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Introduction Ulcerative colitis (UC) is an idiopathic, chronic, and recurrent inflammatory bowel disease (IBD) that occurs in the colon and rectum
.
The colon and rectum are considered to be the main target organs of UC, while the upper gastrointestinal (UGI) manifestations are not common
.
Recently, new evidence has shown that UC has a variety of accompanying symptoms that affect the upper gastrointestinal tract
.
However, UGI related to UC has various manifestations and is often covered up or overlooked
.
In addition, the endoscopic and microscopic features of UC combined with UGI are non-specific, and many doctors may ignore the symptoms of UGI
.
There are no established standards for UC patients who should undergo fibrogastroduodenoscopy
.
Esophageal mucosal lesions Esophagitis Lymphocytic esophagitis (LE) is defined as a large number of peripheral lymphocytes (PLs) or intraepithelial lymphocytes (IELs) without obvious granulocytes (neutrophils and eosinophils) ), LE was initially proven to be a UGI manifestation of children with IBD
.
It is reported that 7% of pediatric UC patients develop LE, which is common in mucosal injury (edema or dyskeratosis); however, no significant differences were found between IBD and non-IBD control patients
.
In contrast, a previous study suggested that the PL found in LE may be a sign of IBD disease activity
.
In addition, the diagnosis of LE in UC patients should be differentiated from candidiasis, lichen planus esophagitis, and lichenoid esophagitis
.
Granulomatous esophagitis has been reported in patients with Crohn's disease (CD), but not in patients with UC
.
The histological diagnostic criteria for granulomatous esophagitis include chronic granulomatous disease, common variant immunodeficiency and infection
.
In addition, previous analysis also showed that there is a statistically significant negative correlation between eosinophilic esophagitis and CD or microscopic colitis, but not UC
.
There are relatively few reports of esophageal ulcers and UC-related esophageal ulcers
.
The results of previous studies have shown that esophageal ulcers are more common in young people than in old people
.
In addition, patients often suffer from complex esophageal ulcers at the onset or recurrence of colitis
.
The endoscopic findings of patients with UC esophageal ulcers are different from those of UC-related gastroduodenitis (GDUC)
.
GDUC is characterized by fragility and granular mucosa.
In contrast, UC-related esophageal ulcers are perforated ulcers, which mostly occur in the middle and lower esophagus
.
Pathologically, all reported cases showed only non-specific inflammatory cell infiltration, without any UC-specific features
.
In terms of histology, the association between esophageal ulcer and UC has not been determined
.
In addition, most patients with UC esophageal ulcers also have other extraintestinal manifestations, including eye damage, skin diseases, and peripheral arthritis
.
Nevertheless, the underlying pathological mechanism is currently unclear.
Therefore, a comprehensive diagnosis is needed to rule out infections and drug-related diseases
.
Gastroduodenal and duodenal mucosal lesions, gastritis or gastritis, it is estimated that 5%-19% of UC patients will develop gastritis or gastroduodenitis
.
Most UC patients have mild local symptoms or asymptomatic
.
Severe gastritis or gastroduodenitis is usually seen in patients with long postoperative intervals after colectomy or in patients with generalized colitis, ileal pouchitis, or pancolitis
.
Focal enhanced gastritis (FEG) is considered to be the most common form of UGI inflammation in patients with UC, followed by mixed inflammation of the base of the stomach and superficial plasmacytosis
.
Previously, FEG was described as a specific diagnostic marker for CD patients
.
But some people also put forward different opinions
.
Some scholars also found that up to 20.
8% of UC children can see FEG
.
Although it is currently uncertain whether FEG can distinguish between adult CD and UC, it has been established that it is not reliable in children
.
Basic and patchy inflammation is the second mode of stomach inflammation and includes a loose mixture of lymphocytes, eosinophils, mast cells, and plasma cells
.
In addition, superficial plasmacytosis is the third most common mode of gastric inflammation, and chronic diffuse gastritis seems to be a common feature of gastric biopsy specimens in patients with UC
.
A recent study showed that active inflammation of the stomach and/or duodenum may be related to drug-refractory UC
.
It is worth noting that ulcers or ulcers complicated by UC are not common
.
Compared with UC, the inflammatory cell infiltration observed in Helicobacter pylori-related gastritis and gastric CD-related chronic superficial gastritis is denser and more diffuse
.
Duodenitis Dyspepsia is the most common symptom of UC-related chronic duodenitis, but it is often covered by the symptoms of UC
.
It is worth noting that most patients with symptomatic duodenitis suffer from severe colitis and in some cases require colectomy
.
A special type of UGI inflammation in UC patients is diffuse chronic duodenitis.
The reported endoscopic findings of symptomatic patients are diverse, including diffuse edema, granular, fragile, and ulcers
.
In addition, the microscopic features of duodenitis associated with UC include mucosal dilatation, diffuse inflammatory infiltration of monocytes and neutrophil inflammation, glandular deformation, erosion or ulceration
.
In summary, due to its non-specific capillary and microscopic features, as well as the overlap with celiac disease, peptic duodenitis and drug-related duodenitis, duodenitis complicated by UC is rarely recognized
.
Conclusion Compared with intestinal manifestations, UC-related UGI manifestations are uncommon and usually non-specific.
Therefore, it is necessary to consider further verification
.
At the same time, the researchers said that this study helps doctors diagnose UC in a correct and timely manner and avoid unnecessary examinations
.
END Yimaitong compiled from: Sun Y, Zhang Z, Zheng CQ,et al.
Mucosal lesions of the upper gastrointestinal tract in patients with ulcerative colitis: A review[J].
