Özet:

A 54-year-old woman with long-standing Crohn's disease was admitted to the hospital with abdominal pain and weight loss. The patient underwent surgery because of obstructive syndrome and had undergone a diverting ileostomy 26 months earlier. She had enterocutaneous fistulizing disease. In our case, there were endoscopic lesions, including mucosal edema, focal and diffuse erythema, nodular lesions, erosion, and ulcers in the antrum and corpus with a paving-stone appearance. Upper endoscopy was suspicious for gastric Crohn involvement. Multiple endoscopic biopsies of the stomach showed granuloma and chronic lymphoplasmacytic inflammation. She had been treated with multiple therapies during that time, including azathioprine 75 mg given daily. Infliximab therapy was initiated to control the patient's underlying Crohn's disease. We stopped infliximab treatment because of side effects, which included hypersensitivity reactions, and then started adalimumab, which is an effective and safe treatment for the induction and maintenance of response in gastric and fistulizing Crohn's disease. Crohn’s disease of the stomach is rare. There is always concomitant disease in the small bowel or colon. Endoscopic findings of proximal Crohn's disease resemble those of distal Crohn's disease. Fistulae will develop in approximately one-third of patients with Crohn's disease. The current gold standard of medical treatment to induce and maintain remission for fistulizing Crohn's disease is infliximab. Adalimumab is an effective and safe treatment for the induction and maintenance of response in luminal and perianal fistulizing Crohn's disease.

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