Crohn’s Disease: Hard to Swallow!

Excerpt

A 30-year-old female was referred to outpatient endoscopy for the evaluation of odynophagia and progressive dysphagia to liquids and solids that developed gradually over several months. She had a history of severe ileocolonic Crohn’s disease (CD) with a predominant inflammatory pattern diagnosed in 2006; her clinical course was complicated by recurrent episodes of bloody diarrhea, anemia, and abdominal pain. Medical therapy initially involved combination therapy with infliximab and azathioprine that was discontinued following a serum sickness-like reaction. With eventual loss of response with combination therapy that included courses of adalimumab, certolizumab, and vedolizumab, the patient was referred to colorectal surgery for subtotal colectomy with loop ileostomy for steroid-refractory Crohn’s colitis. Pathology from the excised colon in April 2016 was consistent with CD with severe chronic active colitis, ileitis, and an associated sigmoid colon abscess. …