Intest Res.  2016 Jan;14(1):60-68. 10.5217/ir.2016.14.1.60.

Gastric lesions in patients with Crohn's disease in Korea: a multicenter study

• So H
• Ye BD
• Park YS
• Kim J
• Kim JS
• Moon W
• Lee KM
• Kim YS
• Keum B
• Kim SE
• Kim KO
• Kim ES
• Lee CK
• Hong SP
• Im JP
• Koo JS
• Choi CH
• Shin JE
• Lee BI
• Huh KC
• Kim YH
• Kim HS
• Park YS
• Han DS
• Korean Association for the Study of Intestinal Diseases

• KMID: 2174511
• DOI: http://doi.org/10.5217/ir.2016.14.1.60

Abstract

BACKGROUND/AIMS
Gastric pathology and Helicobacter pylori (H. pylori) infection among Asian patients with Crohn's disease (CD) are still unclear. We evaluated gastric histologic features and frequency of H. pylori infection in Korean patients with CD.
METHODS
Among 492 patients with CD receiving upper gastrointestinal (GI) endoscopic evaluation in 19 Korean hospitals, we evaluated the endoscopic findings and gastric histopathologic features of 47 patients for our study. Histopathologic classification was performed using gastric biopsy tissues, and H. pylori infection was determined using the rapid urease test and histology.
RESULTS
There were 36 men (76.6%), and the median age of patients at the time of upper GI endoscopy was 23.8 years (range, 14.2-60.5). For CD phenotype, ileocolonic disease was observed in 38 patients (80.9%), and non-stricturing, non-penetrating disease in 31 patients (66.0%). Twenty-eight patients (59.6%) complained of upper GI symptoms. Erosive gastritis was the most common gross gastric feature (66.0%). Histopathologically, H. pylori-negative chronic active gastritis (38.3%) was the most frequent finding. H. pylori testing was positive in 11 patients (23.4%), and gastric noncaseating granulomata were detected in 4 patients (8.5%). Gastric noncaseating granuloma showed a statistically significant association with perianal abscess/fistula (P=0.0496).
CONCLUSIONS
H. pylori-negative chronic active gastritis appears to be frequent among Korean patients with CD. The frequency of H. pylori infection was comparable with previous studies. An association with perianal complications suggests a prognostic value for gastric noncaseating granuloma in patients with CD.

Keyword

Crohn disease; Stomach; Helicobacter pylori; Gastritis; Granuloma

MeSH Terms

Asian Continental Ancestry Group
Biopsy
Classification
Crohn Disease*
Endoscopy
Gastritis
Granuloma
Helicobacter pylori
Humans
Korea*
Male
Pathology
Phenotype
Stomach
Urease
Urease

Figure

• 

  Fig. 1 Representative upper gastrointestinal endoscopic images of study subjects (A: patient 1, B-D: patient 2). (A) Multiple aphthous erosions are observed in the anterior wall of the gastric antrum. (B) The opening of a fistula in the anterior wall of the antrum (black arrows) and deformity of the pyloric ring due to active ulcer (arrowheads) are observed. On the posterior wall of the antrum, an ulcer scar is also observed (white arrows). (C) Closer view of ulcer of the pyloric ring (arrows) (D) Closer view of the opening of the fistula (arrows). A fistulous tract between the small bowel and gastric antrum was found at surgery.

• 

  Fig. 2 Histology of biopsy specimens from antral erosions of patient 1. (A) The gastric mucosa showing multifocal aggregates of mixed inflammatory cells in the lamina propria, with multiple crypt abscesses (arrows) and a focal noncaseating granuloma (arrowhead) (H&E, ×100; scale bar=300 µm). (B) The granuloma is of medium size and has no necrosis (arrow) (H&E, ×200; scale bar=120 µm).

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