Multifocal Crohn’s disease involving the upper gastrointestinal tract: a complex case presentation and management approach

N van der Schyff; GE Chinnery; MA Gyan; JC Maluleke; G Watermeyer

Authors

N van der Schyff University of Cape Town https://orcid.org/0000-0002-7456-4453
GE Chinnery University of Cape Town https://orcid.org/0000-0002-9097-8648
MA Gyan University of Cape Town https://orcid.org/0009-0002-5654-9441
JC Maluleke University of Cape Town https://orcid.org/0000-0001-7017-7424
G Watermeyer University of Cape Town https://orcid.org/0009-0009-4680-2619

Keywords:

multifocal Crohn’s disease, upper gastrointestinal tract

Abstract

A 38-year-old male patient from Mitchell’s Plain, Cape Town presented to the Gastrointestinal (GI) unit at Groote Schuur Hospital with a longstanding history of upper GI symptoms dating back to 2017. He described recurrent episodes of nausea, vomiting, severe abdominal cramps, and post-prandial fullness. The patient reported an inability to tolerate meals, with symptoms typically occurring within 30 minutes of eating. The frequency and intensity of these episodes became progressively worse over time and were associated with anorexia and significant weight loss. Additionally, he experienced chronic, watery, non-bloody diarrhoea, with 6-7 episodes per day, as well as occasional fevers but no night sweats or history of tuberculosis contacts. He denied any history of dysphagia, odynophagia, or previous episodes of GI bleeding.

The patient also had a significant history of smoking, recreational drug use (marijuana), and previous heavy alcohol abuse. He had no family history of inflammatory bowel disease or GI malignancies, and no other comorbid illnesses.

Author Biographies

N van der Schyff, University of Cape Town

Division of Gastroenterology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, South Africa

GE Chinnery, University of Cape Town

Upper Gastrointestinal Surgery Division, Department of Surgery, Groote Schuur Hospital, University of Cape Town, South Africa

MA Gyan, University of Cape Town

Division of Anatomical Pathology, Department of Pathology, University of Cape Town and National Health Laboratory Services, South Africa

JC Maluleke, University of Cape Town