Esophageal post-inflammatory polyposis in extensive and severe Crohn's disease treated with anti-tumor necrosis factor alpha.

Content Provider	Semantic Scholar
Author	Soriani, Paola Tontini, Gian Eugenio Neumann, Helmut Ishaq, Sauid Annunziata, Maria Laura Pastorelli, Luca Vecchi, Maurizio
Copyright Year	2016
Abstract	Post-inflammatory polyposis (PIP) of the large bowel is a common endoscopic finding in patients with inflammatory bowel disease as it results from reparative processes following severe inflammation. To date, extra-intestinal localization of PIP is exceptional and poorly understood [1–3]. Here we report the case of a 69-year-old man with a history of ileocolonic Crohn’s disease who presented to our department with diarrhea, weight loss, severe pyrosis, and dysphagia. Ileocolonoscopy and cross-sectional imaging showed severe and extensive inflammatory lesions consistent with the diagnosis of Crohn’s disease, while upper gastrointestinal endoscopy revealed multiple areas of mucosal denudation spread throughout the esophagus with no stigmata of gastroesophageal reflux disease or an infectious disorder (●" Fig.1). Histopathological analysis of biopsies that were taken from an area at least 2cmabove the squamocolumnar junction revealed a severe, acute and chronic cellular infiltratewith no evidence of a granuloma but suggesting for upper gastrointestinal tract involvement of Crohn's disease The patient was initially treated with a course of systemic steroidsplus full dosage of a proton pump inhibitor (PPI). Given the persistence of severe disease despite steroid treatment, he was started on anti-tumor necrosis factor alpha (TNFα) therapy, to which he showed an immediate global clinical response. A repeat upper gastrointestinal endoscopy 1 year later revealed healing of the esophageal mucosa but the presence of widespread filiform polyps of 3–6mm in size and subtle scars (●" Fig.2; ●" Video1). Histopathological analysis of the resected polyps showed no sign of active inflammation and microscopic architectural changes consistent with the diagnosis of esophageal PIP. This case is interesting for several reasons. First, we have provided detailed image and video documentation of an exceptional case of esophageal PIP using high definition and digital chromoendoscopy with i-scan. Secondly, we documented the first case of esophageal Crohn’s disease that healed with the use of antiTNFα therapy and resulted in PIPs. Third, this case focused on uncommon clinical manifestation of upper gastrointestinal Crohn’s disease [4], which presented with symptoms of reflux disease non-responsive to PPIs, thus raising the clinical degree of suspicion.
Starting Page	125
Ending Page	132
Page Count	8
File Format	PDF HTM / HTML
Alternate Webpage(s)	https://www.thieme-connect.com/products/ejournals/pdf/10.1055/s-0042-110487.pdf
PubMed reference number	27489996v1
Alternate Webpage(s)	https://doi.org/10.1055/s-0042-110487
DOI	10.1055/s-0042-110487
Journal	Endoscopy
Volume Number	48
Language	English
Access Restriction	Open
Subject Keyword	Biomarkers, Tumor Biopsy Chromoendoscopy Cicatrix Communicable Diseases Crohn Disease Deglutition Disorders Diarrhea Document completion status - Documented Endoscopy, Gastrointestinal Esophageal Tissue Esophageal mucous membrane Esophageal spasm Esophagogastroduodenoscopy Esophagus Gastroesophageal reflux disease Gastrointestinal tract structure Heartburn Inflammatory Bowel Diseases Intestinal Diseases Intestines Large Intestinal Wall Tissue Patients Proton Pump Inhibitors Protons Squamocolumnar Junction Steroid therapy Steroids Upper Gastrointestinal Tract polyposis polyps tumor necrosis
Content Type	Text
Resource Type	Article