Crohn's disease with gastroduodenal involvement: Diagnostic approach

Abstract

Crohn's disease (CD) is a chronic idiopathic inflammatory disease of gastrointestinal tract characterized by segmental and transmural involvement of gastrointestinal tract. Ileocolonic and colonic/anorectal is a most common and account for 40% of cases and involvement of small intestine is about 30%. Isolated involvement of stomach is an extremely unusual presentation of the disease accounting for less than 0.07% of all gastrointestinal CD. To date there are only a few documented case reports of adults with isolated gastric CD and no reports in the pediatric population. The diagnosis is difficult to establish in such cases with atypical presentation. In the absence of any other source of disease and in the presence of nonspecific upper gastrointestinal endoscopy and histological findings, serological testing can play a vital role in the diagnosis of atypical CD. Recent studies have suggested that perinuclear anti-neutrophil cytoplasmic antibody and anti-Saccharomycescervisia antibody may be used as additional diagnostic tools. The effectiveness of infliximab in isolated gastric CD is limited to only a few case reports of adult patients and the long-term outcome is unknown.

Keywords: Anti-Saccharomycescervisia antibody; Crohn’s disease; Gastrointestinal tract; Isolated gastric involvement; Perinuclear anti-neutrophil cytoplasmic antibody.

Figure 1

Endoscopic findings include patchy erythematic, gastric outlet narrowing.

Figure 2

Biopsy showing non-caseating granulomas and oedema in the submucosa (HE × 10). A: Non-caseating granulomas; B: Oedema alongwith granulation tissue.