Diagnostic Role of Upper Gastrointestinal Endoscopy in Patients with Inflammatory Bowel Disease.

Dear Editor: We have read with interest the article by Dr. Aduful et al1 who retrospectively reviewed the endoscopic work of their unit. The authors report a list of indications for upper gastrointestinal (GI) endoscopy, but they fail to mention anything about the role of upper GI endoscopy in the diagnosis of suspected inflammatory bowel disease. Although there are no official figures concerning the prevalence of Crohn's disease and ulcerative colitis in Ghana, the extrapolated statistics of the US Census Bureau suggest a prevalence of over 38,000 cases of Crohn's disease in Ghana2. The definite role of upper GI endoscopy in the initial diagnostic evaluation of suspected inflammatory bowel disease has also now been advocated [inflammatory bowel disease working group of European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) 2005]. The macroscopic and histological appearances of the upper gastrointestinal tract (for example, the presence of aphthoid ulcers or giant cell granulomas) may confirm the diagnosis of Crohn's disease in as many as 20–25% of cases that would otherwise have been missed3,4. Therefore, it would be interesting to know if the authors consider upper GI endoscopy as part of the initial work-up in all patients with suspected inflammatory bowel disease, particularly those with abdominal pain and endoscopic findings suggesting proximal Crohn's disease [aphthoid erosions, peptic ulcer-like lesions (atypical or linear ulcers), thickening of folds, nodules, erythema and stenosis] 5,6.