To the Editor.–The recent article by Dr Tootla et al in the August archives (111:855, 1976) concerning gastroduodenal Crohn disease was received with much interest. I am writing to you to report a case that I observed, while an intern, of this same rare condition.
A 27-year-old woman was admitted to a local hospital with severe epigastric pain, nausea, vomiting, and watery stools. She had a history of small bowel Crohn disease, which had been quiescent for two years prior to admission. She had responded to medical therapy previously. She was taking no medication, although in the past she had been treated with corticosteroids and azathioprine (Imuran).
Barium studies were consistent with the "ram's horn" sign1 and suggestive of gastroduodenal Crohn disease. Panendoscopy revealed a cobblestone mucosa,2 which also had been reported as suggestive of gastric Crohn disease. Biopsy findings were similar to those reported by Dr