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Sample records for aktiv morbus crohn

  1. Spondylodiscitis with presacral abscess formation due to fistulisation in a patient with Crohn's disease in the small intestine; Spondylodiszitis mit praesakraler Abszedierung durch Fistelung bei Morbus Crohn des Duenndarmes

    Energy Technology Data Exchange (ETDEWEB)

    Zajac, M.; Engelhard, K. [Krankenhaus Martha-Maria, Nuernberg (Germany). Abt. fuer Diagnostische Radiologie; Schuhmann, R. [Krankenhaus Martha-Maria, Nuernberg (Germany). Chirurgische Klinik

    2000-07-01

    The double contrast examination according to Sellink continues to play a significant role for the detection of Crohn's disease in the small intestine. For detection of accompanying complications, such as fistulisation or abscess formation, CT and MRI perform better than the double contrast examination. Sometimes, however, supplementing examinations may lead to wrong conclusions, as is shown with the case reported. (orig./CB) [German] Die Duenndarm-Doppelkontrastuntersuchung nach Sellink hat weiterhin einen hohen Stellenwert bei der Abklaerung eines Duenndarmbefalles bei Morbus Crohn. Bei der Erkennung von begleitenden Komplikationen wie Fistelbildungen und Abszessen sind die Computertomographie und die Kernspintomographie der Duenndarmdoppelkontrastuntersuchung ueberlegen. Gelegentlich koennen jedoch ergaenzende Untersuchungen zu einer irrefuehrenden Diagnostik fuehren, wie der vorliegende Fall aufzeigt. (orig.)

  2. MRI in Crohns disease after transduodenal contrast administration using negative oral MRI constrast media; MRT-Diagnostik des Morbus Crohn nach transduodenaler Fuellung mit negativem oralem MR-Kontrastmittel

    Energy Technology Data Exchange (ETDEWEB)

    Holzknecht, N.; Helmberger, T.; Herrmann, K.; Reiser, M. [Institut fuer Klinische Radiologie, Ludwig-Maximilians-Universitaet Muenchen (Germany); Ochsenkuehn, T.; Goeke, B. [Medizinische Klinik II, Ludwig-Maximilians-Universitaet Muenchen (Germany)

    2003-01-01

    To compare the efficacy and quality of conventional and MR enteroclysis with different filling methods regarding the assessment of extension and extraluminal manifestations in Crohn's disease.Material and Methods 190 patients with known Crohn's disease were studied following small bowel enteroclysis, after oral administration or direct transduodenal filling in the MRI-department.T1- and T2-weighted breathhold MRI-scans w/o spectral fat suppression w/o i.v.Gd-DTPA were applied using negative oral superparamagnetic contrast media. Typical findings were marked bowel wall thickening with laminated wall contrast enhancement.In 135 patients 98,2% of affected bowel segments, 97,5% of stenoses and all 16 fistulas were detected,when conventional enteroclysis was employed as standard of reference.Additional important extraluminal findings such as ileoileal (n = 18), ileosigmoidal adhesions (n = 12), extraluminal abscesses (n = 35) and pseudotumors (n = 8) were visualized in 73/135 patients. Concerning the distension of jejunum and ileum, oral filling was rated significantly inferior to transduodenal filling in all small bowel segments,whereas filling in the MRI-unit was rated superior to fluoroscopic, mostly due to a mean transport time of 20 min to the MRI-unit. No clinically important findings of enteroclysis were missed when using MRI. Therefore, in patients with Crohn's disease, conventional enteroclysis can be replaced by MRI.For optimal bowel distension oral contrast administration is inferior to transduodenal filling, if a larger time delay between filling and the MRI-scan can be avoided. (orig.) [German] Zielsetzung Vergleich der diagnostischen Effizienz und Qualitaet von konventionellem und MRT-Enteroklysma mit unterschiedlichen Fuellungsmethoden und negativem oralem KM bzgl.Ausdehnung und relevanter Zusatzinformationen bei Morbus Crohn.Material und Methoden 190 Patienten mit bekanntem Morbus Crohn wurden teils nach Enteroklysma, oraler KM-Gabe, oder

  3. Udredning og behandling af morbus Osler

    DEFF Research Database (Denmark)

    Kjeldsen, Anette Drøhse; Andersen, Poul Erik; Tørring, Pernille Mathiesen

    2011-01-01

    Morbus Osler or hereditary haemorrhagic telangiectasia (HHT) is a genetic disorder resulting in development of arteriovenous malformations in the mucosa and in visceral organs. The most common symptom is epistaxis. The disease may, however, cause a variety of other serious manifestations such as ......Morbus Osler or hereditary haemorrhagic telangiectasia (HHT) is a genetic disorder resulting in development of arteriovenous malformations in the mucosa and in visceral organs. The most common symptom is epistaxis. The disease may, however, cause a variety of other serious manifestations...

  4. Fra aktivering til beskæftigelse

    DEFF Research Database (Denmark)

    Pico Geerdsen, Peter; Pico Geerdsen, Lars

    Med arbejdsmarkedsreformen i 1994 har aktivering fået en fremtrædende rolle i dagpengesystemet. Den rolle er blevet forstærket i de efterfølgende reformer. I 1994 kunne man være ledig og modtage dagpenge i op til fire år uden at deltage i aktivering. Den periode er nu sat ned til ét år. Denne...... rapport ser på, hvad der karakteriserer dagpengemodtagere i aktivering og på overgangen fra aktivering til beskæftigelse. Rapporten fokuserer blandt andet på de aktiveredes lønniveau og valg af branche efter endt aktivering. Rapporten, som er finansieret af Beskæftigelsesministeriet og Socialministeriet...

  5. Osler's disease; Morbus Osler

    Energy Technology Data Exchange (ETDEWEB)

    Ahlhelm, F.; Mueller, U. [Kantonsspital Baden AG, Institut fuer Radiologie, Baden (Switzerland); Lieb, J. [Universitaetsspital Basel, Klinik fuer Radiologie und Nuklearmedizin, Basel (Switzerland); Schneider, G. [Universitaetskliniken des Saarlandes, Klinik fuer Diagnostische und Interventionelle Radiologie, Homburg/Saar (Germany); Ulmer, S. [Medizinisch-Radiologisches Institut, Zuerich (Switzerland)

    2013-12-15

    Osler's disease, also known as hereditary hemorrhagic telangiectasia (HHT) and Osler-Weber-Rendu syndrome, is an autosomal dominant disorder leading to abnormal blood vessel formation in the skin, mucous membranes and often in organs, such as the lungs, liver and brain (arteriovenous malformations AVM). Various types are known. Patients may present with epistaxis. Teleangiectasia can be identified by visual inspection during physical examination of the skin or oral cavity or by endoscopy. Diagnosis is made after clinical examination and genetic testing based on the Curacao criteria. Modern imaging modalities, such as computed tomography (CT) or magnetic resonance imaging (MRI) have become more important as they can depict the AVMs. Pulmonary AVMs can be depicted in CT imaging even without the use of a contrast agent while other locations including the central nervous system (CNS) usually require administration of contrast agents. Knowledge of possible clinical manifestations in various organs, possible complications and typical radiological presentation is mandatory to enable adequate therapy of these patients. Interventional procedures are becoming increasingly more important in the treatment of HHT patients. (orig.) [German] Der Mobus Osler (Synonyme: hereditaere haemorrhagische Teleangiektasie [HHT], Morbus Rendu-Osler-Weber) ist eine Multisystemerkrankung und gehoert zur Gruppe der vaskulaeren haemorrhagischen Erkrankungen. Bei der autosomal dominanten Erkrankung, die zu den haeufigsten Phakomatosen zaehlt, kann je nach Gendefekt zwischen verschiedenen Formen, die zu einer Stoerung der Blutgefaessbildung fuehren, unterschieden werden. Neben der genetischen Diagnostik und der klinischen Untersuchung sind bildgebende Verfahren entscheidend fuer die Diagnose. Klinisch stehen die Epistaxis, mukokutane Teleangiektasien und viszerale arteriovenoese Malformationen (AVM) v. a. in Lunge, Leber und Hirn sowie die Folgen dieser Gefaesspathologien wie z. B

  6. Crohn's Disease

    Science.gov (United States)

    Crohn's disease causes inflammation of the digestive system. It is one of a group of diseases called inflammatory ... small intestine called the ileum. The cause of Crohn's disease is unknown. It may be due to an ...

  7. Foreningsfitness - portræt af de aktive medlemmer

    DEFF Research Database (Denmark)

    Østerlund, Karsten; Kirkegaard, Kasper Lund

    Rapport, der bl.a. kortlægger aktive fitnessmedlemmers træningsmotiver, tilfredshedsgrad og selvvurderede sundhed i foreningsdrevne centre under DGI og DIF's udviklingsprojekt Foreningsfitness.......Rapport, der bl.a. kortlægger aktive fitnessmedlemmers træningsmotiver, tilfredshedsgrad og selvvurderede sundhed i foreningsdrevne centre under DGI og DIF's udviklingsprojekt Foreningsfitness....

  8. The legg-calve-perthes disease; Morbus Perthes

    Energy Technology Data Exchange (ETDEWEB)

    Kramer, J.; Scheurecker, A. [Institut fuer CT- und MRT-Diagnostik, Linz (Austria); Hofmann, S. [Allgemeines und Orthopaedisches LKH, Stolzalpe (Austria); Tschauner, C.

    2002-06-01

    The Legg-Calve-Perthes disease is an idiopathic avascular necrosis of the hip during early childhood. It is characterized by different stages with the main risk of persisting hip deformation, dysfunction of the joint movement, and the potential for early osteoarthritis. For the evaluation of prognosis and therapy planning patients age and extent of the necrotic area of the epiphysis are important factors. For an early diagnosis and sufficient therapy all radiological efforts have to be performed. MR imaging is an ideal method for the assessment of osteonecrotic changes of the Morbus Perthes. Compared to plain radiography by MR imaging pathologic alterations can be detected earlier and with higher specificity. However, conventional radiograms have to be still used as basic imaging modality. Nowadays x-rays and MR imaging should be the main methods for the evaluation of children suffering from Perthes disease. (orig.) [German] Beim Morbus Perthes handelt es sich um eine idiopathische Osteonekrose des Hueftgelenks im fruehkindlichen Alter (3.-12. Lebensjahr). Das Hauptrisiko dieser selbstlimitierenden Erkrankung mit suffizienter Reparatur und charakteristischem stadienhaftem Verlauf ist eine Defektheilung mit deformiertem Hueftkopf (Coxa magna) und sekundaer dysplastischer Pfanne. Diese praearthrotische Deformitaet fuehrt zur Einschraenkung der Hueftfunktion und einer fruehzeitigen Koxarthrose. Zur Abschaetzung der Prognose und Therapieplanung spielen Alter des Patienten bei Krankheitsbeginn sowie Groesse und Lokalisation des Nekroseareals eine entscheidende Rolle. Es ist somit augenscheinlich, dass alle radiologischen Register gezogen werden muessen, um eine moeglichst fruehe Diagnose und eine suffiziente Stadieneinteilung als Voraussetzung fuer eine risikoadaptierte Therapie zu gewaehrleisten. Die MRT eignet sich in idealer Weise zur Beurteilung ischaemischer Knochenmarkveraenderungen im Rahmen des Morbus Perthes. Verglichen mit dem konventionellen Roentgen ist die

  9. Crohn's disease.

    LENUS (Irish Health Repository)

    Shanahan, Fergus

    2012-02-03

    Crohn\\'s disease is a disorder mediated by T lymphocytes which arises in genetically susceptible individuals as a result of a breakdown in the regulatory constraints on mucosal immune responses to enteric bacteria. Regulation of immune reactivity to enteric antigens has improved understanding of the pathophysiological mechanisms of Crohn\\'s disease, and has expanded therapeutic options for patients with this disorder. Disease heterogeneity is probable, with various underlying defects associated with a similar pathophysiological outcome. Although most conventional drug treatments are directed at modification of host response, therapeutic manipulation of the enteric flora is becoming a realistic option.

