Esophageal Crohn's disease

Introduction to esophageal Crohn's disease Crohn's disease is a chronic, non-specific, full-thickness granulomatous inflammation of the gastrointestinal tract. The lesion is segmental and can involve a segment of the digestive tract from the mouth to the anus. Invasion of several segments, the distribution of lesions in the small intestine, the end of the ileum accounted for about 90%. Crohn's disease foiece (Crohn'sdiseaseofesophagus) broadly refers to Crohn's disease involving the esophagus, esophageal lesions are part of the entire Crohn's disease, most with a wide range of gastrointestinal Crohn's disease, and Have gastrointestinal manifestations. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: esophageal perforation

Causes of esophageal Crohn's disease

(1) Causes of the disease

The cause of Crohn's disease has not been known so far and may be related to the following factors:

1. Infection:

Because its pathological manifestations are similar to tuberculosis, it has been thought that this disease may be caused by Mycobacterium tuberculosis. It is now believed that Crohn's disease is caused by viral infection, but it has not been proven that any virus is involved in the pathogenesis of this disease.

2. Genetics:

Clinical data show that the incidence of this disease is higher in the same family members, and there is a significant difference in the incidence among different ethnic groups, suggesting that its occurrence may be related to genetic factors, but no genetic law has been found, which may be related to multi-gene or multi-factor control. The inheritance has a certain relationship.

3. Immune response:

Because the main pathological change of this disease is granulomatous inflammation, which is a common histological change of delayed type allergic reaction, it is considered that the pathogenesis of Crohn's disease is related to immune response, and in tissue culture, its circulating lymphocytes are autologous or The same species (including fetal) colonic epithelial cells have cytotoxic effects; about half of the patients' serum found anti-colon epithelial cell antibodies or circulating immune complexes, suggesting the presence of humoral immune abnormalities, the disease often occurs extraintestinal damage, such as arthritis , iridocyclitis, sclerosing cholangitis, etc., and after treatment with adrenocortical hormone can ease the condition, suggesting the presence of cellular immune abnormalities, the above characteristics indicate that Crohn's disease may be an autoimmune disease, but in Crohn In the occurrence and development of the disease, the role, status and exact pathogenesis of the immune response need further study.

(two) pathogenesis

Crohn's disease at all sites has similar pathological anatomical features.

1. See the general specimen:

Madden et al (1969) considered that the most prominent feature of esophageal Crohn's disease in gross specimens is that the lesion involves the entire layer of the esophageal wall, that is, the pathological process is transmural, and the lesion infiltrates the muscular layer and causes ischemic esophageal mucosa. Necrosis, followed by erosion, shedding, and formation of superficial ulcers, 33% of cases of esophageal Crohn's disease reported by Gad (1989) showed typical microgranulomas under the microscope, such as no granulomatous changes, other histology Changes such as mucosal edema, erosion, ulcer formation, lymphatic vessel expansion and inflammation can be used as a basis for the diagnosis of esophageal Crohn's disease.

2. Seen under the microscope:

The most significant histological change in esophageal Crohn's disease is also non-caseous epithelioid granulomas, which are formed by epithelial-like tissue cells, which can be associated with Langhans multinucleated giant cells, surrounded by lymphocytes at the edges, center There is no cheese necrosis; it can be seen in the whole layer of the wall, but it is most common in the submucosal layer. Its microscopic features are: the lesion is transmural, which is characterized by granuloma or microgranuloma, mostly located under the esophageal mucosa, adventitia In the lymph nodes of the muscle space and drainage area, about 60% of cases have this feature, and also showed focal lymphocyte agglomeration, thickening of the submucosa (tissue edema, lymphatic vessels and vasodilation and lymphoid tissue hyperplasia). Caused by).

Esophageal Crohn disease prevention

Proper bed rest, prevention of infections in the upper respiratory tract, intestinal tract, etc., due to infection can promote the exacerbation or recurrence of the disease, avoid the application of NSAID to avoid the disease.

Esophageal Crohn's disease complications Complications perforation of the esophagus

Esophageal Crohn's disease combined with esophageal obstruction, perforation, fistula formation, cancer, massive bleeding and other serious complications.

Symptoms of esophageal Crohn's disease Common symptoms Anal lesions Post-sternal pain Esophageal ulcers Nausea nodules Loss of appetite Swallowing pain Difficulty swallowing Weight loss

Some patients have acute flare-up, acute esophageal Crohn's cause esophagitis or esophageal ulcer often causes swallowing pain, pain is mostly located behind the sternum, ulcers in the mouth and throat, ulcers in the perineum Treatment with corticosteroids may cause esophageal ulcer healing, and some patients may develop chronic lesions. This full-wall inflammation and stenosis can cause difficulty in swallowing and swallowing pain, nausea, and patients often suffer from loss of appetite, burnout, and weight loss. May be associated with fever, joint pain, nodular erythema, anemia, oral cutaneous Sjogren's syndrome (sjogren's syndrome) and other gastrointestinal manifestations, acute erythrocyte sedimentation rate increased.

