other hand, histologically evaluated biopsies from the lower oesophagus, body of the stomach, gastric antrum and the duodenal bulb of patients with Crohn's disease from whom the upper gastrointestinal tract is normal, according to X-ray or endoscopy may reveal lesions, which are considered to be pathologically diagnostic. Jejunal involvement occurs in 4–10% of patients with ileitis, ileocolitis or colitis. In early studies biopsies of apparently normal buccal mucosa from patients with Crohn's disease showed a significant correlation between the activity of the disease, as defined by the Crohn's Disease Activity Index, and the number of plasma cells containing IgM, suggesting a generalized activated humoral defence system during relapse. A diagnosis of Crohn's disease of the upper gastrointestinal tract can be achieved by combining recognition of clinical, roentgenographic, and endoscopic features. Provided that other causes of granulomatous involvement of the gastrointestinal tract can be excluded, non-caseating granulomas are generally accepted as the histological proof of Crohn's disease. When Crohn's disease does involve the upper gastrointestinal tract, there is nearly always concomitant disease in the small bowel or colon. Compared to patients with an ileocolonic localization, patients with Crohn's disease in the upper gastrointestinal tract more frequently have colic-like abdominal pain and/or cramps, nausea and anorexia as presenting symptoms and are younger at onset of the disease. Medical therapeutic principles are the same as for Crohn's disease elsewhere in the gastrointestinal tract. Absolute indications for surgical treatment are massive bleeding, progressive stenosis, and extensive fistula formation.     

Gastrointestinal, hepatic, and pancreatic involvement with Cryptococcus neoformans in AIDS

We describe three cases of acquired immunodeficiency syndrome (AIDS) complicated by disseminated cryptococcosis with gastrointestinal involvement. The stomach, duodenum, colon, pancreas, and liver showed invasion by the fungus. Although none of the patients had any symptoms attributable to Cryptococcus neoformans, we speculate that cryptococcal invasion of the liver and gastrointestinal tract may be a contributor to the morbidity in these immunocompromised patients.     

Upper gastrointestinal carcinoid tumors incidentally found by endoscopic examinations

AIM: This study shares Asian clinical experiences of carcinoid tumors that originated in the upper gastrointestinal tract. METHODS: From May 1987 to June 2002, we had found only 13 cases of histologically confirmed carcinoid tumors in the upper gastrointestinal tract by endoscopic examinations. There were eight males and five females. The mean age was 53.16±20.51 years that ranged from 26 to 82 years. Each of their clinical presentations, locations, tumor morphology, and size and the treatment outcome were analyzed and discussed. RESULTS: One patient had a polypoid lesion at the lower esophagus, nine were stomach lesions and three located at the duodenum. All patients with polypoid and submucosal tumor types were of small size (<1.7 cm) and all patients survived after simple excision or polypectomy. Four of the five patients in tumor mass forms died and the tumors were more than 2.0 cm in size. CONCLUSION: Carcinoid tumors rarely originated from the upper gastrointestinal tract and are usually found accidentally after endoscopic study. Bigger size (more than 2 cm) tumor masses may indicate a more severe disease and poor prognosis.     

Gastrointestinal tract metastasis in patients with germ-cell tumor of the testis

A study of the incidence and clinical course of testicular germ-cell tumor metastatic to the gastrointestinal tract is presented. Gastrointestinal tract metastasis occurred in 25 cases, 5% of all patients evaluated with germ-cell tumor of the testis. Although embryonal carcinoma was the dominant component in all cases, elements of choriocarcinoma were found in 20 cases and HCG was positive in 22 cases. Metastasis occurred most commonly by direct invasion from adjacent tumor. The most frequent site of gastrointestinal involvement was the proximal small intestine. Involvement of the duodenum was noted in seven cases. The most common gastrointestinal tract manifestations were intestinal obstruction and gastrointestinal bleeding. Although a variety of therapeutic modalities were tried, the average length of survival from the time of diagnosis of gastrointestinal metastasis to death was six months.Supported in part by the American Cancer Society Clinical Fellowship 3697 to Dr. Chait, and American Cancer Society Junior Faculty Clinical Fellowship 352 to Dr. Kurtz.     

