Gastritis and duodenitis with ulcerative colitis in a young adult patient – a distinct diagnosis?

Background: Ulcerative colitis (UC) is a widespread inflammatory bowel disease (IBD) which usually affects the large bowel continuosly beginning from the rectum, reaching at most the terminal ileum. Extraintestinal manifestations are well-known and can affect multiple organ systems due to the systemic character of the disease.

Case: We report the case of a 36-year-old patient with known indeterminate colitis who presented with massive diarrhea and abdominal cramps. At colonoscopy, pancolitis was seen and the diagnosis of ulcerative colitis was made. An upper GI endoscopy revealed signs of gastritis and duodenitis. Histologically, an involvement of the upper GI by ulcerative colitis was stated. The patient was treated with pantoprazole and prednisolone, a therapy with azathioprine was initiated. The patient responded well and could be discharged in good shape.

Discussion: Gastritis and duodenitis with ulcerative colitis (GDUC) is a presentation dealt with relatively seldom in the literature. Reports describe its occurrence in children, and an association with pouchitis. The exact prevalence and clinical significance is unknown as GDUC may be mimicked by bacterial infections in frequently immunocompromised patients with IBD, another phenomenon that needs further systematic investigation. Our case shows, that the upper GI might be affected in the average UC patient as well. In case clinical signs lead to upper endoscopy and GDUC is suspected, a thorough histological and microbiological examination of biopsies may allow distinguishing between infection and manifestations of IBD.