Isolated severe gastropathy--an unusual presentation of Crohn's disease in a child.

Crohn’s disease may involve any part of the gastrointestinal tract, but isolated involvement of the stomach is rare [1]. In common presentations, the diagnosis of Crohn’s disease is usually based on a combination of typical clinical, laboratory, endoscopic and pathological findings. However, the diagnosis is difficult to establish in cases of atypical presentation as in isolated gastroduodenal disease. In such a scenario other possible etiologies must be systematically ruled out in order to establish the diagnosis. These may include Helicobacter pylori infection, tuberculosis, non-steroidal anti-inflammatory drugs, eosinophilic gastritis, Menetrier’s disease, gastrinoma, collagen vascular disease, and lymphoma. Additional diagnostic strategy in atypical cases of inflammatory bowel disease is the use of anti-Saccharomyces cervisia antibody. This serological marker can be a helpful adjunctive tool in the diagnostic process despite the test’s limitations. Treatment regimens for gastric Crohn’s disease have been poorly studied. The routine treatment of inflammatory gastritis in Crohn’s disease includes the concomitant use of acid-suppressive drugs and immunomodulators such as ASA products, or steroids. In recent years infliximab (anti-tumor necrosis factor-alpha) has become an important addition to the therapeutic options in Crohn’s disease. The effectiveness of infliximab in isolated gastric Crohn’s disease is limited to only a few case reports of adult patients and the long-term outcome is unknown [2,3]. We present a child with isolated gastric Crohn’s disease and discuss the diagnostic