TY - JOUR
T1 - Diagnosis and Management of Upper Gastrointestinal Involvement in Adult Patients With Crohn’s Disease
T2 - A Systematic Review
AU - Cohen, Nathaniel A.
AU - Sror, Neta
AU - Naseer, Maliha
AU - Bettenworth, Dominik
AU - Lu, Cathy
AU - Khedraki, Raneem
AU - Abreu, Maria T.
AU - Atreya, Raja
AU - Al-Bawardy, Badr
AU - Connor, Susan J.
AU - d’Haens, Geert
AU - Dotan, Iris
AU - Dignass, Axel
AU - El Ouali, Sara
AU - Feagan, Brian
AU - Feakins, Roger
AU - Gearry, Richard
AU - Gordon, Ilyssa O.
AU - Hedin, Charlotte
AU - Kobayashi, Taku
AU - Leibovitzh, Haim
AU - Maharshak, Nitsan
AU - Ollech, Jacob
AU - Sebastian, Shaji
AU - Siegmund, Britta
AU - Rubin, David T.
AU - Silverberg, Mark S.
AU - Steinwurz, Flavio
AU - Torres, Joana
AU - Watermeyer, Gill
AU - Hernandez-Rocha, Cristian
AU - Gurizzian, Paige
AU - Silfen, Alexa
AU - Tzadok, Roie
AU - Falloon, Katherine
AU - Rieder, Florian
N1 - Publisher Copyright:
© 2026 AGA Institute.
PY - 2026/4
Y1 - 2026/4
N2 - Background & Aims The diagnosis and management of ileocolonic Crohn’s disease are well-established. In contrast, standardized guidance pertaining to the diagnosis and management of upper gastrointestinal Crohn’s disease (UGICD) is lacking, despite its potentially severe consequences. This comprehensive systematic review describes the prevalence, clinical presentation, and medical and surgical management of involvement of the upper GI tract in adult patients with Crohn’s disease. Methods A systematic review of available literature was conducted using the search engines Medline, Cochrane, and Embase, with pre-defined search algorithms. Studies published from 1947 to July 2024 were considered. The review included papers describing both clinical characteristics and the effectiveness of medical and interventional procedures in patients with UGICD. All included papers underwent quality appraisal using the Joanna Briggs Institute checklist. Results Following screening and full-text review, 47 articles were eligible. The median prevalence of UGICD was found to be 8.7% (interquartile range, 4.74%–24.36%). Over one-third of patients with UGICD are asymptomatic, and abdominal pain was the most frequently reported symptom in symptomatic patients (41%; range, 5%–93%). Endoscopy is the most used diagnostic tool (96%), with the duodenum being the most common disease location (69%). Accepted definitions of UGICD within each diagnostic modality have not been devised. Anti-tumor necrosis factor therapy appears to be efficacious for UGICD (overall clinical response, 81%). The current data are limited by the significant heterogeneity in study design and definitions between studies, particularly inconsistency in diagnosis and outcome measures used. Conclusions We highlight the need for the development of standardized guidance in both diagnosing and managing UGICD. This work serves as preparation for an international consensus on the management of UGICD.
AB - Background & Aims The diagnosis and management of ileocolonic Crohn’s disease are well-established. In contrast, standardized guidance pertaining to the diagnosis and management of upper gastrointestinal Crohn’s disease (UGICD) is lacking, despite its potentially severe consequences. This comprehensive systematic review describes the prevalence, clinical presentation, and medical and surgical management of involvement of the upper GI tract in adult patients with Crohn’s disease. Methods A systematic review of available literature was conducted using the search engines Medline, Cochrane, and Embase, with pre-defined search algorithms. Studies published from 1947 to July 2024 were considered. The review included papers describing both clinical characteristics and the effectiveness of medical and interventional procedures in patients with UGICD. All included papers underwent quality appraisal using the Joanna Briggs Institute checklist. Results Following screening and full-text review, 47 articles were eligible. The median prevalence of UGICD was found to be 8.7% (interquartile range, 4.74%–24.36%). Over one-third of patients with UGICD are asymptomatic, and abdominal pain was the most frequently reported symptom in symptomatic patients (41%; range, 5%–93%). Endoscopy is the most used diagnostic tool (96%), with the duodenum being the most common disease location (69%). Accepted definitions of UGICD within each diagnostic modality have not been devised. Anti-tumor necrosis factor therapy appears to be efficacious for UGICD (overall clinical response, 81%). The current data are limited by the significant heterogeneity in study design and definitions between studies, particularly inconsistency in diagnosis and outcome measures used. Conclusions We highlight the need for the development of standardized guidance in both diagnosing and managing UGICD. This work serves as preparation for an international consensus on the management of UGICD.
KW - Crohn’s disease
KW - Duodenum
KW - Esophagus
KW - Stomach
KW - Stricture
UR - https://www.scopus.com/pages/publications/105010332085
U2 - 10.1016/j.cgh.2025.03.024
DO - 10.1016/j.cgh.2025.03.024
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C2 - 40378982
AN - SCOPUS:105010332085
SN - 1542-3565
VL - 24
SP - 932
EP - 948
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 4
ER -