Severe isolated Crohn's-like disease of the gastroduodenal tract.

We report four cases of isolated GCD of the stomach and proximal small intestine that were refractory to conventional management. Gastric ulcers were present in patients 1-3 for 4, 13, and 22 years and erosive gastritis in patient 4 was present for at least 2 years. High-dose proton pump inhibition and H. pylori eradication failed to induce healing. Neither ileocolonic lesions nor typical CD pathology with granulomas were detected in any of the patients, but all behaved clinically like CD. The three patients with gastric ulcers failed initial partial gastrectomy and required multiple reoperations because of duodenojejunal ulceration and anastomotic stricture formation. Patient 1 did not improve with infliximab. Patient 2 healed on steroids and infliximab. Patient 3 did not tolerate sulfasalazine and steroids and is currently being treated with 6-mercaptopurine (6-MP). Patient 4 healed on prednisone and 6-MP. We conclude that GCD should be considered in isolated refractory gastroduodenal inflammation and ulceration. Immunomodulators and surgery may play a role in the treatment of this difficult-to-manage condition.