Published online Jun 16, 2016. doi: 10.12998/wjcc.v4.i6.146
Peer-review started: January 19, 2016
First decision: February 26, 2016
Revised: March 23, 2016
Accepted: April 20, 2016
Article in press: April 22, 2016
Published online: June 16, 2016
Crohn’s disease (CD) can involve any part of the gastrointestinal tract from the mouth to anus. However, gastroduodenal CD is rare with a frequency reported to range between 0.5% and 4.0%. Most patients with gastroduodenal CD have concomitant lesions in the terminal ileum or colon, but isolated gastroduodenal Crohn’s disease is an extremely rare presentation of the disease accounting for less than 0.07% of all patients with CD. The symptoms of gastroduodenal CD include epigastric pain, dyspepsia, early satiety, anorexia, nausea, vomiting, and weight loss. The diagnosis of gastroduodenal CD requires a high level of clinical suspicion and can be made by comprehensive clinical evaluation. Here we report a rare case of isolated duodenal CD not confirmed by identification of granuloma on biopsy, but diagnosed by clinical evaluation.
Core tip: Most gastroduodenal Crohn’s disease (CD) is associated with involvement of the terminal ileum and colon. CD confined to the stomach or duodenum may occur very rarely. Upper CD is typically confirmed by the presence of granulomas on biopsy, but endoscopic biopsies often fail to reveal granulomas. Thus, diagnosis of gastroduodenal CD requires a high level of clinical suspicion and can be made by comprehensive clinical evaluation if there are no definite histologic findings. This rare case highlights the importance of clinical suspicion and comprehensive clinical evaluation for the diagnosis of isolated gastroduodenal CD.