Clin Exp Pediatr > Accepted Articles
DOI: https://doi.org/10.3345/cep.2021.00661    [Accepted]
Published online September 10, 2021.
Upper gastrointestinal tract involvement of Crohn disease: clinical implications in children and adolescents
Eun Sil Kim  , Mi Jin Kim 
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Correspondence: 
Mi Jin Kim, Email: mijin1217.kim@samsung.com
Received: 17 May 2021   • Revised: 2 August 2021   • Accepted: 7 August 2021
Abstract
Crohn’s disease (CD) is a multifactorial inflammatory disorder that can affect all segments of the gastrointestinal (GI) tract but typically involves the ileum and/or colon. To assess patient prognosis and choose appropriate treatment, it is necessary to accurately evaluate the factors influencing poor outcomes, including disease phenotype. Pediatric CD involving the upper GI (UGI) tract has become increasingly recognized with the introduction of routine upper endoscopy with biopsies for all patients and the increased availability of accurate small bowel evaluations. Most clinical manifestations are mild and nonspecific; however, UGI involvement should not be overlooked since it can cause serious complications. Although controversy persists about the definition of upper gastrointestinal involvement, aphthoid ulcers, longitudinal ulcers, a bamboo joint–like appearance, stenosis, and fistula are endoscopic findings suggestive of CD. In addition, the primary histological findings, such as focally enhanced gastritis and non-caseating granulomas, are highly suggestive of CD. The association between UGI involvement and poor prognosis of CD remains controversial. However, the unstandardized definition and absence of a validated tool for evaluating disease severity complicate the objective assessment of UGI involvement in CD. Therefore, more prospective studies are needed to provide further insight into the standardized assessment of UGI involvement in and long-term prognosis of CD. Our review summarizes the findings to date in the literature as well as UGI involvement in CD and its clinical implications.
Key Words: Crohn's disease, Upper gastrointestinal, Oral cavity, Gastroduodenal, Small bowel


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