The Clinical Significance of Incidental Computer Tomography Finding of Gastrointestinal Luminal Wall Thickening as Evaluated by Endoscopy

The widespread use of computerized tomography in evaluating patients with various abdominal complaints gave rise to reports of incidental gastrointestinal luminal wall thickening (GILWT), the clinical significance of which remains uncertain. In order to determine the endoscopic significance of GILWT we reviewed 1609 abdominal and/or pelvic CT scans. Ninety-two patients with GILWT were identified. Patients with obvious clinical cause of this abnormality were excluded from the study. The median age of the patients was 58 years, with no significant difference in gender distribution. The GILWTs were distributed along the GI tract as follows: 24 upper (esophageal, gastric, and duodenum), 13 small intestine (jejunum and ileum), 3 combined small and large intestine, and 52 colon. Fifty of these patients underwent endoscopic evaluation. Six patients (12%) had cancer, all of which involved the colon. The endoscopy was unremarkable in 19 (38%) and revealed a nonmalignant finding in the remaining 25 patients (50%). None of the upper GI or small bowel GILWTs were malignant, while 6 of the 34 colonic GILWTs (18%) were malignant. The mean age of the colonic GILWT group was 59. None of the patients younger than 50 had cancer, while 6 of the 24 older patients (25%) had colon cancer. We conclude that as GILWT is not a common finding and could be the initial presentation of malignancy, particularly when involving the colon in patients older than 50, endoscopic evaluation should be strongly recommended in patients who do not have an alternative diagnosis that can satisfactorily explain GILWT.     

Kaposi's sarcoma

We have evaluated 19 homosexual/bisexual male patients with biopsy-proven Kaposi's sarcoma (KS) of the skin in order to define the extent of gastrointestinal involvement and determine its correlation with oral mucosal disease, skin findings, and immunologic function. Nearly half the patients had oral mucosal lesions. In patients with oral mucosal lesions, 75% had gastrointestinal lesions. Some gastrointestinal involvement during the period of observation was present in 10 of the 19 patients. Involvement of the upper gastrointestinal tract was more common than colonic involvement: esophagus 1, stomach 8, duodenum 3, and colon 6. Significant immunosuppression was observed in these patients, measuredin vitro by natural killer (NK) assay, and lymphocyte proliferation response to mitogens.     

Beh?et's syndrome and the digestive tract

Gastrointestinal involvement represents only 14% of the anatomical sites of Beh?et's syndrome in France. The various segments of the gastrointestinal tract may be affected. Episodes of mucosal aphthae are more frequent in the oesophagus than in the stomach or duodenum. Intestinal involvement constitutes the major gastrointestinal localisation. Colonic or ileo-colonic lesions may appear after several years of recurrent aphthosis and present in the form of acute complications (perforation, massive haemorrhage) or by prolonged haemorrhagic diarrhoea with marked deterioration in the general state. The radiological and endoscopic signs are similar to those observed in various forms of severe acute colitis such as haemorrhagic proctocolitis or Crohn's disease. The diagnosis of an intestinal localisation of Beh?et's syndrome is based on the richness of the extra-intestinal signs and moreover on the presence of deep colonic ulcerations frequently situated in healthy mucosa, the presence of an adjacent non-specific inflammatory infiltrate affecting all of the colonic wall, lesions of vasculitis and perivasculitis with signs of leukocytoclasis and fibrinoid necrosis. Surgical treatment is frequently necessary. The high incidence of ulcerative recurrences in the anastomoses, in which fistulae may also develop, requires extensive intestinal resections or diversions by long-term ileostomies.     

Endoscopic removal of submucous tumours.

Although gastrointestinal submucous tumours are increasingly being discovered with the development of endoscopic examination techniques, the reliable diagnosis of these lesions remains difficult at present. Before endoscopy became available, the treatment strategy for gastrointestinal submucous tumours was either surgery or observation. With the rapid evolution of therapeutic endoscopy, the endoscopic removal of various tumours in the gastrointestinal tract has been described, but the resection of submucous tumours is still reported only infrequently. Endoscopic removal of submucous tumours of the gastrointestinal tract has yet to become widespread, and this technique has not been fully evaluated. Not all patients need the treatment; however, endoscopic submucous tumour removal may be the treatment of choice for certain patient subgroups. This article reviews recent literature regarding the endoscopic removal of gastrointestinal submucous tumours and discusses the possibility of removing submucous tumours using endoscopic resection.     

