Εsophageal Crohn's disease in adults: A systematic review of the literature.

Abstract

Esophageal involvement in Crohn's disease is rare and poorly understood, presenting with nonspecific symptoms that contribute to delayed diagnosis and inconsistent management. This systematic review aims to characterize the clinical presentation, diagnostic pathways, and treatment approaches for adult patients with esophageal Crohn's disease. A systematic search of PubMed and Scopus was conducted through May 2025 to identify studies reporting on adult patients with esophageal Crohn's disease. Descriptive statistics, univariate comparisons, and post hoc pairwise testing with Bonferroni correction were performed. Ninety studies, involving 100 adult patients (54% women; median age, 38 years), were included. The most common primary location was ileocolic (31%), and 20% of the study population had isolated upper gastrointestinal involvement. Dysphagia was the most frequent symptom (41%). Endoscopic diagnosis was made in 98% of patients, with predominant findings of ulcers (70%) and strictures (37%). Granulomas were identified in 29% of biopsy specimens. First-line treatments varied, with corticosteroids (29.6%) and surgery (14.3%) used most frequently. Biologic agents were used in 15.4% of patients, as most studies were published before the biologics era. Four deaths were reported due to postoperative complications. Significant associations were found between the primary site of Crohn's disease and both esophageal behavior and endoscopic findings. Esophageal Crohn's disease is a rare entity with diagnostic delays and inconsistent treatment. The variability in clinical features, diagnostic findings, and treatment approaches reported in adult patients, as well as the lack of consensus definitions and standardized management, is reflected in high rates of surgical intervention and morbidity in the past. Improved awareness and collaborative research are needed to establish evidence-based guidelines and improve patient outcomes.