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Diagnostic Challenges of Upper Gastrointestinal Tract Crohn's Disease
Sruthi Beladev1, Krupa A Joseph1, Nikhil Charles Madathiparambu1
1Acute Medicine, Queen Elizabeth The Queen Mother Hospital, Margate, GBR.
Insights
Upper gastrointestinal Crohn's disease (CD) can be challenging to diagnose, often requiring advanced imaging like capsule endoscopy. This case highlights the importance of thorough evaluation for accurate diagnosis and management of this condition.
Area of Science:
- Gastroenterology
- Inflammatory Bowel Disease
- Diagnostic Challenges
Background:
- Crohn's disease (CD) typically affects the lower gastrointestinal tract.
- Upper gastrointestinal (UGI) involvement in CD is often underdiagnosed due to limited endoscopic and biopsy utilization.
- Persistent symptoms despite conventional treatments necessitate exploring less common disease manifestations.
Observation:
- A 30-year-old male with an 11-year history of symptomatic CD presented with persistent issues.
- Multiple standard endoscopic and imaging evaluations yielded normal results, with persistently elevated fecal calprotectin.
- Video capsule endoscopy revealed duodenitis and aphthous ulcers, leading to esophagogastroduodenoscopy (OGD) confirmation of gastric and duodenal inflammation.
Findings:
- Histological examination confirmed focal inflammation consistent with upper gastrointestinal Crohn's disease.
- Fecal calprotectin served as a reliable indicator of ongoing inflammation.
- Despite aggressive treatment, the patient's symptoms persisted, emphasizing the need for comprehensive nutritional support.
Implications:
- This case highlights the diagnostic difficulties associated with upper GIT CD.
- Emphasizes the critical role of detailed endoscopic and histological assessments for accurate diagnosis and effective management of CD.
- Underscores the significance of fecal calprotectin monitoring and nutritional management in controlling symptoms of upper GIT CD.
Abstract:
Crohn's disease (CD) is a chronic inflammatory disorder that commonly affects the distal small bowel and proximal large bowel. However, it can involve any part of the gastrointestinal tract (GIT), including the upper GIT. However, upper GIT involvement is often overlooked due to the limited use of upper gastrointestinal (UGI) endoscopy and biopsy for diagnosis. We present a case of a 30-year-old male with an 11-year history of symptomatic CD. Despite multiple normal findings on various endoscopic and imaging evaluations, his symptoms persisted, leading to numerous treatment modifications from Pentasa foam enema to various biologics. Despite this, fecal calprotectin remained elevated. A critical diagnosis was made via video capsule endoscopy, revealing duodenitis and aphthous ulcers, and subsequent esophagogastroduodenoscopy (OGD) with histology confirming focal inflammation consistent with upper GIT CD of the stomach and duodenum. Despite aggressive treatment, the patient's symptoms persisted, necessitating comprehensive nutritional management. This case underscores the diagnostic challenges of upper GIT CD and highlights the importance of thorough endoscopic and histological evaluations for accurate diagnosis and effective management. Additionally, it underscores the usefulness of fecal calprotectin as an indication of inflammation and the relevance of nutritional management in controlling symptoms of upper GIT CD.
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