Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2026 Mar;11(3):243-255.
doi: 10.1016/S2468-1253(25)00347-4. Epub 2026 Jan 8.

Definitions, diagnosis, management, and outcomes of upper gastrointestinal Crohn's disease: an international, expert RAND/UCLA appropriateness study

Affiliations
Review

Definitions, diagnosis, management, and outcomes of upper gastrointestinal Crohn's disease: an international, expert RAND/UCLA appropriateness study

Nathaniel A Cohen et al. Lancet Gastroenterol Hepatol. 2026 Mar.

Abstract

Patients with Crohn's disease can have isolated or co-existent upper gastrointestinal involvement, but this is an understudied clinical manifestation. There are neither standardised definitions nor diagnostic or management recommendations to help to guide clinical practice. Therefore, we conducted a RAND/University of California Los Angeles appropriateness study on the definition, diagnosis, management, and appropriate outcomes of upper gastrointestinal Crohn's disease (UGICD). An international expert panel of 30 gastroenterologists and pathologists and two patient representatives were recruited. Following a previously published systematic review, 1061 candidate items were grouped into questions and evaluated for appropriateness. Two modified Delphi rounds of voting with an interposed moderated group discussion were performed. The expert panel defined UGICD as disease occurring in the oesophagus, stomach, and/or duodenum (proximal to the ligament of Treitz) that can occur at any time during the disease course. Upper endoscopy is appropriate only in patients with newly diagnosed or existing Crohn's disease with suspicion for upper gastrointestinal involvement (eg, upper gastrointestinal symptoms or the presence of anaemia). Management of UGICD should be determined on a case-by-case basis and factors, such as disease location and symptomatic, endoscopic, and imaging severity, should guide medical, endoscopic, and surgical intervention. Both clinical and endoscopic response and remission are appropriate treatment targets for routine clinical practice; there is uncertainty about the value of histological outcomes in UGICD.