  10. Limited ankle dorsiflexion: a predisposing factor to Morbus Osgood Schlatter?

    Science.gov (United States)

    Sarcević, Zoran

    2008-08-01

    Quadriceps femoris muscle contracts eccentrically during the stance phase of running till the beginning of propulsion when the knee reaches the highest level of flexion. Limited dorsiflexion in the ankle joint is associated with a compensatory increased knee flexion, tibial inversion, and foot pronation during the stance phase of running. Theoretically, these compensatory mechanisms might cause increased stress on the quadriceps femoris muscle attachment to the tuberositas tibia. This study is aimed at evaluating a possible relationship between limited dorsiflexion of the ankle and the occurrence of Morbus Osgood Schlatter (MOS) in sports-active children. Forty-five children, including 40 boys (mean age 13 years, range 11-14) and 5 girls (mean age 12 years, range 10-12) with the clinical diagnosis of MOS, were studied. Dorsiflexion angle (DFA) of less than 10 degrees was found in 37 boys, whereas 3 of them had a DFA of more than 10 degrees . All five girls had a DFA of less than 10 degrees . In conclusion, limited dorsiflexion of the ankle joint might be of significant importance for MOS. Further studies are warranted to evaluate the cause-effect relationship.

  11. Radiation therapy for Morbus Ledderhose - indication and clinical results; Strahlentherapie beim Morbus Ledderhose - Indikation und klinische Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Seegenschmiedt, M.H.; Attassi, M. [Klinik fuer Radioonkologie, Strahlentherapie und Nuklearmedizin, Alfried-Krupp-Krankenhaus, Essen (Germany)

    2003-12-01

    Background: morbus ledderhose (ML) is a rare hyperproliferative disorder of the plantar aponeurosis which is similar in its clinical course to morbus dupuytren (MD). We examined whether radiotherapy (RT) can effect symptoms and prevent disease progression. Patients and methods: from June 1996 to December 2001, 25 patients (12 female/13 male) aged 9-76 (median: 56) years had radiotherapy (RT) for symptomatic ML. Follow-up (FU) was at least 1 year. 36 feet (16 right/20 left) were treated, as eleven patients had bilateral disease. Twelve (48%) patients had MD. There were 63 nodules (with 0,5-6,5 cm diameter) on all feet and 20 cords (with 1-4 cm length) on 13 (52%) feet prior to RT. 21 (84%) patients had one or more signs: 14 (56%) severe local pain, eight (32%) walking difficulties, twelve (48%) other symptoms, pressure or tension sensation. The RT field involved all nodules and cords plus safety margin. Two RT-series were applied (each 5 x 3 gy in 1 week) separated by 8-12 weeks up to a total dose of 30 gy. Evaluation was performed at the end of RT, after 3 and 12 months FU and in December 2002. The primary endpoint was prevention of disease progression and avoidance of surgery. Secondary endpoints were objective changes of morphological and functional parameters and patient's satisfaction measured on a visual analogue scale (VAS). Results: with a median FU of 38 (12-67) months no patient experienced progression or underwent surgery: 11 of 36 (44%) feet had a reduced number (overall: - 16) or size of nodules, 7 of 13 (54%) feet had a reduced number (overall: -9) or length of cords; gait was improved in six of twelve (50%) feet; pain was reduced or had completely disappeared in 9 of 15 (60%) feet, and other symptoms disappeared in 8 of 18 (44%) symptomatic feet. 20 (80%) patients regarded 28 of 36 (78%) treated feet as improved and 8 (22%) in stable condition. The median relative improvement stated by patients on the VAS was 50% (0-100%). Treatment side effects

  12. Magnetic resonance imaging for ankylosing spondylitis; Magnetresonanztomographie bei ankylosierender Spondylitis (Morbus Struempell-Marie-Bechterew)

    Energy Technology Data Exchange (ETDEWEB)

    Bollow, M. [Augusta-Kranken-Anstalt, Inst. fuer Radiologie, Bochum (Germany)

    2002-12-01

    ] Die ankylosierende Spondylitis (AS) gilt als Prototyp der Spondylarthropathien, welche mit einer Praevalenz von 2% zu den haeufigsten rheumatischen Erkrankungen gerechnet werden. Die Spondylarthropathie umfasst die 5 Entitaeten AS, reaktive Arthritis, Psoriasis arthropathica, enteropathische Arthritis bei Morbus Crohn und Colitis ulcerosa und die undifferenzierte Spondylarthropathie. Bei 99% der Patienten mit AS sind die ersten pathologischen Befunde an den Sakroiliakalgelenken zu finden. Die zur Diagnose einer AS geforderten Roentgenbefunde treten erst mit einer Latenz von 5-9 Jahren nach Beginn der klinischen Symptome in Erscheinung. Mit Hilfe der MRT der Sakroiliakalgelenke lassen sich sowohl chronisch-entzuendliche Veraenderungen (Erosionen, Sklerosierungen, Knochenbruecken) als auch akut-entzuendliche Veraenderungen (Synovitiden, Kapsulitiden, Osteitiden) sicher nachweisen und bezueglich ihrer Chronizitaet und Akuitaet graduieren. Enthesitiden der Ligamenta interossea des Spatium retroarticulare gehoeren zum Bild der AS. Eine Spondylodiszitis (Andersson 1937) kann als entzuendliche und als nichtentzuendliche Form (transdiskaler Ermuedungsbruch) auftreten. Zur Ankylosierung fuehrende Entzuendungen der Facetten- und der kostospinalen Gelenke sind fuer die AS typisch. Veraenderungen der Wirbelkoerper finden sich als Spondylitis anterior (Romanus 1952), posterior und marginalis. Charakteristisch fuer alle Spondylarthropathien sind darueberhinaus asymmetrische Synovitiden an den grossen Gelenken vor allem der unteren Extremitaet (Gonarthritis, Coxitis, Tarsitis, periphere Oligoarthritis), die Fibroostitis rheumatica (pelvine Enthesitis, Calcaneopathia rheumatica) und die Peri- und Synchondritiden der Symphysis pubica und der Synchondrosis sternalis. Da sich bei der AS fruehe entzuendliche Veraenderungen an der Wirbelsaeule und an den extravertebralen Manifestationsorten in der MRT vor deren Auftreten im Roentgenbild nachweisen lassen und damit die diagnostische Luecke

  13. Intravenous injection of Ra-224 as a treatment in Morbus Paget

    International Nuclear Information System (INIS)

    Koch, W.

    1976-01-01

    Between 1956 and 1973, 21 patients with histologically verified Morbus Paget were treated at the author's hospital with low dosage 224 Ra. In none of these patients an immediate or late impairment of the hematogenic or parenchymal organs was observed. (MG) [de

  14. Radiation therapy for early stages of Morbus Ledderhose

    International Nuclear Information System (INIS)

    Heyd, Reinhard; Dorn, Anne Pia; Mueller-Schimpfle, Marcus; Herkstroeter, Markus; Roedel, Claus; Fraunholz, Ingeborg

    2010-01-01

    Purpose: To evaluate the efficacy of radiation therapy (RT) in the treatment of early stages of benign plantar fibromatosis (Morbus Ledderhose [ML]). Patients and Methods: From 2003 to 2008, 24 patients (33 sites) with a mean age of 52 years received RT for symptomatic ML. Prior to RT, 19 patients complained of pain and 15 had walking difficulties. 21 patients (28 sites) were irradiated with orthovolt-age X-rays and three (five sites) received electron-beam irradiation. The RT protocol consisted of five weekly fractions of 3.0 Gy (15 Gy), repeated after 6 weeks to a total dose of 30 Gy in 20 patients (28 sites). In four patients (five sites), two single fractions of 4.0 Gy were applied, repeated at intervals of 4 weeks to total doses of 24-32 Gy. Primary study endpoints were the prevention of disease progression and the avoidance of a surgical intervention. Secondary endpoints were pain relief, improvement of gait, and patients' subjective satisfaction measured with a linear analog scale (LAS). Results: After a median follow-up of 22.5 months, none of the patients experienced a progression of number and size of the lesions or the clinical symptoms. In eleven sites (33.3%) complete remission of cords or nodules occurred, in 18 (54.5%) a reduced number or size was noted, and four sites (12.1%) were unchanged. Pain relief was achieved in 13/19 patients (68.4%), and an improvement of gait abnormalities was noted in 11/15 patients (73.3%). The patients' subjective satisfaction measured by means of the LAS revealed a median improvement of 3.5 points in 22/24 patients (91.6%). Skin or soft tissues toxicities RTOG grade > 2 were not noted. Conclusion: RT is effective for treatment of the early stages of ML and may obviate the need for a surgical intervention. Long-term follow-up studies including a larger number of patients are required to define the role of RT in the management of this disorder. (orig.)

  15. What Is Crohn's Disease

    Science.gov (United States)

    ... of this page please turn JavaScript on. Feature: Crohn's Disease What is Crohn's Disease Past Issues / Winter 2016 Table of Contents As ... large intestine, leading to the anus. Who Gets Crohn's Disease? Both men and women can get Crohn's disease, ...

  16. klima:aktiv - the Austrian initiative for climate protection

    International Nuclear Information System (INIS)

    Raimund, Willy; Cerveny, Michael; Fickl, Stephan; Matt, Elisabeth

    2005-01-01

    In 2004 Austria launched its long-term umbrella programme for active climate protection (until 2010). It combines various market-constituent measures and effectuates target-oriented implementation. klima:aktiv is an innovative add-on to common instruments, introducing target-group oriented programmes in the areas construction and living, mobility, company policies, electricity saving and renewable energy sources. By following a systematic approach, klima:aktiv is determined to effect a breakthrough in the use of climate-friendly technologies and services for increased energy-efficiency and of renewable energy sources, as well as to accrue their market shares. Implementing tailor-made, target-oriented programmes. klima:aktiv programmes develop technological and organisational solutions able to compete on the market, take care of innovative quality standards and promote training of all relevant groups. Implementation of the klima:aktiv programmes must be accomplished within set time limits and results in concrete measurable targets. 8 programmes already launched (May 2005): eco:facility - innovative refurbishment of private service buildings; e5 programme - energy-efficient municipalities (similar to European Energy Award); Solar thermal programme ('solarwaerme'); Quality management for new biomass district heating stations and heating plants ('qm heizwerke'); Mobility management for companies ('Betriebliches Mobilitaetsmanagement'); Refurbishment of residential buildings (multi-family houses) ('wohn modern'); Energy wood ('energie holz'); Biogas - heat, power, gas and transport fuels from renewables ('bio gas') Programmes for heat pumps and for energy-efficiency in small and medium-sized enterprises are next to be launched. By the end of 2005, the number of thematic programmes number will raise to about 15. More than 3 million Euro/year-plus contributions from partners The government provides over 3 million Euro/year. In addition, relevant economy branches are

  17. Crohn's disease.

    Science.gov (United States)

    Ballester Ferré, María Pilar; Boscá-Watts, Marta Maia; Mínguez Pérez, Miguel

    2017-12-12

    Crohn's disease is a chronic inflammatory bowel disease of unknown etiology associated with an impaired immune response, with periods of activity and remission. It is characterised by patchy and transmural lesions which can affect the entire gastrointestinal tract, from the mouth to the anus. The most frequent symptoms are abdominal pain and diarrhoea, which can seriously affect patients' quality of life. The increasing incidence and prevalence of the disease in our area has had a large impact on clinical practice, with the rapid development of diagnostic and therapeutic techniques. To reduce the risk of complications, primary care physicians and gastroenterologists should be familiar with the management of the disease. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  18. Immunotherapy of Crohn's disease

    NARCIS (Netherlands)

    van Montfrans, C.; Camoglio, L.; van Deventer, S. J.

