Case Study Sheds Light on Rare and Challenging Presentation of Crohn’s Disease
Isolated upper gastrointestinal (GI) Crohn’s disease, a rare and diagnostically elusive condition, presented life-threatening complications in a 47-year-old patient, according to an abstract presented at Advances in Inflammatory Bowel Diseases annual meeting.
The report, which highlights the challenges of managing this condition, also introduces risankizumab as a potentially effective treatment for refractory cases.
The patient presented with recurrent bleeding ulcers in the proximal small bowel, causing symptomatic anemia and repeated hospitalizations. Initial investigations, including upper endoscopy, colonoscopy, capsule endoscopy, and advanced imaging, failed to provide a definitive diagnosis. Despite a partial small bowel resection, the disease recurred rapidly, with severe bleeding and elevated fecal calprotectin levels pointing to ongoing inflammation.
A presumptive diagnosis of isolated small bowel Crohn’s disease was eventually made, and the patient was started on budesonide. However, anti-tumor necrosis factor (TNF) therapy with infliximab proved ineffective, leading to the initiation of risankizumab. The patient has been in clinical remission for 10 months since initiating risankizumab, with significant improvement in jejunal ulceration.
“Isolated upper GI Crohn’s disease presents unique diagnostic and management challenges due to its heterogeneous presentation and refractory nature,” the authors noted. They emphasized the limited data on therapeutic options beyond anti-TNF agents and highlighted the success of risankizumab as a potential breakthrough in treatment.
While nausea, vomiting, and weight loss are more common symptoms of this form of Crohn’s disease, this patient’s life-threatening bleeding underscores the variability in presentation. The findings provide anecdotal support for risankizumab in managing similar challenging cases, marking a step forward in understanding and treating this rare condition.
Reference:
Murone JN, Clarke K, Panganiban R. Recurrent hemorrhagic enteritis: a challenging case of presumed proximal small bowel crohn’s disease. Presented at: Advances in Inflammatory Bowel Disease annual meeting; December 9-11, 2024. Orlando, Florida.
