Contributions of endoscopy in upper Gastrointestinal Crohn's Disease

Upper gastrointestinal involvement in Crohn’s disease is uncommon and frequently asymptomatic, yet it represents a marker of disease severity. In this retrospective study of 296 patients followed at Ibn Sina University Hospital between 2017 and 2022, 18 patients (6%) had confirmed upper GI involvement. The mean age was 33.8 years, with a male-to-female ratio of 1.57. Half of the patients were asymptomatic (50%, n = 9). The inflammatory phenotype predominated in nine patients (60%, n = 9), while structuring and mixed structuring-fistulizing forms were observed in six patients (40%, n = 6). Duodenal involvement was most frequent (44.4%, n = 8), followed by jejunal (16.6%, n = 3), duodenojejunal (11.1%, n = 2), gastric (11.1%, n = 2), esophageal (11.1%, n = 2), and bunco-esophageal (5.5%, n = 1) locations. Endoscopic abnormalities were present in 11 patients (61.2%, n = 11), and biopsies confirmed disease even in two patients (20%, n = 2) with normal endoscopy. These results highlight the importance of systematic upper GI endoscopy with biopsies for early detection, risk stratification, and guiding therapeutic decisions in Crohn’s disease.