Diaphragm disease and stricturing Crohn’s disease: a clinicopathological study of overlapping and distinguishing features

Diaphragm disease is an uncommon stricturing disease of the small bowel associated with non-steroidal anti-inflammatory (NSAID) use. First described by Lang et al, it was characterised macroscopically by localised ‘diaphragm’-like strictures which contain submucosal fibrosis histologically.1 The condition most commonly presents as iron deficiency anaemia or small bowel obstruction and can cause significant morbidity for these patients.2 3 Given the non-specific clinical presentation, the condition is challenging to diagnose without histopathological analysis.4 5 Given the increased usage of NSAIDs and the recognition of other less specific forms of NSAID-induced small bowel injury, it is likely that diaphragm disease is significantly underdiagnosed.6–8