The Diagnostic Challenge of Crohn's Disease With Initial Duodenal Involvement: Two Cases and Literature Review

Upper gastrointestinal Crohn's disease (UGI-CD) is rare, with an adult prevalence of 0.5%-4.0%. Its nonspecific symptomatology and the absence of clear diagnostic guidelines pose significant diagnostic challenges.

We present two patients with UGI-CD treated at Hainan General Hospital. In the first case, a 47-month diagnostic delay led to disease progression and surgical intervention. In the second case, prompt diagnosis of a duodenal ulcer enabled medical management, avoiding surgery. Both patients received infliximab and achieved remission.

These cases highlight diagnostic challenges in UGI-CD and offer three key lessons: (i) UGI-CD should be suspected in refractory, Helicobacter pylori-negative duodenal ulcers; (ii) an endoscopic-radiologic mismatch may occur; and (iii) we propose a diagnostic algorithm to assist early recognition, though it has not been prospectively validated. Given the descriptive nature of this two-case series, these findings are hypothesis-generating and require further validation.