[Pathological features and treatment of ulcerative lesions of the duodenum associated with Crohn's disease]

Among a total of 22 patients with Crohn's disease, eight patients with duodenal ulcerative lesions were investigated for pathological features and treatment. All duodenal ulcerative lesions of the eight patients were difficult to be distinguished morphologically from peptic duodenal ulcers at the beginning. But during the course of observation six of eight lesions revealed different pathological features from peptic duodenal ulcers: One showed highly edematous mucosa. Four granular mucosa, and another one longitudinal ulcers and cobblestone appearance. Gastric analysis of these patients showed 6.6 +/- 4.0 mEq/L of BAO and 21.3 +/- 3.4 mEq/L of MAO which was comparable to high acidity of peptic duodenal ulcers. Effectiveness of administration of anti-peptic ulcer drugs only and both anti-peptic ulcer drugs plus drugs against Crohn's disease were 40.0% and 57.1%, respectively. Two patients underwent distal partial gastrectomy. Recurrence was not observed. In conclusion, high acidity would be a cause of duodenal ulcerative lesions associated with Crohn's disease, and the pathological features of them would be affected by Crohn's disease itself. Anti-peptic ulcer drugs should to be administered as well as drugs against Crohn's disease. The method which has hypoacidity effect should be selected in operative therapy to such patients as to have stenosis of the duodenum.