Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2015; 3(6): 479-483
Published online Jun 16, 2015. doi: 10.12998/wjcc.v3.i6.479
Crohn’s disease with gastroduodenal involvement: Diagnostic approach
Sachin B Ingle, Baban D Adgaonkar, Nawab P Jamadar, Saleha Siddiqui, Chitra R Hinge
Sachin B Ingle, Saleha Siddiqui, Department of Pathology, MIMSR Medical College, Latur, Maharashtra 4132512, India
Baban D Adgaonkar, Chitra R Hinge, Department of Physiology, MIMSR Medical College, Latur, Maharashtra 4132512, India
Nawab P Jamadar, Department of Anesthesia, MIMSR Medical College, Latur, Maharashtra 4132512, India
Author contributions: Ingle SB, Adgaonkar BD, Siddiqui S and Hinge CR prepared the manuscript; Ingle SB and Jamadar NP critically revised the intellectual content and gave final approval of manuscript.
Conflict-of-interest: None is to be declared.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sachin B Ingle, Professor, Department of Pathology, MIMSR Medical College, Ambajogai Road, Vishwanathpuram, Latur, Maharashtra 413531, India. dr.sachiningle@gmail.com
Telephone: +91-2382-227424 Fax: +91-2382-228939
Received: November 21, 2014
Peer-review started: November 22, 2014
First decision: December 12, 2014
Revised: April 14, 2015
Accepted: April 27, 2015
Article in press: April 29, 2015
Published online: June 16, 2015

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

Core tip: The stomach is rarely the sole or predominant site of Crohn’s disease (CD) accounting for less than 0.07% of all gastrointestinal CD. Serological testing and meticulous histopathological examination by excluding other causes of granulomatous gastritis can play a vital role to arrive at the correct diagnosis.