БОЛЕЗНЬ КРОНА: ПОРАЖЕНИЕ ПИЩЕВОДА, ЖЕЛУДКА И ДВЕНАДЦАТИПЕРСТНОЙ КИШКИ

  • Юрий Павлович Успенский Санкт-Петербургский государственный педиатрический медицинский университет. 194100, Российская Федерация, г. Санкт-Петербург, ул. Литовская, д. 2
  • Заурбек Хазбиевич Гулунов Санкт-Петербургский государственный педиатрический медицинский университет. 194100, Российская Федерация, г. Санкт-Петербург, ул. Литовская, д. 2 https://orcid.org/0000-0002-1866-9736
  • Нина Гивиевна Корбесова Санкт-Петербургский государственный педиатрический медицинский университет. 194100, Российская Федерация, г. Санкт-Петербург, ул. Литовская, д. 2
Ключевые слова: воспалительное заболевание кишечника, ВЗК, болезнь Крона, пищевод, желудок, двенадцатиперстная кишка

Аннотация

Симптомы болезни Крона, проявляющиеся в верхних частях желудочно-кишечного тракта, обычно маскируются под типичные признаки поражения подвздошной и ободочной кишки и встречаются лишь у 0,5–4% взрослых пациентов. Но с усовершенствованием эндоскопических техник и более распространенным применением эзофагогастродуоденоскопии с биопсией все чаще обнаруживаются как асимптомные, так и клинически важные проявления в пищеводе, желудке и двенадцатиперстной кишке. Диагноз болезни Крона с поражением верхних отделов желудочно-кишечного тракта должен базироваться на комбинации клинического анамнеза, эндоскопической и гистологической картины. Эндоскопические изменения, такие как афтоидные или продольные язвы и рисунок «бамбукового стебля», указывают на болезнь Крона, но гистологическое исследование увеличивает чувствительность диагностики заболевания, так как гистологические изменения могут присутствовать даже на эндоскопически нормальной слизистой оболочке. В то же время гистологические данные могут быть неспецифичными во многих случаях, и знание истории болезни критически важно для установления точного диагноза. В этом обзоре рассмотрены ключевые клинические, эндоскопические и гистологические характеристики болезни Крона с поражением пищевода, желудка и двенадцатиперстной кишки.

Литература

Дементьева Е.А., Степанова А.А., Гурина О.П. и др. Лабораторные показатели аутоагрессии при воспалительных заболеваниях кишечника у детей. Медицина: теория и практика. 2018; 3(3 приложен): 9–12.

Клинические рекомендации диагностике и лечению болезни Крона у взрослых. Колопроктология. 2020; 19(2): 8–38.

Петров С.В., Успенский Ю.П., Фоминых Ю.А. и др. Клинический случай осложненного течения болезни Крона: трудности диагностики и лечения. Университетский терапевтический вестник. 2022; 4(3): 39–46.

Сантимов А.В., Колобов А.В., Карев В.Е. и др. Экспрессия CD68 и Fas-лиганда в слизистой толстой кишки у больных с воспалительными заболеваниями кишечника как прогностические маркеры канцерогенеза. Педиатр. 2016; 7(3): 42–8. DOI: 10.17816/PED7342-48.

Юрьев В.К., Афонина Е.В., Лихтшангоф А.З. Здоровье населения и методы его изучения. СПб.: Санкт-Петербургский государственный педиатрический медицинский университет; 1993.

Abuquteish D., Putra J. Upper gastrointestinal tract involvement of pediatric inflammatory bowel disease: a pathological review. World J Gastroenterol. 2019; 25: 1928–35.

Alcántara M., Rodriguez R., Potenciano J.L. et al. Endoscopic and bioptic findings in the upper gastrointestinal tract in patients with Crohn’s disease. Endoscopy. 1993; 25: 282–6.

Alimchandani M., Lai J.P., Aung P.P. et al. Gastrointestinal histopathology in chronic granulomatous disease: a study of 87 patients. Am J Surg Pathol. 2013; 37: 1365–72.

American Society for Gastrointestinal Endoscopy Standards of Practice Committee, Shergill A.K., Lightdale J.R. et al. The role of endoscopy in inflammatory bowel disease. Gastrointest Endosc. 2015; 81: 1101–21.e213.

