БОЛЕЗНЬ КРОНА: ПОРАЖЕНИЕ ПИЩЕВОДА, ЖЕЛУДКА И ДВЕНАДЦАТИПЕРСТНОЙ КИШКИ
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.