    1998-01-01

    Although the initiating events of Crohn's disease are unknown, models of experimental colitis have provided new insights in the immunologically mediated pathways of mucosal inflammation. In Crohn's disease activated mucosal T lymphocytes produce proinflammatory cytokines within the mucosal

  19. Oropharyngeal Crohn's disease.

    Science.gov (United States)

    Mohamed, Rachid; Schultz, Robert; Fedorak, Richard N

    2008-01-01

    Crohn's disease is a chronic inflammatory disease that can affect any part of the gastrointestinal tract. Classically the disease has a predilection for the distal small bowel and colon and presents with dominant symptoms of abdominal pain and diarrhea. This case report describes a 38-year-old woman with Crohn's disease who presented with odynophagia. Direct visualization of the oropharynx revealed a large serpiginous Crohn's disease ulcer. A precipitous drop in hemoglobin prompted a series of gastroenterologic investigations that confirmed both ileal and oropharyngeal Crohn's disease. This manuscript describes the presentation of oropharyngeal Crohn's and reviews previous reports and management options.

  20. Aktiver submariner Vulkanismus am Gakkel Ruecken, Arktischer Ozean

    OpenAIRE

    Schlindwein, Vera; Müller, Christina; Jokat, Wilfried

    2006-01-01

    Aktiver submariner Vulkanismus am Gakkel Rücken, Arktischer OzeanVera Schlindwein, Christian Müller und Wilfried JokatStiftung Alfred-Wegener-Institut für Polar- und MeeresforschungAm alten Hafen 26D 27568 BremerhavenModelle für die Magmaproduktion an mittelozeanischen Rücken sagen eine Abnahme der Magmenmenge und somit Krustendicke für abnehmende Öffnungsraten voraus. Geringe Öffnungsraten und eine kühle Lithosphäre an den Riftachsen sorgen für konduktive Kühlung des oberen Mantels, die das ...

  1. Crohn's Disease Transvaal Blacks

    African Journals Online (AJOL)

    W. Most of these cases are probably not Crohn's disease, and various other aetiologies have been suggested. In Scandinavia, Yersinia enterocolitica has been commonly encountered." In Japan, acute. ileitis .has been caused by Anisakis larvae.2S However, a few cases are probably acute Crohn's disease from the outset.

  2. The Crohn disease

    International Nuclear Information System (INIS)

    Hetessy, Gy.; Horvath, L.

    1980-01-01

    On the basis of X-ray examinations of the small and large intestines in 15 patients suffering from Crohn disease the radiological symptoms and the clinical and histological observations are reviewed in detail. The possibilities and signs of differential diagnosis of the Crohn disease from colitis ulcerosa are discussed, too. (author)

  3. Epidemiology of Crohn's Disease.

    Science.gov (United States)

    Sandler, R S; Golden, A L

    1986-04-01

    Although our current understanding is limited, epidemiologic investigation of Crohn's disease holds great promise. Certain aspects of the epidemiology are clear. The incidence of Crohn's disease, which has increased over the past few decades, may have reached a plateau. The disease has its peak onset in early life, with a second peak among the elderly. It is more common in the developed countries and among Jews. Whether the disease is related to occupation, social class, marital status, stress, infection, diet, smoking, and oral contraceptives is less certain. This paper reviews the epidemiology of Crohn's disease and proposes areas in which further research is needed.

  4. Learning about Crohn's Disease

    Science.gov (United States)

    Skip to main content Learning About Crohn's Disease Enter Search Term(s): Español Research Funding An Overview Bioinformatics Current Grants Education and Training Funding Extramural Research News Features Funding Divisions Funding ...

  5. Immunotherapy of Crohn's disease

    Directory of Open Access Journals (Sweden)

    C. van Montfrans

    1998-01-01

    Full Text Available Although the initiating events of Crohn's disease are unknown, models of experimental colitis have provided new insights in the immunologically mediated pathways of mucosal inflammation. In Crohn's disease activated mucosal T lymphocytes produce proinflammatory cytokines within the mucosal compartment. With this understanding, there has been a shift in past years from the use of unspecific anti-inflammatory agents (corticosteroids, aminosalicylates to the use of immunomodulatory drugs (azathioprine, methotrexate. Moreover, novel strategies have been designed for specific targets in Crohn's disease, in particular T lymphocytes and cytokines. In an open label study treatment of steroid-refractory Crohn's disease with anti- CD4+ antibodies was well tolerated and showed clinical benefit. However, a sustained depletion of the CD4+ cells precluded further clinical trials. In controlled clinical studies, anti-tumour necrosis factor (TNF-α antibodies induced com plete remissions and few side effects were observed. One study suggested efficacy in active Crohn's disease of recombinant interleukin-10. Long term treatment studies will have to answer questions about the indications for use, benefit and toxicity. Altogether, these results hold promise for future management of Crohn's disease, where disease-modifying interventions and strategies that effectively maintain disease remission will play a key role.

  6. [Familial incidence of Crohn disease].

    Science.gov (United States)

    Bürger, L; Karoff, C; Wagner, H

    1981-03-12

    This study reports about the frequent incidence of Crohn's disease in four families. This evidence in confirmed by literature. Relatives of patients with Crohn's disease are ten times more likely to suffer from that disease than those of healthy families. Familial accumulation of Crohn's disease can possibly be explained by genetic factors. Other factors like autoimmunological processes, infections, overnutrition and deficient composition of alimentation with refined carbohydrates might start Crohn's diseases in these families.

  7. [Crohn's disease surgery].

    Science.gov (United States)

    Kala, Zdeněk; Marek, Filip; Válek, Vlastimil A; Bartušek, Daniel

    2014-01-01

    Surgery of Crohns disease is an important part of the general treatment algorithm. The role of surgery is changing with the development of conservative procedures. The recent years have seen the return to early treatment of patients with Crohns disease. Given the character of the disease and its intestinal symptoms, a specific approach to these patients is necessary, especially regarding the correct choice of surgery. The paper focuses on the luminal damage of the small and large intestine including complications of the disease. We describe the individual indications for a surgical solution, including the choice of anastomosis or multiple / repeated surgeries.

  8. Evaluation of Crohn's disease

    International Nuclear Information System (INIS)

    Fishman, E.K.; Jones, B.

    1988-01-01

    The application of CT to the evaluation of inflammatory disease of the small bowel and colon has evolved in parallel with the development of scanners with shorter scan times and higher resolution and with increasing sophistication of the radiologist in the use of this imaging technique. Although high-quality barium studies remain the examination of choice for the demonstration of mucosal disease, CT is now considered the gold standard for evaluating the extraluminal components of the disease process. This chapter reviews the typical CT findings and possible complications of Crohn's disease and discusses the potential impact of CT on the clinical management of the patient with Crohn's disease

  9. Aktive Strategien zur Schutzzielverletzungerkennung durch eine kontrollierte Machtteilung in der Zugriffskontrollarchitektur

    OpenAIRE

    Abendroth, Jörg

    2004-01-01

    Zugangskontrolle und Intrusion Detection werden oft separat behandelt. Zur Erkennung von Schutzzielverletzungen wird hauptsächlich der Datenverkehr eines Netzwerkes ausgewertet - dies geschieht in einer passiven Weise. Aktive Strategien zum Erkennen von Angriffen sind nur durch neue Zugriffskontrollsysteme und kontrollierte Machtteilung möglich. In dem vorliegenden Beitrag wird eine neue Kategorisierung von Zugriffskontrollsysteme vorgestellt und insbesondere auf die kontrol...

  10. MRI in Crohn's disease

    NARCIS (Netherlands)

    Horsthuis, Karin; Lavini, Cristina; Stoker, Jaap

    2005-01-01

    Technological developments have extended the role of MRI in the evaluation of the gastrointestinal tract. The potential of MRI to evaluate disease activity in Crohn's disease has been investigated extensively, as MRI has intrinsic advantages over other techniques, including noninvasiveness and the

  11. What Is Crohn's Disease?

    Science.gov (United States)

    ... What are Crohn's & Colitis? > What is Crohn’s Disease? Crohn’s Disease is a Chronic Condition By understanding your body ... live a full and rewarding life What is Crohn’s Disease? Email Print + Share Named after Dr. Burrill B. ...

  12. Gastroduodenal Crohn's disease

    International Nuclear Information System (INIS)

    Hoermann, M.; Lammer, J.

    1983-01-01

    A case of gastroduodenal Crohn's disease is presented by describing the acute phase and findings after one year. Typical signs are the localisation in the region of the antrum-pylorus-bulbus, as well as the paving-stone relief pattern and the pseudo-post-Billroth-l sign. (orig.) [de

  13. Magnetic Resonance Enterography in Crohn׳s Disease.

    Science.gov (United States)

    Westerland, Olwen; Griffin, Nyree

    2016-08-01

    Over the past decade, magnetic resonance (MR) enterography has become established as the first-line imaging test for patients with Crohn׳s disease. This article reviews the role of MR enterography in assessing the extent and activity of Crohn׳s disease at baseline and on treatment follow-up. It discusses the role of diffusion-weighted imaging, and the recent introduction of MR scoring systems to facilitate noninvasive objective assessment of disease activity and cumulative bowel damage. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. MRI of vulvar Crohn disease

    International Nuclear Information System (INIS)

    Pai, Deepa; Dillman, Jonathan R.; Mahani, Maryam Ghadimi; Strouse, Peter J.; Adler, Jeremy

    2011-01-01

    Crohn disease is a chronic granulomatous inflammatory disorder that most commonly affects the gastrointestinal tract, particularly the distal small bowel and colon. While certain extraintestinal manifestations of Crohn disease are relatively common and well-known, others, such as metastatic cutaneous involvement, are quite rare and may be difficult to recognize, particularly in the pediatric population. This case report illustrates the magnetic resonance imaging (MRI) appearance of vulvar region cutaneous Crohn disease in an 11-year-old girl. (orig.)

  15. Crohn's & Colitis Foundation of America

    Science.gov (United States)

    ... Flares Health Insurance Medication Ostomy Patient Rights Pregnancy Sexuality Stress Symptom Management Traveling Treatments Women's Issues Work & School Types of Medications for Crohn's Disease and Ulcerative ...

  16. Unusual complication of Crohn's disease

    International Nuclear Information System (INIS)

    Kulke, H.; Sommer, H.; Ehl, M.; Braun, H.