Ammoury R.F., Pfefferkorn M.D. Significance of esophageal Crohn disease in children. J Pediatr Gastroenterol Nutr. 2011; 52: 291–4.

Bao J.R., Clark R.B., Master R.N. et al. Acid-fast bacterium detection and identification from paraffin-embedded tissues using a PCR-pyrosequencing method. J Clin Pathol. 2018; 71: 148–53.

Basseri B., Vasiliauskas E.A., Chan O. et al. Evaluation of peripapillary lymphocytosis and lymphocytic esophagitis in adult inflammatory bowel disease. Gastroenterol Hepatol (N Y). 2013; 9: 505–11.

Bathori A., Sejben A., Hegedűs F. et al. Gastric metaplasia and paneth cell hyperplasia in the biopsy diagnosis of chronic ileitis: neglected histological features of Crohn’s disease. Mod Pathol. 2021; 34 (suppl 2): 386–7.

Batts K.P., Ketover S., Kakar S. et al. Appropriate use of special stains for identifying Helicobacter pylori: recommendations from the Rodger C. Haggitt Gastrointestinal Pathology Society. Am J Surg Pathol. 2013; 37: e12–e22.

Cary E.R., Tremaine W.J., Banks P.M. et al. Isolated Crohn’s disease of the stomach. Mayo Clin Proc. 1989; 64: 776–9.

D’Haens G., Rutgeerts P., Geboes K. et al. The natural history of esophageal Crohn’s disease: three patterns of evolution. Gastrointest Endosc. 1994; 40: 296–300.

De Felice K.M., Katzka D.A., Raffals L.E. Crohn’s disease of the esophagus: clinical features and treatment outcomes in the biologic era. Inflamm Bowel Dis. 2015; 21: 2106–13.

De Matos V., Russo P.A., Cohen A.B. et al. Frequency and clinical correlations of granulomas in children with Crohn disease. J Pediatr Gastroenterol Nutr. 2008; 46: 392–8.

Decker G.A., Loftus E.V. Jr., Pasha T.M. et al. Crohn’s disease of the esophagus: clinical features and outcomes. Inflamm Bowel Dis. 2001; 7: 113–9.

Diaz L., Hernandez-Oquet R.E., Deshpande A.R. et al. Upper gastrointestinal involvement in crohn disease: histopathologic and endoscopic findings. South Med J. 2015; 108: 695–700.

Ebach D.R., Vanderheyden A.D., Ellison J.M. et al. Lymphocytic esophagitis: a possible manifestation of pediatric upper gastrointestinal Crohn’s disease. Inflamm Bowel Dis. 2011; 17: 45–9.

Ectors N.L., Dixon M.F., Geboes K.J. et al. Granulomatous gastritis: a morphological and diagnostic approach. Histopathology. 1993; 23: 55–61.

Fan Y.C., Steele D., Kochar B. et al. Increased prevalence of esophageal eosinophilia in patients with inflammatory bowel disease. Inflamm Intest Dis. 2019; 3: 180–6.

Farman J., Faegenburg D., Dallemand S. et al. Crohn’s disease of the stomach: the “ram’s horn” sign. Am J Roentgenol Radium Ther Nucl Med. 1975; 123: 242–51.

Fujiya M., Sakatani A., Dokoshi T. et al. A bamboo joint-like appearance is a characteristic finding in the upper gastrointestinal tract of Crohn’s disease patients: a case-control study. Medicine (Baltimore). 2015; 94: e1500.

Genta R.M., Sonnenberg A. Non-Helicobacter pylori gastritis is common among paediatric patients with inflammatory bowel disease. Aliment Pharmacol Ther. 2012; 35: 1310–6.

Gómez-Aldana A., Jaramillo-Santos M., Delgado A. et al. Eosinophilic esophagitis: current concepts in dia­gnosis and treatment. World J Gastroenterol. 2019; 25: 4598–4613.

Gomollón F., Dignass A., Annese V. et al. 3rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: Part 1: diagnosis and medical management. J Crohns Colitis. 2017; 11: 3–25.

Greenstein A.J., Present D.H., Sachar D.B. et al. Gastric fistulas in Crohn’s disease. Report of cases. Dis Colon Rectum. 1989; 32: 888–92.

