Duodenal Crohn’s disease: Case report and systematic review

ARTICLE HIGHLIGHTS

Research background

Inflammatory bowel disease (IBD), comprising Crohn’s disease (CD) and ulcerative colitis, presents a global health challenge affecting millions. While duodenal CD (DCD) manifests throughout the gastrointestinal tract, duodenal DCD specifically involves the initial section of the small intestine. Despite its rarity (0.5%-4% prevalence among Crohn’s patients), DCD poses significant complications, including strictures, fistulas, and varied symptoms. Diagnostic challenges arise from its asymptomatic nature, subtle presentation, and lack of a definitive standard, leading to delayed diagnosis and potential health consequences. The prevalence and incidence of DCD vary globally, with factors contributing to these disparities still unclear. Additionally, the multifaceted impact of DCD on patients’ lives extends beyond physical symptoms, affecting dietary, financial, psychological, and social dimensions, highlighting the need for comprehensive research and awareness to enhance patient support.

Research motivation

This study is motivated by the need to address critical gaps in understanding and managing DCD. The rare yet impactful nature of DCD necessitates a focused exploration of its complications, varied presentations, and their implications on patients’ quality of life. The diagnostic challenges associated with DCD demand attention to improve clinical suspicion, reduce delays in diagnosis, and enhance prognosis. By investigating the multifaceted challenges patients face, including the physical, psychological, and social dimensions, this research seeks to contribute valuable insights for future studies in IBD research. Understanding the significance of dietary modifications and their impact on malnutrition, as well as the complexities of sexual dysfunction in IBD patients, can inform tailored interventions and improve overall patient care.

Research objectives

The primary objectives of this systematic review include reporting a rare case of DCD, elucidating the diagnostic challenges associated with the condition, and exploring its implications on prognosis. The study aims to provide a comprehensive overview of DCD’s clinical manifestations, emphasizing the necessity for timely and accurate diagnosis. Realizing these objectives will contribute to enhancing awareness and support for DCD patients, paving the way for future research addressing critical gaps in understanding the global prevalence, diagnostic standards, and comprehensive management strategies for this rare but impactful facet of IBD.

Research methods

The research employed a rigorous methodology, adhering to the PRISMA 2020 guidelines, ensuring transparency in its systematic review. Utilizing Google, PubMed/MEDLINE, American Journal of Gastroenterology, and the University of South Wales database, a focused search with the term “duodenal Crohn’s disease” emphasized the specificity of investigation. The three-phase study selection involved meticulous screening of titles and abstracts, followed by a thorough examination of full-text articles based on selected abstracts. Eligible studies, comprising observational and retrospective research in healthcare settings, addressed the diagnosis and prognosis of DCD in adults. Exclusion criteria targeted systematic reviews, randomized control trials, editorials, and meta-analyses, along with studies on complications, surgery, treatment, management, and other DCD types. No restrictions on publication timeframe or geographic location were imposed, acknowledging DCD as a global concern. The review recognizes limitations, including potential discrepancies in investigation results impacting definitive DCD confirmation and inherent biases within available data.

Research results

The systematic review identified and scrutinized 9 relevant studies encompassing 44 participants diagnosed with DCD. From an initial pool of 2046 studies, careful screening led to the exclusion of 1022, with 50 full-length papers selected for further analysis. The participant ages ranged from 25 to late 70s, predominantly comprising 30 males and 14 females. Remarkably, Plerhoples et al’s work highlighted a case with persistent symptoms spanning over 25 years, undergoing diverse diagnoses, initially as celiac sprue and later as follicular hyperplasia. Of the 44 participants, 11 had a history of DCD affecting other digestive system parts, occurring 4 to 40 years prior to duodenal involvement. Notably, none of the studies utilized standardized scales, like the Crohn’s Disease Activity Index, to assess DCD severity, indicating a gap in consistent measurement. While shedding light on the clinical aspects of DCD, these findings underscore the need for standardized assessment tools and further exploration of the condition’s long-term impact and diagnostic challenges.

Research conclusions

This study proposes novel insights into the diagnostic approaches for DCD. The research underscores the effectiveness of upper gastrointestinal X-rays, computed tomography, magnetic resonance imaging, endoscopy, and histology in diagnosing DCD. The study critically evaluates the strengths and limitations of each method, highlighting the need for personalized imaging choices. The significance of endoscopic techniques, particularly EGD, is underscored, emphasizing its combination with biopsy for effective DCD diagnosis and acknowledges the evolving diagnostic landscape, considering the influence of biological drugs on serology’s reevaluation in DCD diagnosis.

Research perspectives

The direction of future research should focus on enhancing the diagnostic accuracy and specificity of investigative methods for DCD. Prospective research could delve deeper into histological features, unraveling the significance of granulomas, fibrosis, and villous blunting. Further research should explore emerging strategies beyond conventional approaches, considering anatomical site-specific interventions and the potential role of rapamycin in managing strictures. Overall, future research should aim for a comprehensive understanding of DCD characteristics, encompassing prevalence, complications, therapeutic implications, and histological interpretations. This knowledge is vital for gastroenterologists to accurately diagnose and manage DCD, ultimately improving patient outcomes.