Gastroduodenal Crohn's disease. Differential diagnosis and treatment

Gastroduodenal Crohn's disease usually, but not always, occurs in patients with previously established ileal and/or colonic Crohn's disease. Symptoms include postprandial epigastric pain accompanied by nausea and sometimes vomiting, weight loss, anorexia, bloating, and diarrhea. Obstruction is the most common complication. Diagnosis can usually be made radiographically or endoscopically. Certain radiographic patterns are almost diagnostic, eg, obliteration of a distinct pyloric channel and a rigidly narrowed antrum tapering into a diseased duodenal bulb. Endoscopic mucosal biopsy of abnormal areas almost always shows chronic inflammation, although granulomas are not common. In patients with symptoms other than intractable obstruction, medical management, such as intermittent corticosteroid therapy, should be attempted. Surgery is usually indicated for refractory obstruction; gastrojejunostomy is the preferred approach.