Crohn's disease with damage to the upper gastrointestinal tract — difficulties in primary diagnosis (clinical case)

Background. Crohn's disease is a chronic recurrent disease of the gastrointestinal tract of unknown etiology, characterized by transmural, segmental, granulomatous inflammation with the development of local and systemic complications. Currently, in some cases, the diagnosis of Crohn's disease remains a difficult task. It often takes several years from the moment the first symptoms appear to the diagnosis is verified. The variety of clinical manifestations makes it difficult to recognize nosology due to the simultaneous involvement of several parts of the gastrointestinal tract in the pathological process: from the oral cavity to the rectum. Isolated lesions of the upper gastrointestinal tract are the most difficult to verify.

Objective. The aim of the work is to analyze a diagnostically complex case of Crohn's disease with isolated lesions of the upper gastrointestinal tract.

Materials and methods. The article describes a clinical case of Crohn's disease with lesions of the upper gastrointestinal tract in a middleaged (55 years old) patient. The features of this case are the low-symptomatic (erased) course of the disease, the absence of pathognomonic gastrointestinal clinical manifestations and characteristic typical endoscopic and histological changes during colonoscopy with examination of the terminal ileum. To establish a clinical diagnosis, the patient underwent a comprehensive examination, including laboratory, endoscopic and X-ray examinations in combination with morphological verification.

Conclusion. Our clinical observation confirms the importance of a comprehensive examination. The leading diagnostic methods for Crohn's disease with isolated lesions of the upper gastrointestinal tract are enterography and esophagogastroduodenoscopy with morphological examination. The patient was diagnosed based on the results of a histological examination, which confirms the need for mandatory morphological diagnosis during esophagogastroduodenoscopy.

1. Clinical guidelines – Crohn's disease – 2024-2025-2026 (07/17/2024) – Approved by the Ministry of Health of the Russian Federation. (In Russ.)

2. Inflammatory bowel disease: clinical, endoscopic, morphological aspects of diagnosis, principles of modern therapy. Golovenko O. V., Khomeriki S. G., Ivanova E. V. and others. M. Prima Print, 2012. 258 p. (In Russ.)

3. Aleksandrov T. L., Baranova T. A., Galyaev A. V., et al. A series of clinical observations of Crohn's disease of the upper gastrointestinal tract. Eksperimentalnaya i klinicheskaya gastroenterologiya. 2022; 207 (11): 247-251. DOI: 10.31146/1682-8658-ecg-207-11-247-251. (In Russ.)

4. Kovari B., Pai R. K. Upper Gastrointestinal Tract Involvement in Inflammatory Bowel Diseases: Histologic Clues and Pitfalls. Adv Anat Pathol. 2022; 29 (1): 2-14. DOI: 10.1097/PAP.0000000000000311.

5. Greuter T., Piller A., Fournier N., Safroneeva E., Straumann A., Biedermann L., Godat S., Nydegger A., Scharl M., Rogler G., Vavricka S. R., Schoepfer A. M.; Swiss IBD Cohort Study Group. Upper Gastrointestinal Tract Involvement in Crohn's Disease: Frequency, Risk Factors, and Disease Course. J Crohns Colitis. 2018; 12 (12): 1399-1409. DOI: 10.1093/ecco-jcc/jjy121.

6. Uspensky Yu. P., Gulunov Z. Kh. Lesions of the upper gastrointestinal tract in Crohn's disease. Farmateka. 2023; 14: 40-43. DOI: 10.18565/pharmateka.2023.14.40-43. (In Russ.)