Crohn's Disease Consisting Solely of Aphthoid Ulcers at the Time of First Visit: —Clinical Features and Course—

Abstract: It is generally considered that early lesions detected macroscopically in Crohn's disease are aphthoid ulcers. The lesions are usually found close to more advanced lesions and sometimes observed in the distal colon. However, there are a few patients who have almost only aphthoid ulcers without any typical major lesions through the alimentary tract. We studied 5 such cases (4 men and 1 woman, 15–31 years old) out of 107 patients who had not undergone any surgery at the time of their first visit. Four patients had aphthoid ulcers in both the small and large intestine as well as some lesions (ulcer, erosion and redness) in the gastroduodenal region. The remaining case had some lesions only in the large intestine. Non‐caseating epitheloid cell granulomas were detected in the biopsy specimens obtained from the aphthoid ulcers of the colon in 4 cases. These cases with granulomas were considered to suffer from Crohn's disease and were treated with an elemental diet. Aphthoid ulcers showed a remarkable improvement but relapse followed the beginning of an oral diet. In 3 cases, the lesions in the small intestine developed into longitudinal ulcers 18, 27 and 37 months after the first visit, respectively. Although a female patient in whom granulomas could not be proven was not diagnosed as having Crohn's disease, she had bloody stool again 17 months later, and a barium enema revealed a cobblestone appearance in the colon so that she was diagnosed as having Crohn's disease. Consequently, aphthoid ulcers developed into longitudinal ulcers or cobblestoning, with repeated disappearance and reappearance during the follow‐up period in 4 of the 5 cases. Almost only aphthoid ulcers with granulomas in non‐operated cases are considered to be in the earliest stage of what can be diagnosed as being Crohn's disease.