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Case Reports
. 2025 Apr 14;17(4):e82221.
doi: 10.7759/cureus.82221. eCollection 2025 Apr.

Diagnostic Challenges of Upper Gastrointestinal Tract Crohn's Disease

Sruthi Beladev  1 , Krupa A Joseph  1 , Nikhil Charles Madathiparambu  1
Affiliations
Case Reports

Diagnostic Challenges of Upper Gastrointestinal Tract Crohn's Disease

Sruthi Beladev et al. Cureus. .

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.

Keywords: crohn’s disease (cd); endoscopy; histology; nutrition; upper gastrointestinal tract.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Video capsule endoscopy in 2021 showing small aphthous ulcer with erythema
Figure 2
Figure 2. Video capsule endoscopy in 2021 showing distal small bowel aphthous ulcers
Figure 3
Figure 3. Video capsule endoscopy in 2023 showing shallow ulcers (black arrows)
Figure 4
Figure 4. OGD in 2024 showing gastritis and erosive duodenitis
OCD: esophagogastroduodenoscopy
Figure 5
Figure 5. Histology picture demonstrating acute inflammation/neutrophil polymorphs in the villous and crypt epithelium
Figure 6
Figure 6. Demonstration of acute inflammation/neutrophil polymorphs in the villous and crypt epithelium
Figure 7
Figure 7. Histology picture demonstrating acute inflammation/neutrophil polymorphs in the villous and crypt epithelium
See this image and copyright information in PMC

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