PubMed Disclaimer

Conflict of interest statement

Declaration of interests NAC has served as a consultant fees from AbbVie, Iterative Health, Janssen Pharmaceuticals, Seres Pharmaceuticals, Padagis, Bristol-Myers Squibb, Takeda, and Rafa Pharmaceuticals, speakers fees from AbbVie, Janssen Pharmaceuticals, Bristol-Myers Squibb, Takeda, Eli Lilly, and received travel support from Pfizer and Takeda. DTR has received grant support from Takeda and served as a consultant for AbbVie, Abivax, Altrubio, Avalo Therapeutics, Bausch Health, Bristol-Myers Squibb, Buhlmann Diagnostics Corp, Celltrion, ClostaBio, Connect BioPharma, Douglas Pharmaceuticals, Foresee, Eli Lilly, Genentech (Roche), Image Analysis Group, InDex Pharmaceuticals, Iterative Health, Johnson and Johnson, Merck, Odyssey Therapeutics, Pfizer, Sanofi, Spyre, Takeda Pharmaceuticals, Throne, Vedanta Biosciences, and Ventyx. DB received consulting fees from AbbVie, Alfasigma, Amgen, Bristol Myers Squibb, Celltrion, Fresenius, GSK, Hexal, Janssen Cilag, Lilly, MSD, Pharmacosmos, Pfizer, Roche, Sandoz, and Takeda and speakers fees from AbbVie, Alfasigma, Amgen, Bristol Myers Squibb, CED-Service GmbH, Celltrion, DGVS, Diaplan, Falk Foundation, Fresenius, Galapagos, Gastro Today, GSK, Hexal, Ferring, Janssen Cilag, Lilly, Medical Tribune, MSD, Pharmacosmos, Pfizer, Roche, StreamedUp, and Takeda. CL has received consulting fees from AbbVie, Alfasigma, Amgen, Bristol Myers Squibb, Celltrion, Fresenius, GSK, Hexal, Janssen Cilag, Lilly, MSD, Pharmacosmos, Pfizer, Roche, Sandoz, and Takeda, speakers fees from AbbVie, Alfasigma, Amgen, Bristol Myers Squibb, CED-Service GmbH, Celltrion, DGVS, Diaplan, Doctorflix, Else Kroner-Fresenius Foundation, Falk Foundation, Fresenius, Galapagos, Gastro Today, GSK, Hexal, Ferring, Janssen Cilag, Lilly, Medical Tribune, MSD, Pharmacosmos, Pfizer, Roche, StreamedUp, Sandoz, and Takeda, and serves as the Scientific Director for the Intestinal Ultrasound Group of the United States and Canada. GD'H reports consultancy activities for AbbVie, Agomab, Alimentiv, AstraZeneca, AM Pharma, Arena Pharmaceuticals, Bristol-Myers Squibb, Boehringer Ingelheim, Celltrion, Eli Lilly, Exeliom Biosciences, Exo Biologics, Galapagos, Index Pharmaceuticals, Kaleido, Roche, Gilead, GSK, Gossamerbio, Pfizer, Immunic, Johnson and Johnson, Origo, Polpharma, Procise Diagnostics, Prometheus Laboratories, Prometheus Biosciences, Progenit, and Protagonist; speaker's bureau for AbbVie, Arena, Galapagos, Gilead, Pfizer, Bristol-Myers Squibb, and Takeda; and fees for data monitoring board activities for Galapagos, AbbVie, AstraZeneca, and Seres Health. MTA has served as a consultant and on the advisory board for AbbVie, Amgen, Bristol Myers Squibb, Eli Lilly, Genetech, Gilead Sciences, Janssen Pharmaceuticals, Pfizer Pharmaceutical, Takeda Pharmaceuticals, and UCB Pharma. ID has served as a speaker, consultant, and advisory board member for AstraZeneca Takeda, Janssen, AbbVie, Altman, Pfizer, Ferring, Roche/Genentech, Celgene/Bristol-Myers Squibb, Eli Lilly, Falk Pharma, Arena, Gilead, Celltrion, Sublimity, Sandoz, Sangamo, Spyre Therapeutics, and Athos Therapeutics and is a shareholder for Harp Dx. RA has recieved consulting fees from AbbVie, Abivax, AstraZeneca, Bristol-Myers Squibb, Celltrion Healthcare, Johnson-Johnson, Lilly, MSD, Pfizer, and Takeda, speakers fees from AbbVie, Abivax, AlfaSigma, AstraZeneca, Bristol-Myers Squibb, Celltrion Healthcare, Galapagos, Johnson-Johnson, Lilly, MSD, Pfizer, and Takeda, and travel grants from Johnson-Johnson, Lilly, and AbbVie. AD reports consulting fees from AbbVie, Alfasigma, Amgen, Biogen, Boehringer Ingelheim, Bristol Myers Squibb, Celltrion, Dr Falk Foundation, Ferring Pharmaceuticals, Fresenius Kabi, Galapagos, Johson and Johnson, Lilly, MSD, Pfizer, Pharmacosmos, Sandoz, Stada, Takeda, Tillotts, and Vifor Pharma; speaker's fees from AbbVie, Alfasigma, Biogen, CED Service GmbH, Celltrion, Falk Foundation, Ferring, Galapagos, Gilead, High5MD, Janssen, Materia Prima, MedToday, MSD, Pfizer, Streamed-Up, Takeda, Tillotts, and Vifor Pharma; travels grants from AbbVie, Alfasigma, Biogen, CED Service GmbH, Celltrion, Falk Foundation, Ferring, Galapagos, Gilead, High5MD, Janssen, Materia Prima, MedToday, MSD, Pfizer, Streamed-Up, Takeda, Tillotts, and Vifor Pharma; payment for manuscript preparation from AbbVie, Falk Foundation, Johnson and Johnson, Takeda, Thieme, and UniMed Verlag; and is on the advisory board for Abivax, AbbVie, Bristol Myers Squibb, Dr Falk Foundation, Galapagos, Gilead, Janssen, and Pfizer. SEO has received speaker fees from Janssen, AbbVie, Takeda, and Eli Lilly, and has been on the advisory board for Eli Lilly, Janssen, and AbbVie. BF has received grant and research support from Millennium Pharmaceuticals, Merck, Tillotts Pharma, AbbVie, Novartis Pharmaceuticals, Centocor, Elan/Biogen, UCB Pharma, Bristol-Myers Squibb, Genentech, ActoGenix, and Wyeth Pharmaceuticals; consulting fees from Millennium Pharmaceuticals, Merck, Centocor, Elan/Biogen, Janssen-Ortho, Teva Pharmaceuticals, Bristol-Myers Squibb, Celgene, UCB