BACKGROUND: Esophageal Crohn's disease is reported as a rare manifestation, 
although its prevalence may be underestimated because upper endoscopies are not 
routinely performed in asymptomatic adults. Tofacitinib, an oral janus kinase 
inhibitor, is a new biologic that has shown promise in the treatment of 
ulcerative colitis and may be effective in the treatment of Crohn's disease 
according to phase 2 trials. We report the first case of esophageal Crohn's 
disease successfully treated with tofacitinib in a patient with worsening 
symptoms despite maintenance therapy with a tumor necrosis factor-α inhibitor.
CASE PRESENTATION: A 67-year-old Caucasian woman presented with new dysphagia 
and had findings of esophageal Crohn's disease on endoscopy. The dosage of her 
current biologic therapy-adalimumab-was increased in frequency, without 
improvement. Our patient was started on tofacitinib and demonstrated an 
improvement in symptoms, with a repeat endoscopy showing resolution of the 
previous lesions.
CONCLUSION: Esophageal Crohn's disease is likely underdiagnosed but is an 
important consideration in a patient with new symptoms of dysphagia and known 
Crohn's disease. Tofacitinib, while a novel agent, could have a role in the 
treatment of esophageal Crohn's disease that does not improve with 
intensification of the current biologic therapy. It provides a different 
mechanism in patients who become refractory to maintenance therapy.