Greuter T., Piller A., Fournier N. et al. Swiss IBD Cohort Study Group. Upper Gastrointestinal Tract Involvement in Crohn’s Disease: Frequency, Risk Factors, and Disease Course. J Crohns Colitis. 2018; 12(12): 1399–1409. DOI: 10.1093/ecco-jcc/jjy121].

Hardee S., Alper A., Pashankar D.S. et al. Histopatho­logy of duodenal mucosal lesions in pediatric patients with inflammatory bowel disease: statistical analysis to identify distinctive features. Pediatr Dev Pathol. 2014; 17: 450–4.

Hirokawa M., Shimizu M., Terayama K. et al. Bamboo-jointlike appearance of the stomach: a histopathological study. APMIS. 1999; 107: 951–6.

Horjus Talabur Horje C.S., Meijer J., Rovers L. et al. Prevalence of upper gastrointestinal lesions at primary diagnosis in adults with inflammatory bowel disease. Inflamm Bowel Dis. 2016; 22: 1896–1901.

Ikezono G., Yao K., Imamura K. et al. Gastric metaplasia of the duodenal mucosa in Crohn’s disease: novel histological and endoscopic findings. Endosc Int Open. 2021; 9: E181–E189.

Isaacs K.L. Upper gastrointestinal tract endoscopy in inflammatory bowel disease. Gastrointest Endosc Clin N Am. 2002; 12: 451–62.

Jaśkiewicz K., Lemmer E. Histological findings in gastroduodenal mucosa in patients with Crohn’s di­sease. Any diagnostic significance? Pol J Pathol. 1996; 47: 115–8.

Johncilla M., Grover S., Zhang X. et al. Morphological spectrum of immune checkpoint inhibitor therapy-associated gastritis. Histopathology. 2020; 76: 531–9.

Kovacs M., Muller K.E., Arato A. et al. Diagnostic yield of upper endoscopy in paediatric patients with Crohn’s disease and ulcerative colitis. Subanalysis of the HUPIR registry. J Crohns Colitis. 2012; 6: 86–94.

Kővári B., Pai R.K. Upper Gastrointestinal Tract Involvement in Inflammatory Bowel Diseases: Histolo­gic Clues and Pitfalls. Adv Anat Pathol. 2022; 29(1): 2–14. DOI: 10.1097/PAP.0000000000000311.

Kuriyama M., Kato J., Morimoto N. et al. Speci­fic gastroduodenoscopic findings in Crohn’s disease: comparison with findings in patients with ulcerative colitis and gastroesophageal reflux disease. Dig Liver Dis. 2008; 40: 468–75.

Levine A., Koletzko S., Turner D. et al. European Society of Pediatric Gastroenterology, Hepatology, and Nutrition. ESPGHAN revised porto criteria for the dia­gnosis of inflammatory bowel disease in children and adolescents. J Pediatr Gastroenterol Nutr. 2014; 58: 795–806.

Limketkai B.N., Shah S.C., Hirano I. et al. Epidemio­logy and implications of concurrent diagnosis of eosi­nophilic oesophagitis and IBD based on a prospective population-based analysis. Gut. 2019; 68: 2152–60.

Loreto-Brand M., Fernández-Pérez A., Celeiro-Muñoz C. et al. Crohn’s disease: upper gastrointestinal involvement. Rev Gastroenterol Mex. 2015; 80: 282–5.

Lv M., Tang K., Meng Y. et al. Primary isolated asymp­tomatic gastric tuberculosis of the cardia mimicking gastric stromal tumor: a rare case report and literature review. BMC Gastroenterol. 2020; 20: 108.

Maaser C., Sturm A., Vavricka S.R. et al. ECCO-

ESGAR guideline for diagnostic assessment in IBD Part 1: initial diagnosis, monitoring of known IBD, detection of complications. J Crohns Colitis. 2019; 13: 144–64.

Magalhães-Costa M.H., Reis B.R., Chagas V.L. et al. Focal enhanced gastritis and macrophage microaggregates in the gastric mucosa: potential role in the differential diagnosis between Crohn’s disease and ulce­rative colitis. Arq Gastroenterol. 2014; 51: 276–82.

Matsuoka K., Kobayashi T., Ueno F. et al. Evidence-based clinical practice guidelines for inflammatory bowel disease. J Gastroenterol. 2018; 53: 305–53.

McHugh J.B., Gopal P., Greenson J.K. The clinical significance of focally enhanced gastritis in children. Am J Surg Pathol. 2013; 37: 295–9.

