Mucosal lesions of the upper gastrointestinal tract in patients with ulcerative colitis: A review

Yan Sun, Zhe Zhang, Chang-Qing Zheng, Li-Xuan Sang, Yan Sun, Zhe Zhang, Chang-Qing Zheng, Li-Xuan Sang

Abstract

Ulcerative colitis (UC) is a chronic, nonspecific, relapsing inflammatory bowel disease. The colorectum is considered the chief target organ of UC, whereas upper gastrointestinal (UGI) tract manifestations are infrequent. Recently, emerging evidence has suggested that UC presents complications in esophageal, stomachic, and duodenal mucosal injuries. However, UC-related UGI tract manifestations are varied and frequently silenced or concealed. Moreover, the endoscopic and microscopic characteristics of UGI tract complicated with UC are nonspecific. Therefore, UGI involvement may be ignored by many clinicians. In addition, no standard criteria have been established for patients with UC who should undergo fibrogastroduodenoscopy. Furthermore, specific treatment recommendations may be needed for patients with UC-associated UGI lesions. Herein, we review the esophageal, gastric, and duodenal mucosal lesions of the UC-associated UGI tract, as well as the potential pathogenesis and therapy.

Keywords: Endoscopic and microscopic manifestations; Inflammatory bowel disease; Ulcerative colitis; Upper gastrointestinal tract.

Conflict of interest statement

Conflict-of-interest statement: All authors have no conflicts of interest related to the manuscript.

©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.

Figures

Figure 1
Figure 1
Common upper gastrointestinal endoscopic and microscopic presentations in ulcerative colitis. UGI: Upper gastrointestinal; UC: Ulcerative colitis.
Figure 2
Figure 2
Endoscopic and microscopic presentations of esophageal ulcers associated with ulcerative colitis. A: Endoscopic view showing multiple ulcerative lesions of the esophagus; B: Microscopic view showing squamous epithelial hyperplasia, interstitial fibrous tissue proliferation, inflammatory cell infiltration, and visible neutrophil aggregation.
Figure 3
Figure 3
Endoscopic and microscopic manifestations of gastritis-associated ulcerative colitis. A: Endoscopic image displaying multiple protrusion lesions of the gastric mucosa; B: Microscopic image showing mucosal inflammation with hyperplastic polypoid changes.
Figure 4
Figure 4
Pathogenesis of upper gastrointestinal mucosal lesions.
Figure 5
Figure 5
Endoscopic pictures of esophageal ulcer- and gastritis-associated ulcerative colitis after treatment. A: Endoscopic picture revealing a healing scar of multiple esophageal ulcers after administration of remicade (infliximab for injection); B: Endoscopic picture demonstrating multiple protrusion lesions of the gastric mucosa after treatment with remicade and methylprednisolone.

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