    1981-01-01

    In diagnosis and therapy of Crohn's disease the occurrence of typical complications is especially regarded. This may result in diagnosing not typical complications of other localizations too late so that therapeutical measures are without success. This is reported of a patient who, having suffered from Crohn's disease for 30 years, was suddenly struck by multiple abscesses of the lung. (orig.) [de

  17. Radiologic diagnosis of Legg-Calve-Perthes disease; Radiologische Diagnostik des Morbus Perthes

    Energy Technology Data Exchange (ETDEWEB)

    Ranner, G. [Graz Univ. (Austria). Universitaetsklinik fuer Radiologie und Gemeinsame Einrichtung von Kliniken und Instituten ``Magnet Resonanz``; Fotter, R. [Graz Univ. (Austria). Universitaetsklinik fuer Radiologie und Gemeinsame Einrichtung von Kliniken und Instituten ``Magnet Resonanz``; Linhart, W. [Graz Univ. (Austria). Universitaetsklinik fuer Radiologie und Gemeinsame Einrichtung von Kliniken und Instituten ``Magnet Resonanz``; Ebner, F. [Graz Univ. (Austria). Universitaetsklinik fuer Radiologie und Gemeinsame Einrichtung von Kliniken und Instituten ``Magnet Resonanz``

    1994-01-01

    In Legg-Calve-Perthes disease (LCPD), magnetic resonance imaging (MRI) and conventional radiography in two planes are considered the most important methods of investigation for early diagnosis and for assessment of the course of the disease. MRI can reveal the early marrow oedema, thus allowing early differential diagnosis against diseases that are similar in clinical appearance (coxitis fugax, epiphyseal dysplasia). The extent of the necrotica area within the epiphysis, the most important indicator of the prognosis of the disease and thus for the therapeutic management, can be assessed earlier and more reliably with MRI than with other techniques. The loss of containment can be visualized by MRI, because depiction of the cartilaginous structures is possible earlier than with conventional radiography. Staging of LCPD is also possible with MRI, especially in stages I and II. Radiography shows the reossification and the osseous remodelling of the epiphysis better. A disadvantage of MRI seems to be the occasional need for sedation or anaesthesia of the child to avoid motion artefacts. (orig.) [Deutsch] In der radiologischen Fruehdiagnostik und Verlaufsbeurteilung des Morbus Legg-Calve-Perthes stehen als aussagekraeftigste Methoden das konventionelle Roengten in 2 Ebenen, die MRT und die Knochenszintigraphie im Vordergrund. In der Fruehdiagnostik bewaehrt sich die Magnetresonanztomographie als empfindliche Methode. Mit aehnlicher Sensitivitaet kann die Knochenszintigraphie die umschriebene Durchblutungsstoerung nachweisen. Daraus ergeben sich Moeglichkeiten zur bereits fruehzeitigen Differentialdiagnose gegenueber Krankheitsbildern mit aehnlicher klinischer Symptomatik. Die Groesse des Nekroseareals als prognostisch bedeutsamster und somit fuer die einzuschlagende Therapie richtungsweisender Faktor kann ebenfalls mittels MR-Tomographie am fruehesten und verlaesslichsten bestimmt werden. Kommt es im Verlauf der Erkrankung durch Subluxation des Caput femoris zum Verlust

  18. Rifaximin and Crohn's disease.

    Science.gov (United States)

    Prantera, Cosimo; Scribano, Maria Lia

    2013-11-14

    In a recent article, Longman and Swaminath analyzed our paper on the use of rifaximin in patients with moderately active Crohn's disease (CD). Here we report some considerations concerning their article. The exploratory post-hoc subgroup analysis showed that early-stage disease and, differently from that written by Longman and Swaminath, also colonic involvement seemed to be associated with a significant higher efficacy of rifaximin-EIR 800 mg twice daily. Early-stage disease is generally considered as the more easily treatable phase of CD, and the better response to rifaximin in Crohn's colitis is in accordance with the high concentration of bacteria in the colon. In addition, patients with C reactive protein level > 5 mg/L achieved remission more significantly than patients with normal values, thus suggesting that the symptoms were probably caused by inflammation instead of by non-inflammatory causes. We also analyze the role of rifaximin against gut bacteria and the clinical situations that could obtain the best results from antibiotics.

  19. Biological treatment of Crohn's disease

    DEFF Research Database (Denmark)

    Nielsen, Ole Haagen; Bjerrum, Jacob Tveiten; Seidelin, Jakob Benedict

    2012-01-01

    Introduction of biological agents for the treatment of Crohn's disease (CD) has led to a transformation of the treatment paradigm. Several biological compounds have been approved for patients with CD refractory to conventional treatment: infliximab, adalimumab and certolizumab pegol (and...

  20. [Ulcerative colitis and Crohn's disease].

    Science.gov (United States)

    Pavlović-Calić, Nada

    2003-01-01

    There is an enigma of inflammatory bowel diseases, despite significant advantages during last 10 years in medicamentous and surgical treatment. Ulcerative colitis and Crohns disease are chronic with remissions and recidives. Crohns disease involves any part of digestive tube. Histological changes in ulcerative colitis are: inflammation of mucosa and submucosal tissue, crypt abscesses and ulcerations, pseudopolpys, bowel shortening and toxic megacolon in severe inflammation. In Crohns disease, transmural inflammation, "jumping lesions", deeper ulcerations, coble-stone mucosa, progressive fibrosis, granuloma with gigantic epithelial cells. ulcerative colitis: mesalazine, rectal 5-ASA and hydrocortisone enemas, surgery. Crohns disease: mesalazine and prednisolone. For terminal ilcitis, corticosteroid budesonid could be applied. Severe symptomatic disease: hospitalization, parenteral nutrition, antibiotics, prednisone, surgery in partial bowel obstruction, fistulas, abscessus, perforation.

  1. Colorectal Cancer Complicating Crohn's Disease

    OpenAIRE

    Freeman, Hugh J

    2001-01-01

    Some earlier studies have indicated that patients with inflammatory bowel disease, especially those with long-standing and extensive ulcerative colitis, have an increased risk of colorectal cancer. Moreover, others in tertiary care centres have suggested that patients with Crohn's disease also have a higher risk of colorectal cancer. Canadian data on colorectal cancer in Crohn's disease appear to be limited. For this investigation, a single clinician database of 877 patients w...

  2. US contribution in Crohn's disease

    International Nuclear Information System (INIS)

    Alessi, V.; Bianco, S.; Traina, G.

    1986-01-01

    The authors report their experience in 40 patients with intestinal Crohn's disease, who underwent both abdominal ultrasound scanning and double-contrast small bowel enema. The various echographic patterns are described, found in the different phases during the evolution of Crohn's disease, underlying the importance of ultrasound in evaluating the real degree of bowel wall thickening and the esoenteric space, only indirectly appreciated with X-ray examination

  3. Epstein-Barr virus-kodet BILF1 er en konstitutivt aktiv G-protein-koblede receptor

    DEFF Research Database (Denmark)

    Paulsen, Sarah J; Rosenkilde, Mette M; Eugen-Olsen, Jesper

    2005-01-01

    Både beta-og gammaherpesviruses kode G-protein-koblede receptorer (GPCRs) med unikke farmakologiske fænotyper og vigtige biologiske funktioner. Et eksempel er ORF74, den gamma2-herpesvirus Kaposis sarkom-associated herpesvirus (KSHV)-kodet GPCR, som er meget konstitutivt aktiv og betragtes som de...

  4. Perianal Crohn Disease

    Science.gov (United States)

    Galandiuk, Susan; Kimberling, Jennifer; Al-Mishlab, Talib G.; Stromberg, Arnold J.

    2005-01-01

    Objective: Fissures, fistulas, abscesses, and anal canal stenosis are manifestations of perianal Crohn disease (CD). There are no known predictors of which patients will fail sphincter-sparing surgical therapy and ultimately require fecal diversion. Methods: Of 356 consecutive patients with CD, 24% (86) had perianal CD (age range, 14–83 years), and women were slightly more frequently affected. Clinical variables were examined for factors predictive of the need for permanent fecal diversion. Results: CD associated with perianal CD was limited to the small bowel and/or ileocolic area in 23% of patients; the remainder had colorectal CD. Eighty-six patients underwent 344 operations. Forty-two patients (49%) ultimately required permanent diversion; among them were 21 of 32 patients (66%) with anal stricture and 12 of 20women (60%) with rectovaginal fistula. Univariate analyses of clinical variables were performed with respect to need for permanent fecal diversion. Significant univariate predictors were the presence of colonic CD (P = 0.0045, odds ratio [OR] 5.4), avoidance of ileocolic resection (P = 0.0147, OR 0.4), and the presence of an anal stricture (P = 0.0165, OR 3.0). In multivariate logistic regression, the presence of colonic disease and anal canal stricture were predictors of permanent diversion. The OR associated with the risk of permanent diversion in the presence of colonic disease and in the absence of anal stricture was 10 (P = 0.0345). In the presence of both colonic disease and anal canal stenosis, the OR associated with permanent stoma was 33 (P = 0.0023). Conclusions: The management of perianal CD continues to be challenging. Roughly half of patients required permanent fecal diversion, which was even more frequently true for patients with colonic CD and anal stenosis. Recognizing these tendencies will assist both patients and surgeons in planning optimal treatment. PMID:15849515

  5. Metastatic Crohn's disease in pediatrics

    Directory of Open Access Journals (Sweden)

    Javier Blasco-Alonso

    Full Text Available Introduction: Metastatic Crohn's disease (MCD is an extraintestinal manifestation of Crohn's disease, with biopsy as fundamental diagnostic tool. There are few References to MCD in children, with a 0.5-1% estimated incidence in adults. There is no consensus about its therapeutic approach. We describe our diagnostic and therapeutic experience in MCD. Case Reports: Four cases of MCD are described in our Pediatric Gastroenterology Unit in a tertiary care hospital. The age at diagnosis was between 7 and 13 years. Lesions appeared before the diagnosis of Crohn's disease in three of them, and during the course of the disease in another one, with genital location in three patients and bilateral pretibial region in the other. All four cases demonstrated non-caseificant granulomas on biopsy. Only two patients used exclusive enteral nutrition therapy with complete resolution, while other two cases received a combination of therapies (corticosteroids, azathioprine, tacrolimus, infliximab and adalimumab because of recurrence. Only one case required surgery after poor clinical control. Discussion: The MCD is infrequent but must always be included in the differential diagnosis of cutaneous lesions in Crohn's disease, considering it could be the debut of the disease. We will rely on biopsy anyway for definitive diagnosis. In this series the genital region is verified as the most commonly affected in children. The therapeutic approach does not differ from the management of intestinal involvement.

  6. European Crohn's and Colitis Organisation Topical Review on Prediction, Diagnosis and Management of Fibrostenosing Crohn's Disease

    NARCIS (Netherlands)

    Rieder, Florian; Latella, Giovanni; Magro, Fernando; Yuksel, Elif S.; Higgins, Peter D. R.; Di Sabatino, Antonio; de Bruyn, Jessica R.; Rimola, Jordi; Brito, Jorge; Bettenworth, Dominik; van Assche, Gert; Bemelman, Willem; D'Hoore, Andre; Pellino, Gianluca; Dignass, Axel U.