Examination of esophageal Crohn's disease

The peripheral blood picture is mild and moderately anemia; the white blood cell count is generally normal, and the disease activity can be increased especially in the presence of complications; the platelet count is significantly increased, and is related to the degree of inflammatory activity, and the serum VIII clotting factor is elevated when the disease is active. ESR increases, C-reactive protein and other acute phase reactants such as 1 antitrypsin, 1 antichymotrypsin, 2 globulin, 2 microglobulin, A amyloid, etc. can be elevated, neopterin is a single nucleus Macrophages are released by -interferon secreted by activated T lymphocytes. When cellular immunity changes, urinary neopterin increases, and its level is negatively correlated with the severity of the disease. Serum lysozyme activity is in CD and other granulation. Swelling lesions can be elevated, serum angiotensin-converting enzyme is also a marker of granulomatous lesions, but its activity is normal or reduced in CD. In recent years, it has also been found that anti-Saccharomyces cerevisiae antibodies may be specific markers of CD.

1. X-ray inspection:

Esophageal barium angiography may have different signs in different periods of esophageal Crohn's disease, characterized by typical septic ulcers and thickening of the wall. These ulcers are similar to those seen in herpetic esophagitis, ie, isolated. Multiple ulcers scattered in the lesion, early esophageal mucosa showed chronic ulcerative esophagitis, ie irregular thickening of the esophageal mucosa, flattening and stenosis of the lumen; as the lesion progresses further, longitudinal fissure ulcers can be seen in the esophageal lumen The strip-shaped sinus area is formed, and the sinus sinus is interlaced with cobblestones. In the late stage of the lesion, the lumen of the esophageal wall is significantly narrow and the wall is stiff. The lesion is first seen in the lower part of the esophagus, and then gradually spread upward until the entire esophagus is involved. Occasionally, the main X-ray of Crohn's disease is local esophageal stenosis, esophageal mucosal disruption or filling defect, stiff wall, difficult to esophagus Identification of cancer.

2. Endoscopy:

The esophageal mucosa of esophageal Crohn's disease is mainly characterized by inflammatory changes. The characteristic features of endoscopy are: the most early esophageal mucosa changes are multiple, the borderline is clear and small erythema, the surrounding mucosa is normal, as the disease progresses, On the basis of the above-mentioned lesions, a sore-like ulcers are formed, single or multiple, of different sizes, with a diameter of 0.1 to 1.5 cm. The appearance of the adjacent mucosa can be completely normal; the condition is further developed, and the esophageal mucosal ulcer is linear, 0.5 to 3.0 cm long. It is 0.5-1.0cm wide and 0.1-0.5cm deep. The edge is excavated. Some ulcers are covered with a membrane formed by necrotic tissue. The inflammation is invaded by the esophageal submucosa, and the mucosal layer on the surface is uneven. Aphthous ulcers and/or linear ulcers, the bottom of the ulcer is covered with white cellulose, and the edge of the ulcer is red; in severe cases, the affected esophageal wall is called "garden hose" due to tissue fibrosis, thickening and stenosis. The local esophageal mucosa may have irregular polypoid nodules with a "cobblestone" appearance, and the stenotic lesions at the center of the esophageal cavity constitute an inflammatory mass and esophagus. Confusing.

Diagnosis and diagnosis of esophageal Crohn's disease

diagnosis

A small number of patients with esophageal Crohn's disease are asymptomatic, often found by endoscopy or X-ray examination and further examination confirmed.

In the diagnosis and diagnosis procedures, for patients with unexplained swallowing pain, dysphagia, post-sternal pain, nausea, vomiting, and hematemesis, the possibility of esophageal inflammatory lesions and tumors should be considered. Esophageal X-ray examination and endoscopy (including endoscopic biopsy histopathological examination), if biopsy pathological examination does not suggest esophageal cancer or other malignant tumors, in addition to other esophagitis should be considered, should consider esophage Crohn's disease For suspected cases, if the other parts of the esophageal Crohn's disease are traced, especially in the small intestine, ileum, oral, anal lesions, this diagnosis of esophageal Crohn's disease is a meaningful circumstantial evidence. However, because lesions occur in the lamina propria or submucosa, endoscopic biopsy is difficult to achieve deep tissue, sometimes no diagnosis of deep mucosal inflammatory lesions, and the possibility of preoperative diagnosis of esophageal Crohn's disease is small.

Differential diagnosis

Esophageal Crohn's disease is a granulomatous esophagitis that, as part of Crohn's disease, is easily differentiated from other gastrointestinal inflammatory diseases. If present alone, it needs to be associated with esophageal sarcoidosis, esophageal fungal disease, and esophageal tuberculosis. For differential diagnosis, the former is more difficult to identify. The latter can be differentially diagnosed by bacterial and fungal culture or smear staining. Some esophageal diseases resemble the manifestations of esophageal Crohn's disease, including esophageal Behcet's disease (Behcet's disease) and The differential diagnosis of Crohn's disease is particularly difficult. Esophageal sarcoma-like changes, esophageal varices, reflux esophagitis are sometimes confused with esophageal Crohn's disease. There are esophageal cancer and Crohn's disease coexisting and esophageal flu in the literature. Report of canceration of the disease.

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