Frontline Gastroenterol doi:10.1136/flgastro-2012-100126
  • Oesophagus and Stomach
  • Case Report

Aggressive Helicobacter pylori-negative peptic ulceration as the initial manifestation of Crohn's disease

  1. Jonathon Snook1
  1. 1Department of Gastroenterology, Poole Hospital, Poole, UK
  2. 2Department of Elderly Care, Poole Hospital, Poole, UK
  1. Correspondence to Dr Jonathon Snook, Department of Gastroenterology, Poole Hospital, Longfleet Road, Poole BH11 9NG, UK; jonathon.snook{at}
  1. Contributors JS conceived the study, TB and SP identified the cases. JC and SB collected and analysed the data. JC and JS wrote the manuscript with contributions from SP. All authors read and approved the final draft.

  • Received 25 January 2012
  • Accepted 12 March 2012
  • Published Online First 1 May 2012


Peptic ulceration is a recognised feature of Crohn's disease, but the characteristics of this manifestation are rather poorly described. Furthermore, most reports in the literature relate to ulcer disease in cases of established Crohn's disease.

The authors report a series of four cases in which the diagnosis of Crohn's disease was preceded by peptic ulceration. Potential confounding factors were as far as possible excluded, implying a true association. Characteristics of the ulcer disease included (1) a multifocal distribution, (2) Helicobacter pylori negativity and (3) an unusually aggressive clinical course despite proton pump inhibitor therapy, necessitating endoscopic or surgical intervention in three cases.

Crohn's-related peptic ulceration is a relatively common manifestation which may precede the diagnosis of Crohn's disease itself. Recognition of the underlying diagnosis may be hampered by non-specific histology, but is important in view of the aggressive course of the ulceration, which may respond to medical therapy for Crohn's disease.


  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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