    2016-01-01

    This ECCO topical review of the European Crohn's and Colitis Organisation [ECCO] focused on prediction, diagnosis, and management of fibrostenosing Crohn's disease [CD]. The objective was to achieve evidence-supported, expert consensus that provides guidance for clinical practice

  7. Pulmonary radio-responses to surface field radiotherapy of Morbus Hodgkin using a 4 MeV linear accelerator. Die pulmonale Strahlenreaktion nach Mantelfeldbestrahlung mit einem 4 MeV-Linearbeschleuniger bei Morbus Hodgkin

    Energy Technology Data Exchange (ETDEWEB)

    Krueger, H.U.

    1982-05-05

    In 119 patients suffering from Morbus Hodgkin who were treated between 1974 and 1979, the pulmonary radio-response was retroperspectively investigated. Besides incidence and degree of severity, the course over the time of the individual stages of radio-response were also investigated. 14 patients showed no paramediastinal irradiation fibrosis as lasting stationary change, 52 showed a light one, 34 a medium-sized and 19 a severe one. Each fibrosis had been preceded by the radiomorphologic sign of pneumonitis of always the same degree of severity. The course over the time of the radiomorphologically subdivided stages determined that on the average the signs of a beginning pneumonitis occurred 11.6 weeks after onset of radiotherapy. An active pneumonitis was detectable after 14.8 weeks (on the average) and 20.4 weeks after radiotherapy had been started, a still florid pneumonitis with beginning shrinkage of the paramediastinal regions was found. The stage of stationary pulmonary fibrosis was reached 34.1 weeks (averaged value) after surface field irradiation had been started. Correlative relations to different individual disease-dependent and radiotherapeutic factors were detected, which are considered to be responsible for the intensity and character of the floride radio-response and the remaining pulmonary fibrosis. Considered from the radiomorphologic course of pulmonary irradiation reaction and its intensity and character, no significant advantage of tumor-reducing chemotherapy compared to irradiation or of split-course-technique compared to continuous fractioning was found. The introduction of individually adjustable shields helped to reduce the degree of severity of radio-response.

  8. Aktive Sterne

    Science.gov (United States)

    Strassmeier, Klaus G.

    Die Sonne ist ein ziemlich durchschnittlicher Stern, der sich vor allem durch seine geringe Entfernung zur Erde auszeichnet. Bei näherer Betrachtung entpuppt sich die Sonnenoberfläche jedoch als wahrer "Hexenkessel" mit Magnetfeldern aller Art, Sonnenflecken, Plasmaeruptionen und plötzlichen Explosionen, die alle einen fundamentalen Einfluß auf unseren Planeten haben, einen Einfluß, den wir erst mit modernster Astronomie messen und verstehen gelernt haben. Dieses Buch erklärt die spannenden Innenwelten, die physikalischen Grundlagen und Funktionsweisen der Sonne und der anderen aktiven Sterne. Die aktuellsten Forschungsergebnisse und neuestes Datenmaterial werden fundiert, aber auch für Laien verständlich, aufbereitet und mit über 200 Bildern, teilweise Aufnahmen mit dem Hubble Weltraumteleskop, illustriert.

  9. Hvorfor Aktivering?

    DEFF Research Database (Denmark)

    Tranæs, Torben

    market activation justified? Are the effects commensurate with the cost? These issues are discussed in this paper, which also includes a discussion of the aim of activation. Is its purpose simply to promote employment, or do social and income distribution considerations also play a role?......Denmark is among the countries of the world that spend the most on Active Labour Market Policy. In 2012 Denmark used DKK 16 billion (EUR 2.15 billion) for this purpose, almost three times as much as the average OECD country, and double that spent by Germany. Is such great expenditure on labour...

  10. Crohn's Disease Defined in Three Elderly Disters

    Directory of Open Access Journals (Sweden)

    Hugh J Freeman

    2005-01-01

    Full Text Available Three elderly sisters presented with symptomatic Crohn's disease. All had ileocolic involvement, and granulomatous inflammation was documented in endoscopic biopsies or surgically resected intestinal specimens. The present report documents the unusual occurrence of very late phenotypical expression of familial ileocolic Crohn's disease. The observations presented here reflect a possible gene-based predisposition to Crohn's disease or, alternatively, disease clustering related to a commonly shared environmental factor.

  11. CT enteroclysis in small bowel Crohn's disease

    International Nuclear Information System (INIS)

    Kohli, Marc D.; Maglinte, Dean D.T.

    2009-01-01

    The diagnostic evaluation of small bowel Crohn's disease has changed dramatically over the last decade. The introduction of wireless capsule endoscopy, double balloon endoscopy and the introduction of newer therapeutic agents have changed the role of imaging in the small bowel. Additionally, advances in multidetector CT technology have further changed how radiologic investigations are utilized in the diagnosis and management of small bowel Crohn's disease. This article describes how we perform CT enteroclysis in the investigation of small bowel Crohn's disease and discusses the role of CT enteroclysis in the current management of small bowel Crohn's disease.

  12. Isolated Crohn's disease of the stomach

    International Nuclear Information System (INIS)

    Traxler, M.; Weiss, W.; Rohrmoser, G.

    1988-01-01

    The spectrum of this disease has undergone major changes since 1932 when Crohn, Ginzberg and Oppenheimer differentiated Ileitis terminalis from nonspecific inflammations of the bowels. Initially, Crohn assumed an inflammation restricted to the terminal ileum. Today, Crohn's disease has been verified to affect the total gastro-intestinal tract from the cavity of the mouth to the anus. In 1949 Ross et al. were the first to report Crohn's disease in the region of the stomach and duodenum. Its localization in the upper intestinal tract, however, is a rare occurrence on the whole. (orig.) [de

  13. Amyloidosis and crohn's disease Amiloidosis y enfermedad de Crohn

    Directory of Open Access Journals (Sweden)

    Antonio Guardiola-Arévalo

    2011-05-01

    Full Text Available Secondary amyloidosis is a rare but serious complication of inflammatory bowel disease that may influence the prognosis even more than the underlying disease. Due to a better knowledge of the association of secondary amyloidosis to inflammatory bowel disease, early diagnosis of this complication is becoming more frequent, but its treatment continues to pose a challenge. We report 4 cases of patients with Crohn's disease and amyloidosis diagnosed in the inflammatory bowel disease Units of Toledo and Ciudad Real, which represent 0.68% of the patients with Crohn's disease of our health areas. There have been not cases of amyloidosis in patients with ulcerative colitis. In our 4 patients the secondary amyloidosis was clearly related to Crohn's disease, which was often of fistulising type. The predominant clinical picture of amyloidosis was nephrotic syndrome. The patients responded to medical and surgical treatment of Crohn's disease and colchicine, which improved renal function in all cases except in one who required kidney transplantation.La amiloidosis sistémica adquirida es una complicación rara pero grave de la enfermedad inflamatoria intestinal crónica, pudiendo condicionar el pronóstico más que la propia enfermedad de base. Debido al mejor conocimiento de la asociación de amiloidosis secundaria a enfermedad inflamatoria intestinal, el diagnóstico temprano se hace cada vez con mayor frecuencia, pero su tratamiento continúa siendo un reto. Describimos 4 casos clínicos de pacientes con enfermedad de Crohn (EC y amiloidosis diagnosticados en las Unidades de EIIC de Toledo y Ciudad Real, lo que representa el 0,68% de los caso de EC de nuestras áreas sanitarias. No se ha descrito ningún caso de amiloidosis en pacientes con colitis ulcerosa. En los 4 pacientes la AA estaba claramente relacionada con la EC, y predominaron las formas estenosantes-perforantes. El cuadro clínico de presentación de la amiloidosis en la mayoría de los casos

  14. Pinworm Infestation Mimicking Crohns' Disease

    OpenAIRE

    Johansson, Joel; Ignatova, Simone; Ekstedt, Mattias

    2013-01-01

    We here report a case of a young man who presented to his general practitioner with diarrhea. Inflammatory bowel disease was suspected and a colonoscopy showed aphthous lesions suggestive of Crohns' disease but biopsies revealed eggs of Enterobius vermicularis. When treated for this parasite, his symptoms were alleviated and a followup colonoscopy revealed a normal colon and distal ileum. Enterobius vermicularis is the most common parasite worldwide and has been attributed with many different...

  15. Crohns disease: a case report.

    Science.gov (United States)

    Adi, Ashindoitiang John; Lloyd, Geoffrey J

    2010-01-01

    Inflammatory bowel disease (IBD) was previously regarded as a disease of the Western Countries. A number of studies showed a high incidence and prevalence of inflammatory bowel disease in United States, United Kingdom and Northern Europe, whereas it was considered uncommon in Asians population and rare in Africa. To report case of crohns disease that is rare in the tropic like Nigeria so as to create a high index of awareness that inflammatory bowel disease may be present but not correctly diagnosed

  16. Surgery for Crohn's Disease: New Developments

    NARCIS (Netherlands)

    Gardenbroek, T. J.; Tanis, P. J.; Buskens, C. J.; Bemelman, W. A.

    2012-01-01

    Background/Aims: Crohn's disease is a chronic relapsing inflammatory bowel disease requiring surgery in a large number of patients. This review describes new developments in surgical techniques for treating Crohn's disease. Results: Single-incision laparoscopic surgery decreases abdominal wall

  17. SKELETAL ABNORMAUTIES IN CROHN'S DISEASE* m

    African Journals Online (AJOL)

    Crohn's disease is a chronic disorder which primarily involves the bowel but may be associated with changes in the joints,' eyes' and skin.' The association between. Crohn's disease and skeletal structures other than those of the joints appears to have been less frequently noted. In this article an outline is presented of the ...

  18. Crohn's disease limited to the vermiform appendix

    DEFF Research Database (Denmark)

    Bak, Martin; Andersen, J C

    1987-01-01

    Thirteen cases of Crohn's disease confined to the vermiform appendix were seen during a 12-year period. They constituted 16.9% of patients with primary resection of the bowel for Crohn's disease in the same period, but only 0.4% of the cases of acute appendicitis. In 10 of the 13 cases there was ......Thirteen cases of Crohn's disease confined to the vermiform appendix were seen during a 12-year period. They constituted 16.9% of patients with primary resection of the bowel for Crohn's disease in the same period, but only 0.4% of the cases of acute appendicitis. In 10 of the 13 cases...... to approach that of recurrence after resection in other parts of the intestines. Collective review of this and three other relatively large case series gave an estimated recurrence rate of 3.5%. We conclude that in Crohn's disease initially confined to the appendix the course appears to be indolent....

  19. Actively controlled current collector; Aktiv geregelter Stromabnehmer. Innovation fuer den schnellen Verkehr auf konventionellen Strecken

    Energy Technology Data Exchange (ETDEWEB)

    Mueller, C.

    2003-07-01

    Deutsche Bahn is presently endeavouring to further improve the interaction between the overhead wire and the current collectors on its locomotives and trainsets. The major factors behind this initiative are cost, quality and noise prevention. The outcome is the development of a completely new type of current collector for high-speed operation even on conventional track. Prototypes have meanwhile undergone practical trials on the 200 km/h line from Augsburg to Donauwoerth. The new current collector is a single-arm pantograph jointly developed by DB and Bombardier Transportation. (orig.) [German] Die Deutsche Bahn versucht derzeit, das Zusammenspiel von Oberleitung und den Stromabnehmern ihrer Lokomotiven und Triebzuege weiter zu verbessern. Kosten, Qualitaet und Laermschutz sind dabei die wesentlichen Gruende. Sie haben zur Entwicklung eines voellig neuen Stromabnehmer-Typus speziell fuer den Hochgeschwindigkeitsverkehr auch auf konventionellen Strecken gefuehrt. Auf der Tempo-200-Strecke von Augsburg nach Donauwoerth absolvierten jetzt Prototypen erste Praxis-Tests. Es handelt sich um aktiv geregelte, akustisch optimierte Einholmstromabnehmer, gemeinsam entwickelt von DB und Bombardier Transportation. (orig.)

