T he inflammatory bowel diseases (IBDs) predominantly affect the colon, ileum, jejunum, perianal area, and the oral cavity. The occurrence of symptomatic macroscopic Crohn's disease (CD) in the in the esophagus, stomach, and duodenum (upper gastrointestinal tract, UGT) has not been systematically explored, but seem to range between 1% and 5% among adults. 1,2 Fig. 1 shows a symptomatic duodenal stricture due to CD in an adolescent girl. In contrast, recent studies, predominantly performed in pediatric IBD patients, have revealed that macro-and microscopic lesions can be frequently identified if looked for systematically, also in patients apparently without UGT symptoms. Figs. 2 and3 show gastric antrum biopsy specimens demonstrating granulomas in a child with CD. Approximately two-thirds of all patients with CD and half of those with ulcerative colitis (UC) have microscopic abnormalities in the UGT, irrespective of the presence of symptoms. [3][4][5] Therefore, routine use of esophagogastroduodenoscopy (EGD) in the initial evaluation of patients suspected of IBD has been suggested. 6 The European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) IBD Working Group recently published guidelines supporting this practice in the pediatric patient ("Every child suspected of IBD should undergo a complete diagnostic program including. . .EGD"). 7 The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the Crohn's and Colitis Foundation of America (CCFA) in a recent joint "clinical report" more cautiously desisted/refrained from a direct recommendation of the routine diagnostic use of EGD, but stressed the need for more research within this area, which they considered to be of importance. 8 Adult gastroenterologists seem to be even more reluctant toward this strategy and although recommended by some ("all newly diagnosed patients with IBD should have at least one EGD. . ."), 9 others reject EGD as a routine part of the initial IBD work-up ("an upper gastrointestinal endoscopy is only indicated in patients with upper gastrointestinal symptoms"). 10 Therefore, this issue continues to be controversial and clinical practice may vary among centers. In the following, I address the "pro's" and "con's" for the routine use of EGD in the diagnostic work-up of presumed IBD patients.