Upper GI Crohn’s Disease Remains Underrecognized, Lacks Standardized Guidance
Upper gastrointestinal Crohn’s disease (UGICD) affects a minority of patients but remains poorly defined and inconsistently managed, according to a comprehensive systematic review evaluating prevalence, clinical features, and treatment approaches. The findings highlight gaps in diagnosis and underscore the need for standardized guidance.
Investigators reviewed 47 studies published between 1947 and 2024, examining adult patients with Crohn’s disease involving the upper gastrointestinal tract. The median prevalence of UGICD was 8.7%, though estimates varied widely. More than one-third of patients were asymptomatic, suggesting that disease burden may be underrecognized in routine practice.
Among symptomatic patients, abdominal pain was the most commonly reported feature, occurring in 41% of cases. Endoscopy was the primary diagnostic modality, used in 96% of studies, with the duodenum identified as the most frequent site of involvement (69%).
Therapeutically, anti–tumor necrosis factor (TNF) agents demonstrated high efficacy, with an overall clinical response rate of 81%. However, variability in study design and outcome measures limited comparisons across treatment strategies and prevented definitive conclusions regarding optimal management.
The authors emphasized that “accepted definitions of UGICD within each diagnostic modality have not been devised,” and concluded that there is a “need for the development of standardized guidance in both diagnosing and managing UGICD.” They noted that this work “serves as preparation for an international consensus” on the condition.
Reference
Cohen NA, Sror N, Naseer M, et al. Diagnosis and management of upper gastrointestinal involvement in adult patients with Crohn's disease: a systematic review. Clin Gastroenterol Hepatol. 2026;24(4):932-948. doi:10.1016/j.cgh.2025.03.024
