Abstract
Background: The diagnosis and management of ileocolonic Crohn's disease (CD) are well established. In contrast, standardized guidance pertaining to the diagnosis and management of upper gastrointestinal CD (UGICD) is lacking, despite its potentially severe consequences.
Objective: 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 CD.
Design: 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 (JBI) 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 (IQR) 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-TNF 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.