Endoscopic and pathologic findings of esophagogastroduodenal involvement in Crohn disease in Korea: a prospective single-center cohort study

Abstract

Background and aims The characteristics and incidence of esophagogastroduodenal involvement in Crohn disease remain unclear in Korea. In this study we aimed to investigate the prevalence and clinicopathological characteristics of Crohn disease with esophagogastroduodenal involvement. Methods A total of 115 patients with Crohn disease who underwent esophagogastroduodenoscopy (EGD) with esophageal, gastric, and duodenal biopsies were prospectively enrolled in 2020-2021 at a tertiary care center. Five specimens were obtained-1 each from the esophagus, gastric body, gastric antrum, duodenal bulb, and second duodenal portion-and histologically reviewed. Results The median patient age was 30.0 years, and 74.8% of patients were male. Based on histological features, 56 patients (48.7%) had esophagogastroduodenal involvement (15 esophageal, 44 gastric, 36 duodenal). Notable histopathological findings included non-caseating granulomas in 8 cases (7.0%), focally enhanced gastritis in 38 cases (33.0%), and lymphocytic esophagitis in 13 cases (10.7%). Endoscopic findings suggestive of esophagogastroduodenal involvement were detected in 94 of 115 patients (81.7%). Typical findings included longitudinal or aphthous erosions (esophagus, 3/115 [2.6%]; stomach, 45/115 [39.1%]; duodenum, 19/115 [16.5%]), longitudinal or aphthous ulcers [duodenum: 4/115 (3.5%)], bamboo-joint-like appearance [stomach: 81/115 (70.4%); duodenum: 3/115 (2.6%)], and scar changes [stomach: 2/115 (1.6%); duodenum: 3/115 (2.6%)]. In multivariable analysis, elevated fecal calprotectin (>= 100 mu g/g) was associated with esophagogastroduodenal involvement in Crohn disease (odds ratio, 6.57; 95% CI, 1.99-21.66; P <.001). Conclusions The proportion of esophagogastroduodenal involvement was relatively high among Korean patients with Crohn disease who underwent EGD. In patients with elevated fecal calprotectin, EGD with histopathological examination is recommended to identify esophagogastroduodenal involvement.