Gastroduodenal CD

Mottet [49], in a recent study, shows the presence of CD at a gastroduodenal level is rather common in patients suffering from CD of other areas of the small bowel. In cases such as this, lesions ascribable to CD may be found in 20% of patients after endoscopic examination and in 40% in biopsies. On the contrary, the presence of gastroduodenal CD as a single manifestation is very rare. Yamamoto [50], indeed, found that 96% of patients suffering from gastrointestinal CD present a second site of the disease at the intestinal level. However, fewer than 4% of patients show symptoms and signs that may be clinically detectable. Surgical treatment applied in the past in the case of stenosis was the bypass procedure (usually gastrojejunostomy) generally associated with a vagotomy to prevent ulcer. Long-term results for this procedure are excellent, as shown by two works with rather long follow-ups (average 12.3 years for Murray [51]; 11 years for Nugent [52]). Resection, on the contrary, showed its limits, which were connected with a high rate of major surgical complications (up to 78% according to Murray [53]).

New pharmacologic therapies have considerably changed the fate of many patients, given the good responses achieved. The few cases still needing surgery have also been treated with stricturoplasties, which is a procedure also recognised by many surgeons in the case of stenoses from duodenal CD [54-56]. Worsey [57] pointed out the advantages of this approach, which does not require vagotomy, mobilisation or use of the jejunum and, especially, creation of a blind loop. Long-term results of this kind of procedure are not yet known, especially considering, as observed by Hirata [58], the poor number of surgeries performed in each centre. Longer follow-ups and a larger sample population are required before definitive conclusions are available.

Another therapeutical option that may be used is endoscopic balloon dilatation, even if experience is still very limited [49].

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