Upper Gastrointestinal Crohn’s Disease in a Young Nigerian: A Case Report

Abstract

Background: Upper gastrointestinal Crohn's disease (UGI-CD) is a rare manifestation of Crohn's disease (CD), particularly in sub-Saharan Africa, where diagnostic challenges and limited resources contribute to underrecognition. UGI-CD, involving the oesophagus, stomach, and duodenum, often presents with nonspecific symptoms, mimicking other disease conditions. While global data suggest UGI-CD occurs in 0.5%-13% of CD cases, reports from Nigeria remain scarce, highlighting the need for increased documentation to improve diagnostic accuracy and management in resource-limited settings.

Case: We report a 40-year-old Nigerian male farmer who presented with a three-month history of dysphagia, odynophagia, epigastric pain, and significant weight loss, in which multiple differential diagnoses were entertained. Esophagogastroduodenoscopy revealed multiple linear and oval ulcers in the oesophagus, stomach, and duodenum. Histopathology confirmed transmural inflammation, granulomas, and cryptitis, consistent with CD. Colonoscopy was unremarkable. The patient achieved clinical and endoscopic remission after nine months of prednisolone and azathioprine therapy.

Conclusion: This case underscores the diagnostic challenges of UGI-CD in resource-limited settings and emphasises the importance of endoscopic and histopathological evaluation in atypical presentations. Although access to biologics remains a concern, successful management with conventional immunosuppressants, despite their limitations, demonstrates their efficacy in improving clinical outcomes. Increased awareness and improved diagnostic infrastructure are essential for early detection and optimal outcomes in African IBD patients.