Gastroduodenal Crohn's disease: diagnosis and selection of treatment

Crohn's disease of the stomach and duodenum is uncommon and difficult to diagnose. This study reviews 23 patients with this condition seen at the Toronto General Hospital between 1970 and 1981. In 12 patients the major symptoms were due to coexisting lower intestinal Crohn's disease (primarily distal disease). Diarrhea and crampy abdominal pain were the primary presenting complaints. None had obstructive symptoms. Nine of the 12 were treated medically, 7 with success; 1 required surgical intervention and 1 continued to have pain but no evidence of ulceration. In the remaining 11 patients, the major symptoms were due to their gastroduodenal Crohn's disease (primarily proximal disease) even though 10 had coexisting disease of the intestine. Their symptoms included postprandial vomiting, upper intestinal bloating, hematemesis and epigastric pain. Only one patient was successfully treated medically; the others required surgical intervention. At the time of writing, 9 of the 11 patients had no symptoms. The authors conclude that response to medical therapy occurs only in patients whose gastroduodenal disease is relatively mild and whose symptoms come from distal intestinal disease. In contrast, patients whose main symptoms are from gastroduodenal involvement usually require surgical treatment. Vagotomy with gastroenterostomy is the procedure of choice.