The Diagnostic Challenge of Crohn's Disease With Initial Duodenal Involvement: Two Cases and Literature Review
Abstract
Background: Upper gastrointestinal Crohn's disease (UGI-CD) is rare, with an adult prevalence of 0.5%-4.0%. Its nonspecific symptomatology and the absence of clear diagnostic guidelines pose significant diagnostic challenges.
Case presentation: We present two patients with UGI-CD treated at Hainan General Hospital. In the first case, a 47-month diagnostic delay led to disease progression and surgical intervention. In the second case, prompt diagnosis of a duodenal ulcer enabled medical management, avoiding surgery. Both patients received infliximab and achieved remission.
Conclusion: These cases highlight diagnostic challenges in UGI-CD and offer three key lessons: (i) UGI-CD should be suspected in refractory, Helicobacter pylori-negative duodenal ulcers; (ii) an endoscopic-radiologic mismatch may occur; and (iii) we propose a diagnostic algorithm to assist early recognition, though it has not been prospectively validated. Given the descriptive nature of this two-case series, these findings are hypothesis-generating and require further validation.
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Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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