  20. Pinworm infestation mimicking crohns' disease.

    Science.gov (United States)

    Johansson, Joel; Ignatova, Simone; Ekstedt, Mattias

    2013-01-01

    We here report a case of a young man who presented to his general practitioner with diarrhea. Inflammatory bowel disease was suspected and a colonoscopy showed aphthous lesions suggestive of Crohns' disease but biopsies revealed eggs of Enterobius vermicularis. When treated for this parasite, his symptoms were alleviated and a followup colonoscopy revealed a normal colon and distal ileum. Enterobius vermicularis is the most common parasite worldwide and has been attributed with many different presentations and pathologies. It is therefore necessary to maintain vigilance, even in high-income countries, in order to diagnose patients with one of the many atypical presentations of pinworms.

  1. 'klima:aktiv energieeffiziente betriebe' (climate:active energy efficient companies) - the Austrian climate change program for industry. Volume 1

    International Nuclear Information System (INIS)

    Sattler, Peter; Sampl, Martin; Fuchsberger, Karin

    2007-01-01

    'klima:aktiv' is the climate change program of the Austrian Federal Ministry of Agriculture, Forestry, Environment and Water Management. The aim of 'klima:aktiv' is to reduce CO 2 emissions as well as reinforce renewable energy in Austria. To achieve these goals more than 20 programs for renewable energies and energy efficiency were created - 'energy efficient companies' being one of them. 'klima:aktiv' was created in order to identify and furthermore realise energy saving and CO 2 reducing measures. To build an active and effective network, regional programs, local consultants and companies on the energy-market are encouraged to become partners of the program to be multipliers.One focus of the program is the support of consultants which are acting as mediators to the companies. A step by step model was developed for companies to help them realise the goals of the program. To ensure the highest service efficiency from the first contact with companies, consultants were furthermore provided with special 'k:a eeb Pro-Tools', which include a wide variety of tools from analysis and development to financing advise.The program started in October 2005. Its mission statement for the first year was to reduce CO 2 emission at 45.000 t or 60 GWh of primarily electrical energy. To reach this goal, single regional agencies were committed to individual objectives. After one year, a detailed evaluation of the program was carried out with the aim to show the areas of success but also to highlight areas that will need adjustments for optimal results

  2. Intestinal tuberculosis sometimes mimics Crohn's disease.

    Directory of Open Access Journals (Sweden)

    Esfandiar Shojaei

    2013-11-01

    Full Text Available Intestinal tuberculosis is an uncommon presentation of tuberculosis (TB and has clinicopathological similarities with Crohn's disease. In regions where TB is endemic clinicians must aware of this condition and fully evaluate their patients when Crohn's disease is diagnosed. We recommend all pathologic specimens be evaluate effectively for TB.Smear,culture and PCR for Mycobacterium.tuberculosis from samples aside the pathological reviews help for better diagnosis. Here we present a case of intestinal tuberculosis which initially diagnosed as Crohn's disease but after starting immunosuppressive agents he presented with disseminated tuberculosis.

  3. Computed tomography of Crohn's disease - reevaluation

    International Nuclear Information System (INIS)

    Kleinhaus, U.; Weich, Y.

    1987-01-01

    The indications and CT features of Crohn's disease were reevaluated, based on 48 examinations in 28 patients. Although CT is indicated mostly in the complications of Crohn's disease, it played a major role in the primary diagnosis of Crohn's disease in 8 patients. 5 unsuspected patients had CT for other abdominal indications and 3 had the examinations as part of an elective diagnostic work-up. The following CT features of Crohn's disease are worthy of note: Bowel wall thickening is usually obvious and needs no measurement. Abscesses are often of inhomogenous density and should be differentiated from inflammatory bowel conglomerates. Late CT scans can be helpful in this respect. Fistulae are not well demonstrated directly by CT. The fistulogram remains the examination of choise, when possible. Mesenteric lymphadenopathy is small and discrete. Mesenteric lipomatosis can be massive and is often a cause of bowel separations and mass effect. (orig.) [de

  4. Paediatric Crohn's disease: a radiological review

    International Nuclear Information System (INIS)

    Ali, S.I.; Carty, H.M.L.

    2000-01-01

    Paediatric Crohn's disease can be a serious and complex condition which is not always easy to diagnose if it presents in an atypical manner. Although the pathological processes are the same in adults and children, the clinical presentation and disease distribution can be different in children. The impact of the disease can also be much more significant in a growing and developing child than in an adult. Numerous investigations are available to establish the diagnosis, define the complications and to demonstrate the extra-intestinal manifestations. Close co-operation is required between the clinician and radiologist when investigating a child suspected of having Crohn's disease or its symptoms to minimise the radiation dose and the psychological and physical trauma. We review the clinical and radiological aspects of Crohn's disease and discuss the imaging modalities available in diagnosing Crohn's disease and its complications and suggest an investigation pathway as used in our institution. (orig.)

  5. Crohn's disease: risk factor for colorectal cancer

    OpenAIRE

    Santos, Sandra Cristina Dias dos; Barbosa, Laura Elisabete Ribeiro

    2016-01-01

    ABSTRACT Background: Crohn's disease is an inflammatory disease that can reach any part of the gastrointestinal tract. This disease has been associated with an increased neoplastic risk, including colorectal carcinoma. Objective: The objective of this work is to describe the mechanisms present in two diseases, and that are responsible for the increased risk in Crohn's disease. Methods: A bibliographic research was conducted in PubMed database. In addition to the articles obtained with an i...

  6. Can Crohn's disease be diagnosed at laparotomy?

    OpenAIRE

    Butterworth, R J; Williams, G T; Hughes, L E

    1992-01-01

    The typical macroscopic features of Crohn's disease have been well described and are widely regarded as sufficient to diagnose the disease at laparotomy. We report six patients undergoing laparotomy for symptomatic Crohn's disease, shown radiologically, who were found to have macroscopically normal small bowel despite careful examination of the bowel by an experienced surgeon. In four cases resection was deferred, but all subsequently deteriorated and required further surgery. Minor abnormali...

  7. A Rare Presentation of Crohn's Disease

    Directory of Open Access Journals (Sweden)

    Sriram Bhat M

    2008-01-01

    Full Text Available Free peritoneal perforation is a rare complication of Crohn's disease with a report of only 100 cases in the literature. It needs an emergency exploration and an unaware general surgeon is confounded in intraoperative decision-making. We present our experience when this rarity struck us in a district hospital and briefly review the guidelines of optimal management of this complication of Crohn's disease.

  8. THERAPIES FOR CROHN'S DISEASE: a clinical update

    Directory of Open Access Journals (Sweden)

    Carlos Walter SOBRADO

    Full Text Available ABSTRACT The main objectives of clinical therapy in Crohn's disease are clinical and endoscopic remission without the use of corticosteroids for long periods of time, prevention of hospitalization and surgery, and improvement of quality of life. The main limitation of drug therapy is the loss of response over the long term, which makes incorporation of new drugs to the therapeutic arsenal necessary. This review analyses the main drugs currently used in clinical treatment of Crohn's disease.

  9. [Meckel's diverticulum and enteroliths complicating Crohn's disease].

    Science.gov (United States)

    Fernández Salazar, Luis; Alvarez-Quiñones Sanz, María; Sánchez Lite, Israel; Velayos Jiménez, Benito; Legido Morán, Patricia; Macho Conesa, Ana; González Hernández, José Manuel

    2013-01-01

    We describe the case of a 43-year-old man recently diagnosed with ileal Crohn's disease complicated by a free peritoneal perforation of a Meckel's diverticulum and the presence of enteroliths in the intestinal lumen. The coexistence of Crohńs disease, Meckel's diverticulum and enteroliths has rarely been reported. Meckel's diverticulum can hamper the management of Crohn's disease. Copyright © 2012 Elsevier España, S.L. and AEEH y AEG. All rights reserved.

  10. [Oxidative stress in Crohn's disease].

    Science.gov (United States)

    Moret, Inés; Cerrillo, Elena; Navarro-Puche, Ana; Iborra, Marisa; Rausell, Francisco; Tortosa, Luis; Beltrán, Belén

    2014-01-01

    Crohn's disease (CD) is characterized by transmural inflammation that is most frequently located in the region of the terminal ileum. Although the physiopathological mechanisms of the disease are not yet well defined, the unregulated immune response is associated with high production of reactive oxygen species (ROS). These elements are associated with complex systems known as antioxidant defenses, whose function is ROS regulation, thereby preventing the harmful effects of these elements. However, the presence of an imbalance between ROS production and ROS elimination by antioxidants has been widely described and leads to oxidative stress. In this article, we describe the most significant findings on oxidative stress in the intestinal mucosa and peripheral blood. Copyright © 2013 Elsevier España, S.L. and AEEH y AEG. All rights reserved.

  11. Ustekinumab to treat Crohn's disease.

    Science.gov (United States)

    Gisbert, Javier P; Chaparro, María

    2017-12-01

    Ustekinumab is a monoclonal antibody directed against the p40 subunit, which is part of interleukins IL-12 and IL-23. The efficacy of ustekinumab versus placebo in terms of clinical response and remission of induction has been shown in phase3 clinical trials. When used as subcutaneous maintenance therapy, the therapeutic benefit of ustekinumab over placebo has been confirmed in both clinical response and remission in patients who have responded clinically to induction therapy. In addition, ustekinumab has demonstrated an improvement in mucosal healing parameters. The safety profile of the drug has been good, with low infection rates (without reactivation of tuberculosis) and absence of tumour reporting. The development of drug immunogenicity appears to be rare. In summary, ustekinumab is a promising treatment option in patients with Crohn's disease, as an alternative to anti-TNFα drugs. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  12. Pembuatan Karbon Aktif Dari Arang Tempurung Kelapa Dengan Aktivator Zncl2 Dan Na2co3 Sebagai Adsorben Untuk Mengurangi Kadar Fenol Dalam Air Limbah

    Directory of Open Access Journals (Sweden)

    Gilar S. Pambayun

    2013-03-01

    Full Text Available Tujuan dari penelitian ini adalah membuat karbon aktif dari arang tempurung kelapa sesuai dengan SII No.0258 – 79 ; untuk mengetahui karateristik kadar air, kadar abu,  iodine number dan surface area karbon aktif dari arang tempurung kelapa ; untuk mempelajari pengaruh konsentrasi dan jenis aktivator terhadap efisiensi penurunan kandungan konsentrasi fenol (persen removal menggunakan karbon aktif dari arang tempurung kelapa ; menentukan kapasitas optimum penyerapan fenol dengan karbon aktif dari arang tempurung kelapa. Berdasarkan hasil penelitian disimpulkan bahwa karbon aktif dapat dibuat dari arang tempurung kelapa dengan aktivasi kimia ZnCl2 dan Na2CO3 disertai pirolisis pada suhu 700 oC selama 4 jam. Karakteristik karbon aktif yang dihasilkan telah sesuai dengan SII No.0258–79, kadar air sebesar 0,382-1,619%, kadar abu 2,28-7,79%, iodine number 448,02-1599,72 mg/g, surface area 189,630-1900,69 m2/g. Semakin tinggi konsentrasi aktivator maka semakin tinggi persen removal dari fenol yang telah diadsorbsi oleh karbon aktif. Persen removal tertinggi didapat pada karbon aktif dengan zat aktivator Na2CO3 5% dengan persen removal sebesar 99,745%. Kapasitas optimum penyerapan fenol dengan karbon aktif dari arang tempurung kelapa terbaik didapat pada karbon aktif dengan zat aktivator Na2CO3 5% dengan kapasitas serapan sebesar 220,751 mg fenol/gram karbon aktif

  13. Infliximab, azathioprine, or combination therapy for Crohn's disease

    DEFF Research Database (Denmark)

    Colombel, Jean Frédéric; Sandborn, William J; Reinisch, Walter

    2010-01-01

    The comparative efficacy and safety of infliximab and azathioprine therapy alone or in combination for Crohn's disease are unknown.......The comparative efficacy and safety of infliximab and azathioprine therapy alone or in combination for Crohn's disease are unknown....