Meucci G., Bortoli A., Riccioli F.A. et al. Frequency and clinical evolution of indeterminate colitis: a retrospective multi-centre study in northern Italy. GSMII (Gruppo di Studio per le Malattie Infiammatorie Intestinali). Eur J Gastroenterol Hepatol. 1999; 11: 909–13.

Mintz M.J., Ananthakrishnan A.N. Phenotype and na­tural history of inflammatory bowel disease in patients with concomitant eosinophilic esophagitis. Inflamm Bowel Dis. 2021; 27: 469–75.

Moore H., Wechsler J., Frost C. et al. Comorbid dia­gnosis of eosinophilic esophagitis and inflammatory bowel disease in the pediatric population. J Pediatr Gastroenterol Nutr. 2021; 72: 398–403.

Naranjo-Rodríguez A., Solórzano-Peck G., López-Rubio F. et al. Isolated oesophageal involvement of Crohn’s disease. Eur J Gastroenterol Hepatol. 2003; 15: 1123–6.

Nomura Y., Moriichi K., Fujiya M. et al. The endoscopic findings of the upper gastrointestinal tract in patients with Crohn’s disease. Clin J Gastroenterol. 2017; 10: 289–96.

Nugent F.W., Richmond M., Park S.K. Crohn’s disease of the duodenum. Gut. 1977; 18: 115–20.

Nugent F.W., Roy M.A. Duodenal Crohn’s disease: an analysis of 89 cases. Am J Gastroenterol. 1989; 84: 249–54.

Oberhuber G., Püspök A., Oesterreicher C. et al. Focally enhanced gastritis: a frequent type of gastritis in patients with Crohn’s disease. Gastroenterology. 1997; 112: 698–706.

Parente F., Cucino C., Bollani S. et al. Focal gastric inflammatory infiltrates in inflammatory bowel diseases: prevalence, immunohistochemical characteristics, and diagnostic role. Am J Gastroenterol. 2000; 95: 705–11.

Patterson E.R., Shmidt E., Oxentenko A.S. et al. Normal villous architecture with increased intraepithelial lymphocytes: a duodenal manifestation of Crohn di­sease. Am J Clin Pathol. 2015; 143: 445–50.

Pimentel A.M., Rocha R., Santana G.O. Crohn’s di­sease of esophagus, stomach and duodenum. World J Gastrointest Pharmacol Ther. 2019; 10: 35–49.

Pittman M.E., Hissong E., Katz P.O. et al. Lymphocyte-predominant esophagitis: a distinct and likely immune-mediated disorder encompassing lymphocytic and Lichenoid esophagitis. Am J Surg Pathol. 2020; 44: 198–205.

Purdy J.K., Appelman H.D., Golembeski C.P. et al. Lymphocytic esophagitis: a chronic or recurring pattern of esophagitis resembling allergic contact dermatitis. Am J Clin Pathol. 2008; 130: 508–13.

Ramaswamy K., Jacobson K., Jevon G. et al. Esophageal Crohn disease in children: a clinical spectrum. J Pediatr Gastroenterol Nutr. 2003; 36: 454–8.

Reynolds H.L. Jr., Stellato T.A. Crohn’s disease of the foregut. Surg Clin North Am. 2001; 81: 117–viii.

Roka K., Roma E., Stefanaki K. et al. The value of focally enhanced gastritis in the diagnosis of pediatric inflammatory bowel diseases. J Crohns Colitis. 2013; 7: 797–802.

Rouphael C., Gordon I.O., Thota P.N. Lymphocytic esophagitis: still an enigma a decade later. World J Gastroenterol. 2017; 23: 949–56.

Rudolph I., Goldstein F., DiMarino AJ. Jr. Crohn’s disease of the esophagus: three cases and a literature review. Can J Gastroenterol. 2001; 15: 117–22.

Ruuska T., Vaajalahti P., Arajärvi P. et al. Prospective evaluation of upper gastrointestinal mucosal lesions in children with ulcerative colitis and Crohn’s disease. J Pediatr Gastroenterol Nutr. 1994; 19: 181–6.

Sakuraba A., Iwao Y., Matsuoka K. et al. Endoscopic and pathologic changes of the upper gastrointestinal tract in Crohn’s disease. Biomed Res Int. 2014; 2014: 610767.

