[Esophagogastroduodenal localizations of Crohn's disease are frequent]

The purpose of this study was to determine the endoscopic features, actual frequency and consequences of upper digestive involvement in Crohn's disease (CD). Between April 1973 and April 1985, one or several upper digestive tract endoscopies with biopsies were performed in 129 of 195 patients admitted for ileal and/or colorectal CD. Endoscopic lesions were small and superficial: aphtous and superficial ulcerations, or erythematous areas. The diagnosis of upper digestive involvement was probable in 36 of the 129 patients who underwent upper endoscopies (28 p. 100), certain (microscopic evidence of granuloma) in 21 patients (16 p. 100). Lesions were isolated or multifocal but their preferential sites were the antrum and proximal duodenum. Histologic study of biopsies showed that granuloma were as frequent in upper as in lower intestinal lesions of CD. A frequency of 20 p. 100 seems to us to be more correct than the 5 p. 100 usually admitted. In our experience, upper digestive involvement in CD could not be regarded as a pejorative prognostic factor. It was sometimes possible to identify colitis or a peptic ulcer disease as a lower or upper digestive manifestation of CD, respectively.