Endoscopic appearance of esophageal CD

What is known

• Early-stage findings are erythema, edema, aphthous ulcers, and granularity; advanced-stage findings are stricturing and stenosis (stenosis typically ≥1 cm). ¹
• Reported endoscopic findings include friability, erosions, aphthoid and deep ulcerations, nodularity, mucosal stiffness, cobblestone appearance, and less often masses, stenoses, and fistulas. ²
• "punched-out" ulcers larger and deeper than aphthoid ulcers resemble herpes/CMV ulcers; aphthoid, punched-out, and linear erosions were the main findings in D'Haens et al. ²
• Two-stage model (inflammatory erosive-ulcerative esophagitis then a stenosing form), predominantly lower esophagus extending proximally. ³
• Most affected sites are the mid and distal third; a bamboo-joint-like pattern may also be suggestive. ^2,4

What is unknown / caveats

• Endoscopic findings are nonspecific and cannot reliably distinguish CD from reflux, infectious (candida, HSV/CMV), or eosinophilic esophagitis
• Granulomas are seen in <25% of cases and often lie deep, limiting biopsy yield; diagnosis usually needs endoscopy + histology + clinical context
• Isolated esophageal CD is rare; most descriptions come from small case series and reviews, and appearances overlap with other esophagitides.

References

1. [No authors listed]. Crohn's Disease of the Esophagus, Duodenum, and Stomach. Clin Colon Rectal Surg. 2019;32(4):231-242. PMID: 31275069.

2. Pimentel AM, Rocha R, Santana GO. Crohn's disease of esophagus, stomach and duodenum. World J Gastrointest Pharmacol Ther. 2019. PMID: 30891327.

3. Huchzermeyer H, Paul F, Seifert E, Fröhlich H, Rasmussen CW. Endoscopic results in five patients with Crohn's disease of the esophagus. Endoscopy. 1977. PMID: 862576.

4. Kővári B, Pai RK. Upper Gastrointestinal Tract Involvement in Inflammatory Bowel Diseases: Histologic Clues and Pitfalls. Adv Anat Pathol. 2022;29:2-14. PMID: 34310370.

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Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct.