Crohn’s disease with isolated gastric involvement as an example of a rare disease phenotype: a clinical case

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Abstract

Crohn's disease (CD), along with ulcerative colitis, is one of the predominant nosological forms of inflammatory bowel diseases. In CD, any part of the gastrointestinal tract can be affected; however, the process is commonly associated with terminal ileum or colon involvement. CD cases with isolated or mixed involvement of upper gastrointestinal tract (esophagus, stomach, and duodenum) are rare and least studied types of the disease. In isolated stomach involvement, the complaints are non-specific and include epigastric pain, gastric dyspepsia, early satiety, decreased appetite, and nausea. Isolated CD of upper gastrointestinal tract can be diagnosed after comprehensive work-up and always requires a high diagnostic level, including clinical, endoscopic and morphological one. We present a clinical case of CD with isolated stomach involvement in a 62-year-old woman. The diagnosis was confirmed by the histopathological findings of an epithelioid cell granuloma in the gastric antrum. Treatment with systemic corticosteroids reduced the disease clinical activity and improved the histological characteristics of the gastric biopsy sampled obtained by endoscopy. In this clinical case, there were specific macroscopic gastric lesions found at endoscopy in CD patients with upper gastrointestinal tract involvement, which is characterized by thickened longitudinal folding and linear grooves. This type of lesion has been described in the literature as “bamboo joint-like appearance”.

Conclusion: Comprehensive assessment of clinical manifestations, endoscopic and histopathological specific features is crucial for the timely diagnosis and treatment of inflammatory bowel diseases.

About the authors

E. B. Avalueva

North-Western State Medical University named after I.I. Mechnikov;
Diagnostic Center with Clinic

Author for correspondence.
Email: avalueva@mail.ru
ORCID iD: 0000-0001-6011-0998

Elena B. Avalueva – MD, PhD, Professor, Chair of Propaedeutics of Internal Diseases, Gastroenterology and Dietetics named after S.M. Ryss North-Western State Medical University named after I.I. Mechnikov; Gastroenterologist, Department of Therapy and General Physician Practice Diagnostic Center with Clinic

47–24 Piskarevsky prospekt, Saint Petersburg, 195067, 

41 Kirochnaya ul., Saint Petersburg, 191015, 

3 Morskoy prospekt, Saint Petersburg, 197110


Russian Federation

I. G. Bakulin

North-Western State Medical University named after I.I. Mechnikov

Email: fake@neicon.ru
ORCID iD: 0000-0002-6151-2021

Igor G. Bakulin – MD, PhD, Professor, Head of the Chair of Propaedeutics of Internal Diseases, Gastroenterology and Dietetics named after S.M. Ryss

41 Kirochnaya ul., Saint Petersburg, 191015

Russian Federation

S. I. Sitkin

North-Western State Medical University named after I.I. Mechnikov;
State Research Institute of Highly Pure Biopreparations;
Almazov National Medical Research Centre

Email: fake@neicon.ru
ORCID iD: 0000-0003-0331-0963

Stanislav I. Sitkin – Dr. med., PhD, Associate Professor, Chair of Propaedeutics of Internal Diseases, Gastroenterology and Dietetics named after S.M. Ryss North-Western State Medical University named after I.I. Mechnikov; Leading Research Fellow, Laboratory of Microbiology State Research Institute of Highly Pure Biopreparations, Head of Epigenetics and Metagenomics Research Group, Institute of Perinatology and Pediatrics Almazov National Medical Research Centre

41 Kirochnaya ul., Saint Petersburg, 191015, 

7 Pudozhskaya ul., Saint Petersburg, 197110, 

2 Akkuratova ul., Saint Petersburg, 197341

Russian Federation

S. L. Vorobyev

National Center for Clinical Morphological Diagnostics

Email: fake@neicon.ru

Sergey L. Vorobyev – MD, PhD, Director

8/2A–6H Oleko Dundicha ul., Saint Petersburg, 192283

Russian Federation

I. A. Belyakov

National Center for Clinical Morphological Diagnostics

Email: fake@neicon.ru

Il'ya A. Belyakov – MD, Pathologist, Head of Department of Pathology

8/2A–6H Oleko Dundicha ul., Saint Petersburg, 192283

Russian Federation

N. A. Trushnikova

Diagnostic Center with Clinic

Email: fake@neicon.ru

Nina A. Trushnikova – MD, PhD, Head of Department of Endoscopy

3 Morskoy prospekt, Saint Petersburg, 197110

Russian Federation

Yu. S. Karpeeva

Diagnostic Center with Clinic

Email: fake@neicon.ru

Yulia S. Karpeeva – MD, PhD, Physician, Department of Therapy and General Physician Practice

3 Morskoy prospekt, Saint Petersburg, 197110

Russian Federation

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Copyright (c) 2019 Avalueva E.B., Bakulin I.G., Sitkin S.I., Vorobyev S.L., Belyakov I.A., Trushnikova N.A., Karpeeva Y.S.

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