Abstract Background The involvement of upper gastrointestinal tract in adult Crohn’s (UGI-CD) patients has been inadequately studied. The rising incidence of inflammatory bowel disease (IBD) and the wide application of esophagogastroduodenoscopy with high-quality endoscopes, may contribute to an increased recognition of upper GI inflammation1. Aim of the study was to evaluate the incidence and characteristics of UGI-CD in adult patients. Methods Retrospective data from patients’ medical records, between 2014-2025, were prospectively obtained. Demographic, clinical, endoscopic, histological features, as well as disease and treatment characteristics were analyzed. Results Among 3867 Crohn’s patients from 9 tertiary centers, 217 (5. 13%) were diagnosed with upper GI disease. Mean age was 37. 8±14. 9 (range 17-84) ; 122 (56. 2%) were males, 65 (30%) were active and 46 (21. 2%) X-smokers. Median disease duration at UGI diagnosis, was 8 years (range 1-36) IQR: 8. Mean BMI was 24. 8 ±4. 44 (range 17-40). Disease location: ileocolonic 118 (54. 4%), ileal 83 (38. 2%), colonic 16 (7. 4%). Disease behavior: inflammatory 173 (79. 7%), stricturing 26 (10. 6%), penetrating 21 (9. 7%), whereas 56 (25. 8%) patients presented extraintestinal manifestations. At the time of UGI-CD diagnosis, mean ΕΖ1 Harvey-Bradshaw score was 1. 94 ±3. 15 (range 0-15), mean SES-CD 3. 83±5. 56 (range 0-26), median CRP 3 (range 1-50) IQR: 7 and median calprotectin 137 (range 13-4348) IQR: 272. Endoscopic lesions in the stomach, duodenum and esophagus were recorded in 164 (75. 8%), 91 (42. 2%) and 29 (13. 7%) patients, whereas histologic abnormalities were found in 178 (82. 2%), 85 (39. 5%) and 28 (13. 1%) patients, respectively. 164 (75. 5%) patients were treated with biologics: adalimumab 84 (38. 7%), infliximab 80 (36. 9%), ustekinumab 39 (17. 9%), vedolizumab 14 (6. 5%) and upadacitinib 9 (4. 1%). IBD-related surgery was reported by 27 (12. 4%) patients and at least one hospitalization by 54 (24. 9%). Standard dose of proton pump inhibitors (PPIs) was offered in 89 (41. 1%) patients and high dose in 29 (13. 8%) patients. Univariate analysis showed that esophageal lesions were associated with younger age (p = 0. 018) and with exposure to multiple biologic treatments (p = 0. 027). ΕΖ1 Conclusion 1. The frequency of UGI-CD in our study was 5. 13%, which is consistent with other reports. 2. The majority had inflammatory ileocolonic disease with moderate activity. One fourth had been hospitalized at least once. 3. In most cases the lesions were found in the stomach and duodenum. 4. Over half of the patients were treated with PPIs and biologics. 5. Esophageal involvement may be associated with refractory disease. Reference: 1. Kővári B, Pai RK. Upper Gastrointestinal Tract Involvement in Inflammatory Bowel Diseases: Histologic Clues and Pitfalls. Adv Anat Pathol. 2022 Jan 1;29 (1): 2-14. Conflict of interest: Dr. Ioannou, Alexandros: No conflict of interest Pardalis, Pavlos: no conflicts Leonidakis, George: No conflict of interest Argyriou, Konstantinos: No conflict of interest Deligianni, Eirini: No conflict of interest Dimopoulou, Konstantina: No conflict of interest Giouleme, Olga: No conflict of interest Kalakos, Nikolaos: I have no conflicts of interest to declare Kapsoritakis, Andreas: No conflict of interest Kyriakos, Nikolaos: No conflict of interest Liatsos, Christos: No Michalopoulos, George: speaker fees TAKEDA, ABBVIE, MSD, GALENICA, ENORASIS, AMGEM PFEIZER Mousourakis, Konstantinos: No conflicts Pagoni, Anna: No conflict of interest Skouloudi, Chara: No conflict of interest Theodoropoulou, Angeliki: No conflict of interest Trimponias, Georgios Dimitrios: No conflict of interest Tzouvala, Maria: No conflict of interest Varka, Alexandra: No conflict of interest Viazis, Nikolaos: No conflict of interest Zacharopoulou, Eirini: No conflict of interest Michopoulos, Spyridon: No conflict of interest Zampeli, Evanthia: I have received honor-aria and speaker fees from Abbvie, Janssen, Pfizer, Takeda, MSD, AMGEN, Genesis, Ferring, Mylan, BMS, Galenica
Ioannou et al. (Thu,) studied this question.