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

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.