Upper Gastrointestinal Crohnʼs Disease Masquerading as a Polyposis Syndrome

INTRODUCTION Inflammatory Bowel Disease (IBD), characterized by cyclic inflammation and healing, likely results from a complex interplay of genetic predisposition, environmental and psychosocial factors and a dysregulation of gut microbiota. Isolated upper gastrointestinal tract (UGI) CD has not been widely described and has no societal recommendations for diagnosis or management. Standard IBD evaluation including serological testing, imaging and endoscopic evaluation may not be useful in this population as it is most fruitful in patients with a high pre-test probability of CD. Lack of classic and non-specific symptomatology in isolated UGI CD may result in low clinical suspicion and a subsequent diagnostic delay. CASE An 18-year-old male presented with a long standing symptomatic iron-deficiency anemia. He had no significant family history or personal GI complaints. IBD serologies were negative, however fecal calprotectin was positive. Endoscopic evaluation revealed polypoid lesions in the stomach and duodenum and underlying erythema. Initial pathology was inconclusive. Repeat evaluation with endoscopic mucosal resection sampled inflammatory polyps, focal crypt abscesses, chronic inflammation in the lamina propria, glandular epithelial reactive changes and superficial foveolar epithelial regenerative changes. Additionally, there was villous blunting in the small bowel.Figure: Polyposis syndromes that may mimic inflammatory polyposis.DISCUSSION Anemia in a male patient warrants further evaluation and consideration of underlying IBD. A 2014 meta-analysis of the prevalence of anemia in IBD patients cited that up to 27% of all patients with CD had clinically significant anemia. Additionally, considering our patients history of an elevated fecal calprotectin, which has been shown to have a 97% sensitivity for IBD, the overall clinical picture was highly suggestive of underlying IBD, despite negative serology. As true and inflammatory polyps can present with anemia, polyposis syndromes could not initially be excluded, in the setting of our gross endoscopic findings. Syndromic polyposis and inflamed polypoid tissue can grossly appear similar however their histological findings are distinct (Table 1.1). As such, a high index of clinical suspicion should be maintained in young males presenting with unexplained anemia, particularly IDA. A diligent workup including laboraty evaluation, imaging and endoscopy is recommendable to establish pathology and dictate subsequent surveillance as well as management.

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.