Duodenal Crohn's disease: an analysis of 89 cases

Duodenal Crohn's disease has an estimated incidence of 1% to 2% among patients with Crohn's disease. We report 89 patients with duodenal Crohn's disease. Common symptoms were upper abdominal pain and symptoms of gastroduodenal obstruction. Contiguous disease of the gastric antrum and duodenum was present in 60% of patients. Endoscopic examination revealed abnormalities in 62 of 67 patients. Granulomas or granulomatous inflammation was found in 37 of 76 patients. Forty-nine patients treated medically were followed up for 2-25 yr (median 9.7 yr). Good to excellent results were obtained in 45 patients. Thirty-three patients required surgical intervention, usually for gastroduodenal obstruction. Reoperation was required in eight patients, seven of whom had had vagotomy with gastroenterostomy or subtotal gastrectomy. In two of these seven patients, marginal ulcers developed. Both patients had had gastroenterostomy and vagotomy. Our experience does not support the routine use of vagotomy when a bypass procedure is performed. Good to excellent results were achieved in 26 of the 30 surgically treated patients followed up for more than 1 yr (1-43 yr; median 11 yr). Measured in terms of need for surgical intervention, gastroduodenal disease generated considerably less morbidity than did distal Crohn's disease (p less than 0.001). Most patients achieved good to excellent results whether treated medically or surgically.