Sanders D.L., Pfeiffer R.B., Hashimoto L.A. et al. Pseudomembranous gastritis: a complication from aspergillus infection. Am Surg. 2003; 69: 536–8.

Satsangi J., Silverberg M.S., Vermeire S. et al. The Montreal classification of inflammatory bowel di­sease: controversies, consensus, and implications. Gut. 2006; 55: 749–53.

Schwartzberg D.M., Brandstetter S., Grucela A.L. Crohn’s disease of the esophagus, duodenum, and stomach. Clin Colon Rectal Surg. 2019; 32: 231–42.

Shah J., Maity P., Kumar-M. et al. Gastroduodenal tuberculosis: a case series and a management focused systematic review. Expert Rev Gastroenterol Hepatol. 2021; 15: 81–90.

Shapiro J.L., Goldblum J.R., Petras R.E.. A clinicopathologic study of 42 patients with granulomatous gastritis. Is there really an “idiopathic” granulomatous gastritis? Am J Surg Pathol. 1996; 20: 462–70.

Sonnenberg A., Melton S.D., Genta R.M. Frequent occurrence of gastritis and duodenitis in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2011; 17: 39–44.

Sonnenberg A., Turner K.O., Genta R.M. Comorbid occurrence of eosinophilic esophagitis and inflammatory bowel disease. Clin Gastroenterol Hepatol. 2021; 19: 613–5.e1.

Tanoglu A., Erdem H., Friedland J.S. et al. Clinicopathological profile of gastrointestinal tuberculosis: a multinational ID-IRI study. Eur J Clin Microbiol Infect Dis. 2020; 39: 493–500.

Tobin J.M., Sinha B., Ramani P. et al. Upper gastrointestinal mucosal disease in pediatric Crohn disease and ulcerative colitis: a blinded, controlled study. J Pediatr Gastroenterol Nutr. 2001; 32: 443–8.

Ueno F., Matsui T., Matsumoto T. et al. Evidence-based clinical practice guidelines for Crohn’s disease, integrated with formal consensus of experts in Japan. J Gastroenterol. 2013; 48: 31–72.

Ushiku T., Moran C.J., Lauwers G.Y. Focally enhanced gastritis in newly diagnosed pediatric inflammatory bowel disease. Am J Surg Pathol. 2013; 37: 1882–8.

Wagtmans M.J., van Hogezand R.A., Griffioen G. et al. Crohn’s disease of the upper gastrointestinal tract. Neth J Med. 1997; 50: S2–S7.

Watanabe C., Komoto S., Hokari R. et al. Prevalence of serum celiac antibody in patients with IBD in Japan. J Gastroenterol. 2014; 49: 825–34.

Witte A.M., Veenendaal R.A., Van Hogezand R.A. et al. Crohn’s disease of the upper gastrointestinal tract: the value of endoscopic examination. Scand J Gastroenterol Suppl. 1998; 225: 100–5.

Wu H., Shen B. Endoscopic and histologic evaluation of the gastrointestinal tract in patients with sarcoidosis. Eur J Gastroenterol Hepatol. 2021; 33: 639–44.

Wu T.T., Hamilton S.R. Lymphocytic gastritis: association with etiology and topology. Am J Surg Pathol. 1999; 23: 153–8.

Xin W., Greenson J.K. The clinical significance of focally enhanced gastritis. Am J Surg Pathol. 2004; 28: 1347–51.

Yao K., Yao T., Iwashita A. et al. Microaggregate of immunostained macrophages in noninflamed gastroduodenal mucosa: a new useful histological marker for differentiating Crohn’s colitis from ulcerative colitis. Am J Gastroenterol. 2000; 95: 1967–73.

Zhu R., Zhou Y., Wang H. et al. Gastric tuberculosis mimicking submucosal tumor: a case series. BMC Gastroenterol. 2020; 20: 23.

Опубликован
2024-09-23
Как цитировать
Успенский, Ю. П., Гулунов, З. Х., & Корбесова, Н. Г. (2024). БОЛЕЗНЬ КРОНА: ПОРАЖЕНИЕ ПИЩЕВОДА, ЖЕЛУДКА И ДВЕНАДЦАТИПЕРСТНОЙ КИШКИ. Университетский терапевтический вестник, 6(2), 32-45. https://doi.org/10.56871/UTJ.2024.32.24.004
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