Distribution of bleeding gastrointestinal angioectasias in a Western population

AIM: To define which segments of the gastrointestinal tract are most likely to yield angioectasias for ablative therapy.METHODS: A retrospective chart review was performed for patients treated in the Louisiana State University Health Sciences Center Gastroenterology clinics between the dates of July 1, 2007 and October 1, 2010. The selection of cases for review was initiated by use of our electronic medical record to identify all patients with a diagnosis of angioectasia, angiodysplasia, or arteriovenous malformation. Of these cases, chart reviews identified patients who had a complete evaluation of their gastrointestinal tract as defined by at least one upper endoscopy, colonoscopy and small bowel capsule endoscopy within the past three years. Patients without evidence of overt gastrointestinal bleeding or iron deficiency anemia associated with intestinal angioectasias were classified as asymptomatic and excluded from this analysis. Thirty-five patients with confirmed, bleeding intestinal angioectasias who had undergone complete endoscopic evaluation of the gastrointestinal tract were included in the final analysis.RESULTS: A total of 127 cases were reviewed. Sixty-six were excluded during subsequent screening due to lack of complete small bowel evaluation and/or lack of documentation of overt bleeding or iron deficiency anemia. The 61 remaining cases were carefully examined with independent review of endoscopic images as well as complete capsule endoscopy videos. This analysis excluded 26 additional cases due to insufficient records/images for review, incomplete capsule examination, poor capsule visualization or lack of confirmation of typical angioectasias by the principal investigator on independent review. Thirty-five cases met criteria for final analysis. All study patients were age 50 years or older and 13 patients (37.1%) had chronic kidney disease stage 3 or higher. Twenty of 35 patients were taking aspirin (81 mg or 325 mg), clopidogrel, and/or warfarin, with 8/20 on combination therapy. The number and location of angioectasis was documented for each case. Lesions were then classified into the following segments of the gastrointestinal tract: esophagus, stomach, duodenum, jejunum, ileum, right colon and left colon. The location of lesions within the small bowel observed by capsule endoscopy was generally defined by percentage of total small bowel transit time with times of 0%-9%, 10%-39%, and 40%-100% corresponding to the duodenum, jejunum and ileum, respectively. Independent review of complete capsule studies allowed for deviation from this guideline if capsule passage was delayed in one or more segments. In addition, the location and number of angioectasias observed in the small bowel was further modified or confirmed by subsequent device-assisted enteroscopy (DAE) performed in the 83% of cases. In our study population, angioectasias were most commonly found in the jejunum (80%) followed by the duodenum (51%), stomach (22.8%), and right colon (11.4%). Only two patients were found to have angioectasias in the ileum (5.7%). Twenty-one patients (60%) had angioectasias in more than one location.CONCLUSION: Patients being considered for endoscopic ablation of symptomatic angioectasias should undergo push enteroscopy or anterograde DAE and re-inspection of the right colon.     

Metastatic tumors to the upper gastrointestinal tract: endoscopic experience.

Metastatic tumors to the upper gastrointestinal tract were identified by esophagogastroduodenoscopy in 14 patients. Malignant melanoma, breast cancer, and lung cancer were the most common primary cancers in four, three, and three patients, respectively. Osteogenic sarcoma, renal cell carcinoma, Meckel cell carcinoma of the skin, and germ-cell tumor were the primary cancer in the remaining four. The esophagus was involved in three patients, the stomach in 13, duodenum in four, and papilla of Vater in one. Upper gastrointestinal bleeding and anemia were the most common presenting features. There was correlation between symptoms and endoscopic findings in all patients. Involvement of gastrointestinal tract at endoscopy was the initial and only evidence of metastases in all patients without evidence of metastases elsewhere, as evidenced by other diagnostic tests in any of these patients. Endoscopic biopsies and/or brush cytology provided histologic diagnosis in all 14 patients. The endoscopic and nonendoscopic literature regarding metastases to the upper gastrointestinal tract is reviewed.     

Clinical aspects and endoscopic management of gastrointestinal bleeding from Dieulafoy's lesion]

