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Crohn's disease, Granulomatous gastritis, Gastric cancer, Prednisolone, Azathioprine
Crohn's disease is usually associated with intestinal disease when it affects the stomach. It is the most common cause of granulomatous gastritis; however, isolated gastric Crohn's disease is an uncommon finding. This is a case report of a 26-year-old woman who presented with intermittent epigastric pain for 2 years and severe weight loss during the course of her illness. Paraclinical investigations ruled out the possibility of malignancy; further investigations revealed a short segment of focal thickening in the gastric antrum. However, small and large bowels were normal on abdominal computed tomography and severe form of hemorrhagic gastritis on upper gastrointestinal endoscopy. Multiple gastric biopsies obtained from the stomach were consistent with the diagnosis of Crohn's disease. Treatment with prednisolone and azathioprine was effective in controlling the patient's symptoms; however, these recurred 3 weeks after she interrupted therapy. Treatment was resumed with the same drugs, and she was symptom-free over the18 months during which she was followed up. This case demonstrates the role of gastric biopsy as an important investigation in establishing the diagnosis of this rare presentation. It also reflects the dramatic response of gastric Crohn's disease to the treatment with prednisolone and azathioprine.