Diagnosis and Management of Upper Gastrointestinal Involvement in Adult Patients With Crohn's Disease: A Systematic Review.

IF 12 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Clinical Gastroenterology and Hepatology Pub Date : 2025-05-14 DOI:10.1016/j.cgh.2025.03.024

Nathaniel A Cohen, Neta Sror, Maliha Naseer, Dominik Bettenworth, Cathy Lu, Raneem Khedraki, Maria T Abreu, Raja Atreya, Badr Al-Bawardy, Susan J Connor, Geert d'Haens, Iris Dotan, Axel Dignass, Sara El Ouali, Brian Feagan, Roger Feakins, Richard Gearry, Ilyssa O Gordon, Charlotte Hedin, Taku Kobayashi, Haim Leibovitzh, Nitsan Maharshak, Jacob Ollech, Shaji Sebastian, Britta Siegmund, David T Rubin, Mark S Silverberg, Flavio Steinwurz, Joana Torres, Gill Watermeyer, Cristian Hernandez-Rocha, Paige Gurizzian, Alexa Silfen, Roie Tzadok, Katherine Falloon, Florian Rieder

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引用次数: 0

Abstract

Background & aims: The diagnosis and management of ileocolonic Crohn's disease are well-established. In contrast, standardized guidance pertaining to the diagnosis and management of upper gastrointestinal Crohn's disease (UGICD) is lacking, despite its potentially severe consequences. This comprehensive systematic review describes the prevalence, clinical presentation, and medical and surgical management of involvement of the upper GI tract in adult patients with Crohn's disease.

Methods: A systematic review of available literature was conducted using the search engines Medline, Cochrane, and Embase, with pre-defined search algorithms. Studies published from 1947 to July 2024 were considered. The review included papers describing both clinical characteristics and the effectiveness of medical and interventional procedures in patients with UGICD. All included papers underwent quality appraisal using the Joanna Briggs Institute checklist.

Results: Following screening and full-text review, 47 articles were eligible. The median prevalence of UGICD was found to be 8.7% (interquartile range, 4.74%-24.36%). Over one-third of patients with UGICD are asymptomatic, and abdominal pain was the most frequently reported symptom in symptomatic patients (41%; range, 5%-93%). Endoscopy is the most used diagnostic tool (96%), with the duodenum being the most common disease location (69%). Accepted definitions of UGICD within each diagnostic modality have not been devised. Anti-tumor necrosis factor therapy appears to be efficacious for UGICD (overall clinical response, 81%). The current data are limited by the significant heterogeneity in study design and definitions between studies, particularly inconsistency in diagnosis and outcome measures used.

Conclusion: We highlight the need for the development of standardized guidance in both diagnosing and managing UGICD. This work serves as preparation for an international consensus on the management of UGICD.

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成人克罗恩病累及上消化道的诊断和治疗：系统综述

背景：回肠结肠克罗恩病（CD）的诊断和治疗已经建立。相比之下，尽管其潜在的严重后果，关于上消化道CD （UGICD）的诊断和管理的标准化指导仍然缺乏。目的：本综合系统综述描述了成年cd患者上消化道受累的患病率、临床表现以及医疗和外科治疗。设计：使用Medline、Cochrane和Embase等搜索引擎，采用预定义的搜索算法，对现有文献进行系统综述。从1947年到2024年7月发表的研究被考虑在内。审查包括描述UGICD患者的临床特征和医疗和介入程序有效性的论文。所有纳入的论文均采用乔安娜布里格斯研究所（JBI）检查表进行质量评估。结果：经过筛选和全文审查，47篇文章符合条件。UGICD的中位患病率为8.7%（四分位数差（IQR） 4.74% ~ 24.36%）。超过三分之一的UGICD患者无症状，腹痛是有症状患者中最常见的症状（41%，范围5%-93%）。内镜是最常用的诊断工具（96%），十二指肠是最常见的疾病部位（69%）。每种诊断方式中UGICD的公认定义尚未制定。抗肿瘤坏死因子治疗似乎对UGICD有效（总体临床反应：81%）。目前的数据受到研究设计和研究之间定义的显著异质性的限制，特别是在诊断和使用的结果测量方面的不一致。结论：我们强调需要制定UGICD诊断和管理的标准化指南。这项工作是为就UGICD的管理达成国际协商一致意见作准备。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Gastroenterology and Hepatology 医学-胃肠肝病学

CiteScore

16.90

自引率

4.80%

发文量

903

审稿时长

22 days

期刊介绍： Clinical Gastroenterology and Hepatology (CGH) is dedicated to offering readers a comprehensive exploration of themes in clinical gastroenterology and hepatology. Encompassing diagnostic, endoscopic, interventional, and therapeutic advances, the journal covers areas such as cancer, inflammatory diseases, functional gastrointestinal disorders, nutrition, absorption, and secretion. As a peer-reviewed publication, CGH features original articles and scholarly reviews, ensuring immediate relevance to the practice of gastroenterology and hepatology. Beyond peer-reviewed content, the journal includes invited key reviews and articles on endoscopy/practice-based technology, health-care policy, and practice management. Multimedia elements, including images, video abstracts, and podcasts, enhance the reader's experience. CGH remains actively engaged with its audience through updates and commentary shared via platforms such as Facebook and Twitter.