S3244 Interesting Presentation of Ulcerative Gastroduodenal Lesion in Ulcerative Colitis

Introduction: Ulcerative colitis (UC) is a chronic, relapsing inflammatory bowel disease that is primarily found in the colo-rectal portion of the GI tract. There have been multiple described case reports of patients with UC with complications in the upper GI tract including esophagus, stomach, and duodenum with mucosal injuries. Given the rarity of these issues, limited endoscopic and microscopic characterizations of these lesions have been established at this time. Also, no standard guideline or criteria for the assessment or surveillance of these lesions is noted at this time. Case Description/Methods: A 69-year-old African American man with a history of UC complicated by a subtotal colectomy and completion proctectomy followed by an IPAA presented from home with nausea, vomiting, and inability to tolerate oral intake for 5 days. The patient denied abdominal pain, changes in bowel habits, fever, chills, hematemesis, or melena. Three months prior, the patient was admitted to the hospital with nausea, vomiting, and coffee-ground emesis. On upper endoscopy during hospitalization, the patient was found to have severe LA grade D esophagitis from 27 to 42 cm, gastritis, stenosis at the pylorus with a pinpoint opening that was traversed after changing to a pediatric endoscope, a large ulcer in the duodenal bulb with no active bleeding. Patient was started on PPI therapy and eventually discharged from the hospital after tolerating PO intake. Patient subsequently presented 6 months later with similar symptoms. Patient was found to have a CT scan which demonstrated at the stomach is markedly distended with narrowing at the gastroduodenal junction which demonstrates mural thickening and evidence of mucosal ulceration, with surrounding edema. Patient was taken to the OR for an open gastrojejunostomy and the patient had an uncomplicated post-operative course (Figure 1). Discussion: Ulcerative colitis-related upper GI manifestations are diverse and typically overshadowed by the manifestations of the lower gastrointestinal tract. In addition, the endoscopic and microscopic characteristics of UGI tract complicated with UC are typically unspecified. However, it is very important to identify UC-associated UGI tract diseases. The lesions could be improved after UC treatment and the pathological examination is similar to the UC. Nevertheless, the diagnostic criteria are not rigorous enough because of the rare reports.Figure 1.: A. Upper Endoscopy Images of Duodenal Bulb with Ulceration B. CT Imaging of Dilated Stomach Due to Duodenal Bulb Ulceration.