  14. Smoking, the oral contraceptive pill, and Crohn's disease.

    Science.gov (United States)

    Wakefield, A J; Sawyerr, A M; Hudson, M; Dhillon, A P; Pounder, R E

    1991-08-01

    Both cigarette smoking and the oral contraceptive pill have been implicated as aggravating factors in Crohn's disease. Based upon the recent demonstration of multifocal gastrointestinal infarction in Crohn's disease, a possible pathogenic mechanism for this condition, we propose how smoking and the oral contraceptive pill may potentiate a tendency for focal thrombosis and hence exacerbate the activity of Crohn's disease.

  15. Successful treatment of metastatic Crohn's disease with cyclosporine.

    Science.gov (United States)

    Carranza, Dafnis C; Young, Lorraine

    2008-08-01

    Metastatic Crohn's disease refers to cutaneous granulomatous lesions that are noncontiguous to the gastrointestinal tract. The treatment of cutaneous Crohn's disease is challenging. A patient with metastatic Crohn's disease whose lesions cleared after a 3-month course of cyclosporine is reported.

  16. Adenocarcinoma arising from chronic perianal crohn's disease: a ...

    African Journals Online (AJOL)

    Malignant transformation of perineal fistula in Crohn's disease has rarely been reported. We report a case of Crohn's disease with recurrent perineal fistulas. A 36-year-old male, diagnosed with Crohn's disease at the age of 24, developed adenocarcinoma in an anorectal fistula that had existed for years. He was treated with ...

  17. Uveitis as first manifestation of probably Crohn's disease

    Directory of Open Access Journals (Sweden)

    Ieda Maria Alexandre Barreira

    2012-12-01

    Full Text Available Extraintestinal manifestations of Crohn's disease are common. Although ocular complications of Crohn's disease are infrequent, most ocular manifestations include iritis, uveitis, episcleritis, scleritis and conjuntivitis. We report a patient who developed uveitis two years before diagnose of Crohn's disease.

  18. Altered potassium homeostasis in Crohn's disease

    International Nuclear Information System (INIS)

    Schober, O.; Hundeshagen, H.; Bosaller, C.; Lehr, L.

    1983-01-01

    The total body potassium (TBK), serum potassium, and the number of red blood cell ouabain-binding sites was studied in 94 patients with Crohn's diease. TBK was measured by counting the endogenous 40 K in a whole body counter. TBK was 87%+-13% in 94 patients was Crohn's disease, while in control subjects, it was 97%+-12% (n=24). This significant reduction in TBK was accompanied by normal serum potassium levels (4.4+-0.5 mM). TBK was significantly correlated with the Crohn's disease activity index (r=0.79, n=113, P 3 H-ouabain showed a significant increse in the number of Na-K pumps in Crohn's disease (396+-65, n=27) compared with the control group. 290+-45 (n=24). These results support the suggestion that changes in TBK may regulate the synthesis of Na-K pump molecules. The total body potassium depletion and the need for a preoperative nutritional support in Crohn's disease are discussed. (orig.)

  19. Diagnostic and treatment difficulties in Crohn's disease

    Directory of Open Access Journals (Sweden)

    Ioana Păunică

    2016-11-01

    Full Text Available Inflammatory bowel diseases are related to a special pathology having a great psychosocial and economic impact, being represented by chronic diseases which often affects the adult/ active population and that require a long-term treatment. The incidence of Crohn's disease has recorded an increasing trend amongst the general population. However, the incidence of regional enteritis is somewhat lower than in the case of ulcerohemorrhagic rectocolitis. The highest prevalence of Crohn's disease is encountered among the populations with a high standard of living; the onset of the disease occurs between 15 and 35 years, but there are also rare cases with onset in childbirth or over 60 years of age. Men and women are approximate equally affected by Crohn's disease. The main purpose of the treatment is to keep under control the disease, and to increase the quality of life with the following goals: diminishing intestinal inflammatory lesions, relieving symptoms and inducing remission, preventing relapses and complications, as well as maintaining proper nutrition. Appropriate treatment should be adapted to the different clinical-evolutionary forms of Crohn's disease, the succession of different treatment methods being therefore different. Surgical treatment plays a much more limited role in Crohn's disease than in ulcerhemorrhagic rectocolitis. Operational interventions are frequently followed by relapses, and surgical resections should be limited to macroscopically affected segments.

  20. Gaucher disease: MR evaluation of bone marrow features during treatment with enzyme replacement; Morbus Gaucher: Analyse der Knochenmarkveraenderungen in der MRT waehrend Enzymersatztherapie

    Energy Technology Data Exchange (ETDEWEB)

    Poll, L.W.; Koch, J.A.; Boerner, D.; Cohnen, M.; Jung, G.; Scherer, A.; Moedder, U. [Duesseldorf Univ. (DF). Inst. fuer Diagnostische Radiologie; Dahl, S. vom; Haeussinger, D. [Duesseldorf Univ. (Germany). Klinik fuer Gastroenterologie, Hepatologie und Infektiologie; Willers, R. [Rechenzentrum, Heinrich-Heine-Univ. Duesseldorf (Germany); Niederau, C. [Innere Abt., St. Josef-Hospital Oberhausen, Akademisches Lehrkrankenhaus der Univ. Essen (Germany)

    2001-10-01

    Purpose: Enzyme replacement therapy (ERT) arrests and reverses the hematological and visceral symptoms of adult Gaucher disease, the most frequent lysosomal storage disorder. There are only a few studies available evaluating bone disease during ERT. The aim of this study was to investigate the features of bone marrow (bm) by magnetic resonance imaging (MRI) in these patients during ERT. Materials and Methods: MRI was performed prospectively in thirty adult type I Gaucher patients before and during ERT with a mean follow-up of 3 years. Spin-echo sequences (T{sub 1}/T{sub 2}) of the lower extremities were obtained and the reconversion (response) or lack of reconversion (non-response) to fatty marrow during treatment was analyzed. The morphological features of bm involvement, a homogeneous or non-homogeneous distribution of bm changes and focal bone lesions surrounded by a rim of reduced signal intensity (SI), were analyzed. Results: Infiltration of bm by Gaucher cells is characterized by a reduction of Sl on both T{sub 1}- and T{sub 2}-weighted sequences. Bone marrow responses were seen in 19 patients (63%) during treatment. Focal bone lesions, surrounded by a rim of reduced Sl, did not respond to ERT and correlated with a non-homogenous distribution of bone involvement and splenectomy. (orig.) [German] Ziel: Unter Enzymersatztherapie (enzyme replacement therapy = ERT) zeigen Patienten mit adulter Form des Morbus Gaucher, der haeufigsten lysosomalen Speicherkrankheit, eine deutliche Besserung der haematologischen und visceralen Symptome. Bislang liegen nur wenige Untersuchungen zur Analyse der Knochenveraenderungen waehrend der ERT vor. Ziel war es, die Knochenmarkveraenderungen bei Gaucher-Patienten waehrend der Enzymersatztherapie mit Alglucerase/Imiglucerase in der Magnetresonanztomographie (MRT) zu evaluieren. Material und Methoden: In einer prospektiven Untersuchung wurden 30 adulte Patienten mit gesichertem Morbus Gaucher vor und waehrend der ERT in der MRT

  1. Crohn's disease limited to the vermiform appendix

    DEFF Research Database (Denmark)

    Bak, Martin; Andersen, J C

    1987-01-01

    Thirteen cases of Crohn's disease confined to the vermiform appendix were seen during a 12-year period. They constituted 16.9% of patients with primary resection of the bowel for Crohn's disease in the same period, but only 0.4% of the cases of acute appendicitis. In 10 of the 13 cases...... to approach that of recurrence after resection in other parts of the intestines. Collective review of this and three other relatively large case series gave an estimated recurrence rate of 3.5%. We conclude that in Crohn's disease initially confined to the appendix the course appears to be indolent....... there was marked fibrous thickening of the appendiceal wall, and in 11 there were epithelioid cell granulomas. Appendectomy was performed in all cases. None had postoperative fistula or later manifestations of the disease within the observation time averaging 6.3 years. The recurrence rate was previously believed...

  2. Oestrogens and Crohn's disease: the missed link.

    Science.gov (United States)

    El-Tawil, A M

    2008-06-01

    Observational studies, sometimes, can not provide us with clear answers for very important questions. The answer for a question on whether sex hormones in general, and oestrogen in particular, play some role in inducing and development of Crohn's disease is uncertain. Study design, inclusion criteria, and different formulations of oral contraceptives may partly explain the conflict results of the published reports. But these may be due to the divergent effects of oestrogen, which are based on dose, tissue specificity and cellular environment. This paper is aimed at examining the influence of androgens on the prognosis of Crohn's disease.

  3. Crohn's disease: risk factor for colorectal cancer

    Directory of Open Access Journals (Sweden)

    Sandra Cristina Dias dos Santos

    2017-01-01

    Full Text Available Background: Crohn's disease is an inflammatory disease that can reach any part of the gastrointestinal tract. This disease has been associated with an increased neoplastic risk, including colorectal carcinoma. Objective: The objective of this work is to describe the mechanisms present in two diseases, and that are responsible for the increased risk in Crohn's disease. Methods: A bibliographic research was conducted in PubMed database. In addition to the articles obtained with an inserted query in Pubmed, other references relevant to the topic in question were included. Results: Colorectal cancer risk varies according to the presence of certain factors, and an example of this is Crohn's disease. Chronic inflammation seems to be an important contribution to carcinogenesis, since it creates a microenvironment suitable for the onset and progression of the disease. There are molecular changes that are common to two conditions, thus justifying the fact of Crohn's disease being a risk factor for colorectal carcinoma. The disease control with an appropriate therapy and with surveillance are two ways to control this risk. Conclusions: A proinflammatory state is the cornerstone in the association between Crohn's disease and colorectal carcinoma. The implementation of surveillance strategies allowed a decrease in morbidity and mortality associated with this cancer. Resumo: Introdução: A doença de Crohn é uma doença inflamatória que pode atingir todo o trato gastrointestinal. Esta patologia tem sido associada a um risco neoplásico aumentado, nomeadamente de carcinoma colorretal. Objetivo: O objetivo deste trabalho é descrever os mecanismos responsáveis pelo aumento do risco de carcinoma colorretal na doença de Crohn. Métodos: A pesquisa bibliográfica foi realizada na base de dados Pubmed. Para além dos artigos obtidos com a query inserida na Pubmed, foram também incluídas outras referências com relevância para o tema em questão. Resultados

  4. Inferior mesenteric vein thrombosis in Crohn`s disease: CT diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Coralnick, J.R.; Budin, J.A.; Sedarat, A. [Hackensack Medical Center, NJ (United States)

    1996-01-01

    Mesenteric vein thrombosis has been described in association with such risk factors as coagulation disorders, postoperative dehydration, sepsis, and trauma. CT and ultrasound have greatly facilitated early diagnosis, and the features of superior mesenteric and portal vein thrombosis are well recognized. We present a case of inferior mesenteric vein thrombosis in a patient with Crohn`s disease. To our knowledge, this entity has not been reported in the radiologic literature. 7 refs., 2 figs.

