Diagnosis and Management of Upper Gastrointestinal Involvement in Adult Patients With Crohn's Disease: A Systematic Review

Nathaniel A Cohen; Neta Sror; Maliha Naseer; Dominik Bettenworth; Cathy Lu; Raneem Khedraki; Maria T Abreu; Raja Atreya; Badr Al-Bawardy; Susan J Connor; Geert d'Haens; Iris Dotan; Axel Dignass; Sara El Ouali; Brian Feagan; Roger Feakins; Richard Gearry; Ilyssa O Gordon; Charlotte Hedin; Taku Kobayashi; Haim Leibovitzh; Nitsan Maharshak; Jacob Ollech; Shaji Sebastian; Britta Siegmund; David T Rubin; Mark S Silverberg; Flavio Steinwurz; Joana Torres; Gill Watermeyer; Cristian Hernandez-Rocha; Paige Gurizzian; Alexa Silfen; Roie Tzadok; Katherine Falloon; Florian Rieder

doi:10.1016/j.cgh.2025.03.024

Diagnosis and Management of Upper Gastrointestinal Involvement in Adult Patients With Crohn's Disease: A Systematic Review

Clin Gastroenterol Hepatol. 2025 May 14:S1542-3565(25)00416-1. doi: 10.1016/j.cgh.2025.03.024. Online ahead of print.

Authors

Nathaniel A Cohen¹, Neta Sror², Maliha Naseer³, Dominik Bettenworth⁴, Cathy Lu⁵, Raneem Khedraki⁶, Maria T Abreu⁷, Raja Atreya⁸, Badr Al-Bawardy⁹, Susan J Connor¹⁰, Geert d'Haens¹¹, Iris Dotan¹², Axel Dignass¹³, Sara El Ouali¹⁴, Brian Feagan¹⁵, Roger Feakins¹⁶, Richard Gearry¹⁷, Ilyssa O Gordon¹⁸, Charlotte Hedin¹⁹, Taku Kobayashi²⁰, Haim Leibovitzh²¹, Nitsan Maharshak²¹, Jacob Ollech¹², Shaji Sebastian²², Britta Siegmund²³, David T Rubin²⁴, Mark S Silverberg²⁵, Flavio Steinwurz²⁶, Joana Torres²⁷, Gill Watermeyer²⁸, Cristian Hernandez-Rocha²⁹, Paige Gurizzian³⁰, Alexa Silfen³¹, Roie Tzadok²¹, Katherine Falloon³², Florian Rieder³³

Affiliations

¹ IBD Center, Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, affiliated with the Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel. Electronic address: nathanielac@tlvmc.gov.il.
² Department of Internal Medicine B, Tel Aviv Sourasky Medical Center, affiliated with the School of Medicine, Tel Aviv University, Tel Aviv, Israel.
³ Department of Gastroenterology, Hepatology and Nutrition; Digestive Diseases Institute, Cleveland Clinic, Cleveland, Ohio.
⁴ CED Schwerpunktpraxis Münster, Münster, Germany and Medical Faculty, University of Münster, Münster Germany.
⁵ Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada.
⁶ Digestive Disease and Surgery Institute Clinical Research Unit, Cleveland Clinic, Cleveland, Ohio.
⁷ Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida.
⁸ First Department of Medicine, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
⁹ Department of Internal Medicine, Division of Gastroenterology and Hepatology, King Faisal Specialist Hospital, Riyadh, Saudi Arabia; Division of Gastroenterology, Yale School of Medicine, New Haven, Connecticut.
¹⁰ Department of Gastroenterology, Liverpool Hospital, Sydney, New South Wales, Australia; University of New South Wales, Sydney, Australia.
¹¹ Medical Faculty, Amsterdam University Medical Center, Amsterdam, The Netherlands.
¹² Department of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.
¹³ Department of Gastroenterology and Hepatology, Agaplesion Markys Hospital, Frankfurt, Germany.
¹⁴ Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
¹⁵ Department of Medicine, Western University, London, Ontario, Canada.
¹⁶ Department of Cellular Pathology, Royal Free Hospital, London, and University College London, United Kingdom.
¹⁷ Department of Medicine, University of Otago, Christchurch, New Zealand.
¹⁸ Division of Anatomic Pathology, Robert J. Tomsich Department of Pathology and Laboratory Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
¹⁹ Gastroenterology Unit, Deptartment of Gastroenterology, Dermatovenereology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
²⁰ Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Kitasato, Japan.
²¹ IBD Center, Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, affiliated with the Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
²² Gastroenterology and Hepatology, Hull and East Yorkshire Hospitals NHS Trust, Hull, United Kingdom.
²³ Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Gastroenterology, Infectious Diseases and Rheumatology, Berlin, Germany.
²⁴ Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois.
²⁵ Division of Gastroenterology, Department of Medicine, Sinai Health System, Toronto, Ontario, Canada.
²⁶ Unit of Inflammatory Bowel Disease, Hospital Israelita Albert Einstein, São Paulo, Brazil.
²⁷ Division of Gastroenterology, Hospital da Luz and Hospital Beatriz Ângelo, Portugal and Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.
²⁸ Department of Gastroenterology, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
²⁹ Department of Gastroenterology, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.
³⁰ Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
³¹ Massachusetts General Hospital, Boston, Massachusetts.
³² Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
³³ Department of Gastroenterology, Hepatology and Nutrition; Digestive Diseases Institute, Cleveland Clinic, Cleveland, Ohio; Massachusetts General Hospital, Boston, Massachusetts; Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio; Program for Global Translational Inflammatory Bowel Disease, Cleveland Clinic, Cleveland, Ohio.

PMID: 40378982
DOI: 10.1016/j.cgh.2025.03.024

Abstract

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.

Conclusion: 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.

Keywords: Crohn’s disease; Duodenum; Esophagus; Stomach; Stricture.