ABSTRACT
AIMS: To describe retrospectively the characteristics of inaugural, symptomatic Crohn's disease of the upper gastrointestinal tract. METHODS: Eighteen patients (12 male and 6 female) with symptomatic Crohn's disease of the upper intestinal tract and without previous distal localisation were studied. RESULTS: Mean age of patients at diagnosis (21.3 years) was less than that usually reported in Crohn's disease. The time elapsed from first symptoms to diagnosis (mean = 29.8 months) was remarkably long for some patients, mainly as a result of an unusual clinical presentation. Abdominal pain and weight loss were the most common presenting features; diarrhea was rarely the main symptom. Persistent anorexia and weight loss without digestive symptoms had led to a diagnosis of anorexia nervosa in 4 patients. Zollinger-Ellison syndrome was the initial diagnosis in 3 other patients. Sixteen patients were followed during at least 2 years. All were treated with steroids for their first attack and 75 % required immunosuppressive therapy for steroid dependence. At the end of follow-up, 6 patients only were in remission without treatment or under mesalamine. CONCLUSION: Crohn's disease with initial symptomatic lesions of the upper gastrointestinal tract occurs mainly in young male patients. The clinical presentation may be very unusual, leading to misdiagnosis. The clinical course is close to that of diffuse jejunoileitis.
Subject(s)
Crohn Disease/diagnosis , Crohn Disease/therapy , Duodenal Diseases/diagnosis , Duodenal Diseases/therapy , Jejunal Diseases/diagnosis , Jejunal Diseases/therapy , Adolescent , Adult , Crohn Disease/complications , Duodenal Diseases/complications , Female , Humans , Jejunal Diseases/complications , Male , Retrospective StudiesABSTRACT
We studied 26 cases of digestive manifestation in AIDS. The 26 patients were divided into two different epidemiological groups: 13 homosexual men, constituted the first group; no homosexual patient was in the second group which included 6 haitians, 6 africans and a pakistanian. The clinical manifestation were: a watery chronical diarrhea in 17 cases a bloody diarrhea in 2 cases; a loss of weight in the 26 cases; a dysphagia in five cases; a jaundice in one patient (due to Kaposi sarcoma of the ampulla of Vater). The digestive lesions found, alone or associated, were necrotizing enteritis (2), ulcerative colitis (1), pseudomembranous colitis (1), candida oesophagitis (10), erythematous duodenitis (6), proctitis (4), Kaposi sarcoma (3) diffuse (2) or localized (1). 13 patients out of the 26 presented opportunistic digestive infections due to one or several germs. The were 10 cases of oesophageal infection (due to (Candida albicans) and 8 cases of enterocolic infection due to Cytomegalovirus (3 cases), Cryptosporidium (3 cases), Mycobacterium avium intracellulare (1 case), Cryptococcus neoformans (1 case). The other digestive infections cases were due to non opportunistic pathogens: Entamoeba histolytica (3 cases); Giardia lamblia (3 cases); Strongyloides stercoralis (2 cases); Salmonella typhi (2 cases); Shigella (1 case). Neither the nature nor the frequency of the digestive infections was different from the first epidemiological group to the second one.
