Stenosing Crohn’s disease of the upper gastrointestinal tract: a diagnostic challenge

Crohn’s disease (CD) with isolated lesions of the upper gastrointestinal tract occurs in less than 5% of patients. In most cases, the complication of this form of the disease is gastroduodenal obstruction, which requires surgical intervention. Aim: to describe a clinical case of CD with an atypical onset mimicking Helicobacter pylori-associated gastric ulcer. Materials and methods. A clinical case of CD simulating gastric ulcer in a 12-year girl is presented. A comprehensive laboratory and instrumental examination of the patient was performed. The diagnosis was made: CD A1b of the upper gastrointestinal tract, ileitis, colitis (L3+L4a), stricturating form (B2) with perianal changes (p), without growth retardation (G0). Results. Taking into account the severe course and stenosing form of CD, severe protein and energy deficiency, to prevent complications, the patient initiated biological therapy with infliximab at the rate of 5 mg/kg, administration in the standard regimen in combination with azathioprine 50 mg/day (1.5 mg/kg/day). Against the background of the treatment and dietary correction, there was a positive trend in the form of relief of vomiting and weight gain (during the hospital stay, the patient gained 4 kg in weight). Conclusion. The use of a multidisciplinary approach made it possible to establish the diagnosis of the stenosing form of CD with a predominant involvement of the upper digestive tract. Biological therapy using infliximab in combination with both azathioprine and diet therapy made it possible to avoid surgical intervention.