An upper gastrointestinal endoscopy with multiple biopsies was performed in 19 children suspected of Crohn disease (CD) who had also undergone X-ray investigations and colonoscopy with multiple biopsies. Biopsies were performed in pathological and/or normal mucous areas. Upper gastrointestinal endoscopy showed macroscopic changes in 7 children (37%). Histologic examinations of the upper gastrointestinal tract were normal or showed only non specific changes in 12 cases (63%). Histopathologic changes specific for CD were found in 7 cases (37%), while specific histologic changes were identified at the rectal or colic level in 3 of these 7 cases only. Thus, upper gastrointestinal endoscopy with multiple biopsies was most useful for the diagnosis of CD, since it was the only diagnostic means in 4 cases. It should be systematically performed when CD is suspected.