World J Gastroenterol 2021; 27(22): 2963- 2978.
.
The colon and rectum are considered to be the main target organs of UC, while the upper gastrointestinal (UGI) manifestations are not common
.
Recently, new evidence has shown that UC has a variety of accompanying symptoms that affect the upper gastrointestinal tract
.
However, UGI related to UC has various manifestations and is often covered up or overlooked
.
In addition, the endoscopic and microscopic features of UC combined with UGI are non-specific, and many doctors may ignore the symptoms of UGI
.
There are no established standards for UC patients who should undergo fibrogastroduodenoscopy
.
Esophageal mucosal lesions Esophagitis Lymphocytic esophagitis (LE) is defined as a large number of peripheral lymphocytes (PLs) or intraepithelial lymphocytes (IELs) without obvious granulocytes (neutrophils and eosinophils) ), LE was initially proven to be a UGI manifestation of children with IBD
.
It is reported that 7% of pediatric UC patients develop LE, which is common in mucosal injury (edema or dyskeratosis); however, no significant differences were found between IBD and non-IBD control patients
.
In contrast, a previous study suggested that the PL found in LE may be a sign of IBD disease activity
.
In addition, the diagnosis of LE in UC patients should be differentiated from candidiasis, lichen planus esophagitis, and lichenoid esophagitis
.
Granulomatous esophagitis has been reported in patients with Crohn's disease (CD), but not in patients with UC
.
The histological diagnostic criteria for granulomatous esophagitis include chronic granulomatous disease, common variant immunodeficiency and infection
.
In addition, previous analysis also showed that there is a statistically significant negative correlation between eosinophilic esophagitis and CD or microscopic colitis, but not UC
.
There are relatively few reports of esophageal ulcers and UC-related esophageal ulcers
.
The results of previous studies have shown that esophageal ulcers are more common in young people than in old people
.
In addition, patients often suffer from complex esophageal ulcers at the onset or recurrence of colitis
.
The endoscopic findings of patients with UC esophageal ulcers are different from those of UC-related gastroduodenitis (GDUC)
.
GDUC is characterized by fragility and granular mucosa.
In contrast, UC-related esophageal ulcers are perforated ulcers, which mostly occur in the middle and lower esophagus
.
Pathologically, all reported cases showed only non-specific inflammatory cell infiltration, without any UC-specific features
.
In terms of histology, the association between esophageal ulcer and UC has not been determined
.
In addition, most patients with UC esophageal ulcers also have other extraintestinal manifestations, including eye damage, skin diseases, and peripheral arthritis
.
Nevertheless, the underlying pathological mechanism is currently unclear.
Therefore, a comprehensive diagnosis is needed to rule out infections and drug-related diseases
.
Gastroduodenal and duodenal mucosal lesions, gastritis or gastritis, it is estimated that 5%-19% of UC patients will develop gastritis or gastroduodenitis
.
Most UC patients have mild local symptoms or asymptomatic
.
Severe gastritis or gastroduodenitis is usually seen in patients with long postoperative intervals after colectomy or in patients with generalized colitis, ileal pouchitis, or pancolitis
.
Focal enhanced gastritis (FEG) is considered to be the most common form of UGI inflammation in patients with UC, followed by mixed inflammation of the base of the stomach and superficial plasmacytosis
.
Previously, FEG was described as a specific diagnostic marker for CD patients
.
But some people also put forward different opinions
.
Some scholars also found that up to 20.
8% of UC children can see FEG
.
Although it is currently uncertain whether FEG can distinguish between adult CD and UC, it has been established that it is not reliable in children
.
Basic and patchy inflammation is the second mode of stomach inflammation and includes a loose mixture of lymphocytes, eosinophils, mast cells, and plasma cells
.
In addition, superficial plasmacytosis is the third most common mode of gastric inflammation, and chronic diffuse gastritis seems to be a common feature of gastric biopsy specimens in patients with UC
.
A recent study showed that active inflammation of the stomach and/or duodenum may be related to drug-refractory UC
.
It is worth noting that ulcers or ulcers complicated by UC are not common
.
Compared with UC, the inflammatory cell infiltration observed in Helicobacter pylori-related gastritis and gastric CD-related chronic superficial gastritis is denser and more diffuse
.
Duodenitis Dyspepsia is the most common symptom of UC-related chronic duodenitis, but it is often covered by the symptoms of UC
.
It is worth noting that most patients with symptomatic duodenitis suffer from severe colitis and in some cases require colectomy
.
A special type of UGI inflammation in UC patients is diffuse chronic duodenitis.
The reported endoscopic findings of symptomatic patients are diverse, including diffuse edema, granular, fragile, and ulcers
.
In addition, the microscopic features of duodenitis associated with UC include mucosal dilatation, diffuse inflammatory infiltration of monocytes and neutrophil inflammation, glandular deformation, erosion or ulceration
.
In summary, due to its non-specific capillary and microscopic features, as well as the overlap with celiac disease, peptic duodenitis and drug-related duodenitis, duodenitis complicated by UC is rarely recognized
.
Conclusion Compared with intestinal manifestations, UC-related UGI manifestations are uncommon and usually non-specific.
Therefore, it is necessary to consider further verification
.
At the same time, the researchers said that this study helps doctors diagnose UC in a correct and timely manner and avoid unnecessary examinations
.
END Yimaitong compiled from: Sun Y, Zhang Z, Zheng CQ,et al.
Mucosal lesions of the upper gastrointestinal tract in patients with ulcerative colitis: A review[J].
World J Gastroenterol 2021; 27(22): 2963- 2978.