Pharma, AbbVie, AstraZeneca, Serono, Genentech, Tillotts Pharma, Unity Pharmaceuticals, Albireo Pharma, Given Imaging, Salix Pharmaceuticals, Novo Nordisk, GSK, Actogenix, Prometheus Therapeutics and Diagnostics, Athersys, Axcan, Gilead, Pfizer, Shire, Wyeth, Zealand Pharma, Zyngenia, GiCare Pharma, and Sigmoid Pharma; speaker's bureau fees from UCB Pharma, AbbVie, and Johnson and Johsnon/Janssen; and reports stock options for Evida, EnGene, and Connect Biopharma. RG has received honoraria for speaking and advisory board roles from AbbVie, Janssen, Takeda, Celltrion, Pfizer, and Zespri. IOG received funds paid to the Cleveland Clinic from Morphic and Alimentiv and reports a following patent (patent assignment 2022–3999/CWRUP214US) pertaining to rasiomics signatures for pathologic characterisation of strictures on MR and CT enterography. To date there is no product on the market, and if the product reaches the market any proceeds will go to the institution. CRHH served as a speaker and advisory board member for AstraZeneca, AbbVie, Dr Falk Pharma and the Falk Foundation, Galapagos, Janssen, Pfizer, Ferring, Takeda, and Tillotts Pharma, and received grant support from Tillotts and Takeda. CH-R has received travel support from Johnson and Johnson. TK reports consulting fees from Takeda Pharmaceuticals, Alfresa Pharma Corporation, Seria Pharmaceuticals, Kyorin Pharmaceuticals, Nippon Kayaku, Mitsubishi Tanabe Pharma Corporation, Abbie GK, Pfizer Japan, Janssen Pharmaceuticals, JIMRO, Galapagos; speakers fees from EA Pharma, Kissei Pharmaceuticals, Pfizer Japan, Nippon Kayaku, Alfresa Pharma Corporation, Abbie GK, Mochida Pharmaceutical, Mitsubishi Tanabe Pharma Corporation, Janssen Pharmaceutical; and has received research funding from AbbVie, Alfresa Pharma, Bristol Myers Squibb, EA Pharma, Gilead Sciences, Helmsley Charitable Trust, Kyorin Pharmaceutical, Miyarisan, Mochida Pharmaceutical, Nippon Kayaku, Otsuka Holdings, Pfizer, Sekisui Medical, Samsung, Takeda, and Zeria Pharmaceutical. NM reports consulting fees from Teva Pharmaceuticals, Magentiq Eye, Trobix, and Psyrx; speakers fees from AbbVie, Bristol-Meyers Squibb, Janssen, Eli-Lilly, and Nestle; travel grants from Nestle, Pfizer, Takeda, and Janssen; is on the advisory board for AbbVie, Eli-Lilly, and Pfizer; and has stock options for BiomX. JO received speaker fees from Takeda, Pfizer, Jansen, AbbVie, and Novartis; grant support from Pfizer; and reports participation in an advisory board for Takeda. SS received consulting fees from Takeda, AbbVie, Merck, Ferring, Pharmacosmos, Warner Chilcott, Johnson and Johnson Innovative Medicine, Dr Falk Pharma, Biohit, TriGenix, Celgene, and Tillots Pharma outside the submitted work; payment or honoraria from AbbVie, Takeda, Celltrion, Pfizer, Biogen, AbbVie, Johnson and Johnson Innovative Medicine, Merck, Warner Chilcott, and Dr Falk Pharma outside the submitted work; and is co-director of research for the South Asian IBD Alliance. BS has served as a consultant for AbbVie, Arena, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Eli Lilly, Endpoint Health, Falk Pharma, Galapagos, Gilead, Janssen, Landos, Pfizer, Prometheus, and Takeda, and has received speaker fees from AbbVie, AlfaSigma, CED Service, Eli Lilly, Falk Pharma, Ferring, Galapagos, Janssen, Novartis, Pfizer, Takeda, and Tr1X Bio. MSS has received research support from AbbVie, Gilead, Janssen, Pfizer, Prometheus, and Takeda; speaker fees from Abbvie, Janssen, Takeda, Pfizer, Celltrion, Merck, Amgen, and Lilly; and consulting fees from Abbvie, Janssen, Takeda, Pfizer, Celltrion, Merck, Amgen, and Lilly. FS received consultancy and speaker fees from AbbVie, Amgen, Celltrion, Eurofarma, Ferring, Janssen, Pfizer, Sandoz, and Takeda. KF served on an advisory panel for Janssen. JT has received consulting fees from Janssen, AbbVie, Eli Lilly, Sandoz, and Pfizer, and has received research funding from AbbVie and Janssen. TAO has served on the advisory board for Alimentiv, Ardelyx, Johnson and Johnson, Genentech-Roche, Pfizer, Tillotts, Parexel, Merck, and Sanofi; served as a consultant for AbbVie, Alimentiv, Ardelyx, Johnson and Johnson, Genentech-Roche, Pfizer, Parexel, Walgreens, and Convatec; and has received speaker fees from AbbVie, Alimentiv, Johnson and Johnson, Genentech-Roche, Takeda, Pfizer, Parexel, and Eli Lilly. FR is consultant for Adnovate, Agomab, Allergan, AbbVie, Arena, Boehringer-Ingelheim, Celgene/Bristol Myers Squibb, Clinical Data Interchange Standards Consortium, Celsius, Cowen, Ferring, Galapagos, Galmed, Genentech, Gilead, Gossamer, Guidepoint, Helmsley, Horizon Therapeutics, Image Analysis, Index Pharma, Jannsen, Koutif, Mestag, Metacrine, Mopac, Morphic, Organovo, Origo, Pfizer, Pliant, Prometheus Biosciences, Receptos, RedX, Roche, Samsung, Surmodics, Surrozen, Takeda, Techlab, Theravance, Thetis, UCB, Ysios, and 89Bio. GW has received speaker fees and consulting fees from AbbVie, Takeda, and Janssen. RF has received consulting fees from AbbVie, Janssen, and Decibio, and is a histopathology reader for Alimentiv. All other authors declare no competing interests.

LinkOut - more resources