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<p>Ulcerative colitis is a chronic inflammatory bowel disease usually confined to the colon and rectum. Although extraintestinal manifestations are common, ulcerative colitis-like lesions of the upper gastrointestinal tract, referred to as gastroduodenal ulcerative colitis, are rare and typically observed in patients with pancolitis or after total proctocolectomy. We report a 43-year-old woman with steroid-dependent pancolitis-type ulcerative colitis who developed recurrent duodenal lesions without prior total proctocolectomy. She subsequently presented with nausea and epigastric pain; endoscopy showed circumferential duodenal erosions resembling colonic ulcerative colitis lesions. Histology showed dense neutrophilic infiltration and crypt abscesses. A diagnosis of gastroduodenal ulcerative colitis was made on the basis of these findings. Treatment with the Janus kinase inhibitor upadacitinib at 45&#xa0;mg/day resulted in rapid clinical improvement and mucosal healing. This dose was tapered to 15&#xa0;mg/day, and she has since remained in sustained clinical and endoscopic remission for &gt; 1 year. To our knowledge, this is the first report of upadacitinib being effective for gastroduodenal ulcerative colitis in a patient without total proctocolectomy. This case highlights the potential of Janus kinase inhibitors as a therapeutic option for gastroduodenal ulcerative colitis, particularly in patients with refractory disease who have an inadequate response to biological therapies.</p>

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Diffuse duodenitis in a patient with ulcerative colitis who was successfully treated with upadacitinib

  • 期刊论文

  • 发表日期：

    2026年3月9日

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  • Ryosuke Murata,
  • Yoshiki Okita,
  • Shunsuke Urayoshi,
  • Yusuke Yoshikane,
  • Yuriko Uomi,
  • Misaki Nakamura,
  • Yuhei Umeda,
  • Mikio Kawamura,
  • Yuji Toiyama,
  • Hayato Nakagawa

摘要

Ulcerative colitis is a chronic inflammatory bowel disease usually confined to the colon and rectum. Although extraintestinal manifestations are common, ulcerative colitis-like lesions of the upper gastrointestinal tract, referred to as gastroduodenal ulcerative colitis, are rare and typically observed in patients with pancolitis or after total proctocolectomy. We report a 43-year-old woman with steroid-dependent pancolitis-type ulcerative colitis who developed recurrent duodenal lesions without prior total proctocolectomy. She subsequently presented with nausea and epigastric pain; endoscopy showed circumferential duodenal erosions resembling colonic ulcerative colitis lesions. Histology showed dense neutrophilic infiltration and crypt abscesses. A diagnosis of gastroduodenal ulcerative colitis was made on the basis of these findings. Treatment with the Janus kinase inhibitor upadacitinib at 45 mg/day resulted in rapid clinical improvement and mucosal healing. This dose was tapered to 15 mg/day, and she has since remained in sustained clinical and endoscopic remission for > 1 year. To our knowledge, this is the first report of upadacitinib being effective for gastroduodenal ulcerative colitis in a patient without total proctocolectomy. This case highlights the potential of Janus kinase inhibitors as a therapeutic option for gastroduodenal ulcerative colitis, particularly in patients with refractory disease who have an inadequate response to biological therapies.