OBJECTIVE: the aim of the study was to assess the incidence, clinical presentation, location, and response to endoscopic therapy of gastrointestinal bleeding from Dieulafoy's lesion. MATERIAL AND METHOD: ALL consecutive episodes of gastrointestinal bleeding due to Dieulafoy's lesion seen between 2000 and 2006 were retrospectively reviewed. All main clinical and endoscopic data were collected: type and effectiveness of endoscopic therapy, rebleeding, complications, and mortality during hospitalization. RESULTS: WE found 41 patients, 26 males and 15 females, median age of 71.19 years. Dieulafoy's lesion accounted for 1.55% of all gastrointestinal bleeding episodes during the study period. The incidence of Dieulafoy's lesion was 2.2 cases/100.000 inhabitants/year. Active bleeding at endoscopy was present in 85.36%, and comorbidity in 92.68%. The stomach was the most frequent location (60.97%), followed by duodenum (29.26%). Endoscopic therapy achieved initial hemostasis in all cases. Three patients (7.31%) initially treated with epinephrine injection showed rebleeding and properly responded to a second session of endoscopic therapy. No surgery was needed. The mortality rate during hospitalization was 4.87%. CONCLUSIONS: Dieulafoy's lesion is an uncommon, but potentially severe cause of gastrointestinal bleeding. It may be found in any location within the gastrointestinal tract. Endoscopic therapy is effective and safe. Injected epinephrine alone is associated with a higher risk of rebleeding.     

内镜及病理对胃肠道淀粉样变的诊断意义

目的 探讨淀粉样变的胃镜、肠镜表现特点以及粘膜活组织检查对其诊断的价值。方法 分析内镜诊断的10例淀粉样变患者资料（男5例，女5例），分别总结胃镜、肠镜表现及其活组织检查特点。结果 胃肠道淀粉样变患者的临床症状包括腹痛、便血或黑便、腹胀、慢性腹泻。5例接受胃镜检查的患者中，3例发现淀粉样变，阳性病变包括溃疡、结节、粘膜剥脱、瘢痕，还有1例患者在外观正常处取材确诊。8例接受肠镜检查的患者中，均发现淀粉样变，阳性病变包括息肉、溃疡、粘膜剥脱、结节不平及粘膜充血、水肿等。结论 胃肠道是淀粉样变的好发部位之一，内镜检查可发现病变，其粘膜活组织检查具有重要的诊断价值。     

Gastrointestinal mantle cell lymphoma with isolated mass and multiple lymphomatous polyposis: report of two cases

We herein report two patients with mantle cell lymphoma (MCL), who had isolated mass and multiple lymphomatous polyposis (MLP) in the gastrointestinal tract. In case 1, esophagogastroduodenoscopy revealed a protruding mass in the duodenum and double-balloon endoscopy disclosed numerous polypoid lesions in the ileum. Case 2 had polyposis in the duodenum and a large mass-forming lesion in the ascending colon. Based on the histologic and immunohistochemical findings of the biopsy specimens, the diagnosis of MCL was made in both patients. A combination of isolated mass and MLP is considered as characteristic endoscopic findings of intestinal lesions of MCL.     

The spectrum of GI strongyloidiasis: an endoscopic-pathologic study

BACKGROUND: The aim of this study was a detailed endoscopic-pathologic assessment of patients with various forms of GI strongyloidiasis. METHODS: Six patients with a diagnosis of GI strongyloidiasis who underwent endoscopic evaluation during a 3-year period (January 1998-January 2001) were included. Published information was reviewed in detail, focusing on the endoscopic features and the diagnostic approach to this parasitosis. OBSERVATIONS: Strongyloidiasis has a broad range of endoscopic features. In the duodenum, the findings included edema, brown discoloration of the mucosa, erythematous spots, subepithelial hemorrhages, and megaduodenum. In the colon, the findings included loss of vascular pattern, edema, aphthous ulcers, erosions, serpiginous ulcerations, and xanthoma-like lesions, and, in the stomach, thickened folds and mucosal erosions. A histopathologic diagnosis of strongyloidiasis was made in all cases. CONCLUSIONS: Strongyloidiasis can involve any segment of the GI tract. EGD with procurement of biopsy specimens from the duodenum was the most accurate method of diagnosis in this case series.     

Clinical significance of endoscopic findings in the upper gastrointestinal tract in Crohn’s disease

Crohn’s disease is an inflammatory disorder that can affect the entire gastrointestinal tract but typically involves the ileocecal region. Before endoscopy was widely used, involvement of the esophagus, stomach, and duodenum was thought to be rare. Recent publications demonstrated that not only are upper gastrointestinal lesions common in Crohn’s disease (affecting up to 75% of the patients), but they also present characteristic endoscopic findings with potential clinical significance. It was suggested that lesions in the stomach with a bamboo joint-like appearance might be an endoscopic biomarker for Crohn’s disease. It was also found that this occurrence is related to a more severe disease course. Our review summarizes the literature, as well as our own observations and considerations, concerning the issue of upper gastrointestinal involvement in Crohn’s disease and its clinical meaning.