Differential diagnosis of diseases of the upper gastrointestinal tract (GIT) often is concentrated on the problem of distinguishing organic and functional disorders. In case of confirming gastroduodenal (GDP) pathology, especially its destructive forms, exclusion of diseases such as Crohn’s disease and celiac disease is of great importance.

There were two patients who suffered from Crohn’s disease, whose debut was as a chronic GDP, under our supervision during 2007–2011. A clinical case of Crohn’s disease, which initially was diagnosed as duodenal ulcer, is presented below.

A 14 year old girl Maria T. was admitted to the hospital because of pain in epigastrium, nausea and vomiting. One month before the admission the child had been ill with intestinal infection, the pathogen was not identified. There was fever, diarrhea streaked with blood, dehydration. Treatment was effective, but after discharge from the hospital she lost 3–4 kg of weight. On the following admission to the hospital upper GIT endoscopy showed signs of superficial gastritis, duodenitis, duodenal ulcer oblong shape up to 1,2 cm. Biopsy showed signs of chronic inflammation of the 2nd degree of activity and infiltration of the mucous membrane by lymphoid cells. Helicobacter pylori (Hp) or other microorganisms were not identified. Stool for Hp antigen – test was negative.

Therapy according to the protocol was started. Due to treatment patient’s condition improved: pain and dyspeptic syndromes were reduced, while appeared unstable bowel movements. Coprology: stool contains great amount of mucus, white blood cells, positive test for occult blood. Control upper GIT endoscopy showed duodenal ulcer defect, however, somewhat smaller. Leukocytosis was increased, neutrophilia, anemia, increased ESR up to 23 mm/hr. Low-grade fever. Crohn’s disease was suspected. Colonoscopy showed signs of terminal ileitis with multiple ulcers with a diameter of 0,1–0,2 cm. Morphological examination indicated marked lymphoid infiltration of the lamina propria and submucosa.

Colon without any pathological changes.

Crohn’s disease was diagnosed: a terminal ileitis, duodenitis of the 1st stage (early manifestation). Activity of process according to the PCDAI (Pediatric Crohn’s Disease Activity Index) – 32,5 – between average and high. The following treatment was prescribed: Mesalazine (50 mg/kg), Prednisolone (1,5 mg/kg intravenously), symptomatic therapy (infusion therapy, Smecta), probiotics. The child’s condition gradually improved; activity of process according to the PCDAI decreased up to 10,0 (low). Control upper GIT endoscopy showed scar were duodenal ulcer was found, duodenal pass ability was not impaired. Positive changes in the lab tests – decreasing of leukocytosis, ESR to 12 mm/hr, C-reactive protein to 12 mg/L, slightly increased hemoglobin. The patient was discharged from the hospital, maintenance dose of Mesalazine 15 mg/kg.

Follow-up three years of supervision – no attacks of disease.

Thus, in this case, debut of Crohn’s disease with the clinical symptoms of GDP.

Touch up on the idea of Crohn’s disease could information from anamnesis (“intestinal infection” in the past), weight loss, prolonged increasing of indicators of the activity of inflammatory process. Described above case confirmed the idea of Genta RM et al. (2012) that Hp-negative gastritis or gastroduodenitis often precedes the development of Crohn’s disease in children.

Ключові слова: Crohn’s disease, gastroduodenal pathology in children

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