  5. Enfermedad de Crohn con compromiso cutáneo mucoso Crohn disease with cutaneous mucosal involvement

    Directory of Open Access Journals (Sweden)

    R E Achenbach

    2008-03-01

    Full Text Available Comunicamos dos casos de enfermedad de Crohn con compromiso cutáneo-mucoso; el primer paciente con lesiones del denominado "Crohn metastásico" en las piernas y el segundo con importante compromiso en áreas perineo-genital, osteomal y de mucosa bucal, que luego de la remisión de las mismas sufrió una vasculitis leucocitoclásica en miembros inferiores. Los granulomas característicos de la enfermedad de Crohn se hallaron en la pared intestinal y la piel de ambos pacientes.Two cases of Crohn disease are reported, both with cutaneous-mucosal involvement. The first patient showed lesions of the so called "Metastatic Crohn disease" in the legs, whereas the second one presented severe compromise in the perinealgenital, osteomal and oral mucosae. After the remission of the above mentioned, the patient suffered from leucocytoclastic vasculitis in the lower limbs. In both cases, the typical granulomatous lesions of the Crohn disease were found both in the skin and intestinal wall.

  6. Management of postoperative recurrence of Crohn's disease

    NARCIS (Netherlands)

    van Lent, Anja U.; D'Haens, Geert R.

    2013-01-01

    The course of Crohn's disease (CD) is unpredictable and potentially destructive. The percentage of patients requiring surgery at some stage in their disease accumulates to over 70%. After resection of the affected intestine, reappearance of CD occurs in the majority of patients. Prophylactic medical

  7. Exercise and inflammation in pediatric Crohn's disease

    NARCIS (Netherlands)

    Ploeger, H.; Obeid, J.; Nguyen, T.; Takken, T.; Issenman, R.; de Greef, M.; Timmons, B.

    2012-01-01

    We examined inflammatory cells, cytokines and growth factors in response to acute bouts of moderate intensity continuous exercise and high intensity intermittent exercise in youth with Crohn's disease and in healthy matched-controls. 15 patients and 15 controls performed 30 min of cycling at 50% of

  8. Abdominal abscess in Crohn's disease: multidisciplinary management

    NARCIS (Netherlands)

    de Groof, E. Joline; Carbonnel, Frank; Buskens, Christianne J.; Bemelman, Willem A.

    2014-01-01

    Crohn's disease (CD) is characterized by full-thickness inflammation of the bowel. For this reason, perforating complications such as intra-abdominal abscesses or fistulas are common. A concomitant intra-abdominal abscess with active CD of the small bowel is a challenging dilemma for

  9. Infliximab maintenance therapy for fistulizing Crohn's disease

    NARCIS (Netherlands)

    Sands, Bruce E.; Anderson, Frank H.; Bernstein, Charles N.; Chey, William Y.; Feagan, Brian G.; Fedorak, Richard N.; Kamm, Michael A.; Korzenik, Joshua R.; Lashner, Bret A.; Onken, Jane E.; Rachmilewitz, Daniel; Rutgeerts, Paul; Wild, Gary; Wolf, Douglas C.; Marsters, Paul A.; Travers, Suzanne B.; Blank, Marion A.; van Deventer, Sander J.

    2004-01-01

    Infliximab, a monoclonal antibody against tumor necrosis factor, is an effective maintenance therapy for patients with Crohn's disease without fistulas. It is not known whether infliximab is an effective maintenance therapy for patients with fistulas. We performed a multicenter, double-blind,

  10. Impaired innate immunity in Crohn's disease

    NARCIS (Netherlands)

    Comalada, Monica; Peppelenbosch, Maikel P.

    The aetiology of Crohn's disease - a chronic intestinal disorder that involves an immune response against the commensal bacterial flora - remains fiercely debated. Two hypotheses exist: (i) those who think that the disease is caused by genetic defects that produce exaggerated innate responses to the

  11. Quality of Life in Crohn's Disease

    Czech Academy of Sciences Publication Activity Database

    Gabalec, L.; Bureš, J.; Šedová, Michaela; Valenta, Zdeněk

    2007-01-01

    Roč. 56, Suppl. 3 (2007), A138-A138 ISSN 0017-5749. [United European Gastroenterology Week /15./. 27.10.2007-31.10.2007, Paris] Institutional research plan: CEZ:AV0Z10300504 Keywords : quality of life * Crohn´s disease * inflammatory bowel disease Subject RIV: BB - Applied Statistics, Operational Research

  12. 'Microerosions' in rectal biopsies in Crohn's disease

    DEFF Research Database (Denmark)

    Poulsen, Steen Seier

    1984-01-01

    Small (less than 1 mm), superficial erosions ('microerosions') have been observed stereo-microscopically in surface-stained rectal biopsies in Crohn's disease (CD). Biopsy specimens from 97 patients with CD, 225 with ulcerative colitis (UC), and a control material of 161 patients were investigated...

  13. Prevention of postoperative recurrence in Crohn's disease

    NARCIS (Netherlands)

    D'Haens, G.

    1999-01-01

    Postoperative recurrence of Crohn's disease is often inevitable. Certain risk factors such as smoking, young age, and a perforating disease behavior have been identified. Patients with an enhanced risk profile should be treated with mesalamine or with azathioprine, the latter of which has higher

  14. Computed tomography enterography in assessment of Crohn's ...

    African Journals Online (AJOL)

    Background: Monitoring the disease activity in Crohn's disease (CD) may be challenging with endoscopic manoeuvers due to difficulties in reaching the affected areas and being restricted to mucosal lesions, so the existence of a more tolerable and reliable technique will be highly warranted. Objectives: This study aims at ...

  15. Das Verhalten der Okklusionsebene bei kieferorthopädischer Therapie mittels Aktivator, Tip-Edge- oder Herbst-Apparatur : Eine röntgenkephalometrische Langzeituntersuchung

    OpenAIRE

    Müller, Andrea

    2001-01-01

    Ziel der vorliegenden Untersuchung war die Ermittlung des Einflusses von drei verschiedenen kieferorthopädischen Behandlungsmethoden (Aktivator, Tip-Edge- und Herbst-Apparatur mittels partieller (HP) oder totaler (HT) Verankerung) auf die Neigung von drei definierten Okklusionsebenen: Oberkiefer- (OE), Unterkiefer- (UE) und funktionelle (FE) Okklusionsebene. Anhand der Auswertungen von Fernröntgenseitenbildern des Kopfes (FRS) sollten zwei Fragen beantwortet werden: 1) Wie verän...

  16. Crohn Disease: Epidemiology, Diagnosis, and Management.

    Science.gov (United States)

    Feuerstein, Joseph D; Cheifetz, Adam S

    2017-07-01

    Crohn disease is a chronic idiopathic inflammatory bowel disease condition characterized by skip lesions and transmural inflammation that can affect the entire gastrointestinal tract from the mouth to the anus. For this review article, we performed a review of articles in PubMed through February 1, 2017, by using the following Medical Subject Heading terms: crohns disease, crohn's disease, crohn disease, inflammatory bowel disease, and inflammatory bowel diseases. Presenting symptoms are often variable and may include diarrhea, abdominal pain, weight loss, nausea, vomiting, and in certain cases fevers or chills. There are 3 main disease phenotypes: inflammatory, structuring, and penetrating. In addition to the underlying disease phenotype, up to a third of patients will develop perianal involvement of their disease. In addition, in some cases, extraintestinal manifestations may develop. The diagnosis is typically made with endoscopic and/or radiologic findings. Disease management is usually with pharmacologic therapy, which is determined on the basis of disease severity and underlying disease phenotype. Although the goal of management is to control the inflammation and induce a clinical remission with pharmacologic therapy, most patients will eventually require surgery for their disease. Unfortunately, surgery is not curative and patients still require ongoing therapy even after surgery for disease recurrence. Importantly, given the risks of complications from both Crohn disease and the medications used to treat the disease process, primary care physicians play an important role in optimizing the preventative care management to reduce the risk of complications. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  17. Problems in the Surgical Manag,ement of Crohn's Disease of theColon

    African Journals Online (AJOL)

    ,ement of. Crohn's Disease of theColon*. 11. TREATMENT. Medical Treatment of Crohn's Disease. There are no drugs which have been shown specifically to cure Crohn's disease of the large or small bowel, and. SUMMARY. E. C. GRUEBEL ...

  18. [Corneoscleral involvement in Crohn's disease. Discussion of a case].

    Science.gov (United States)

    Sahel, J; De Korvin, H; Annonier, P; Jouin, H; Brini, A

    1986-01-01

    The authors are reporting an unusual case of scleral involvement in a case of Crohn's disease. A distinctive subepithelial keratopathy developed which though uncommon, should be regarded as a distinct clinical sign of Crohn's disease. The exact situation of ocular lesions among extra-intestinal complications of Crohn's disease, their incidence and aspects are discussed. The possible immunological basis of these manifestations, still unconvincing, is exposed and related to local deposition of antigen-antibody complexes.

  19. Persistent erythema and edema of the midthird and upper aspect of the face (morbus morbihan): evidence of hidden immunologic contact urticaria and impaired lymphatic drainage.

    Science.gov (United States)

    Wohlrab, Johannes; Lueftl, Matthias; Marsch, Wolfgang C

    2005-04-01

    A persistent erythema and edema of the midthird and upper aspect of the face, which bears some resemblance to Melkersson-Rosenthal syndrome and rosaceous lymphedema, has been characterized as morbus morbihan (MM) by French dermatologists. The disease of yet unknown cause starts with recurrent facial edema of short duration, which ultimately leads to persistent swelling after a period of weeks or months. We recruited 6 patients with MM and acquired their history, routine blood tests, and individual UV light tolerability. To check for contact allergies the allergen patch test and the open epicutaneous patch test were performed. To objectify the skin conditions laser Doppler flowmetry and 20-MHz ultrasound were used. Five patients with similar symptoms, but with definitely transient facial erythema and edema caused by proven contact urticaria on cosmetics served as a comparison group. In all patients, routine blood tests and UVA/UVB light tests showed no pathologic results. Observations of 6 patients with MM revealed the common feature of a clinically relevant immunologic contact urticaria caused by various cosmetic ingredients, which could be diagnosed in all of them. Delayed resorption of the acute edema and prolonged inflammation were shown by laser Doppler flowmetry and 20-MHz ultrasound in the affected skin areas in patients with MM after induction of immunologic contact urticaria by a cosmetic ingredient. Strict avoidance of cosmetics yielded a remarkable clinical benefit in the follow-up examinations. We conclude that recurrent and possibly subclinical inflammation caused by immunologic contact urticaria in conjunction with a locally pre-existing lowered lymphatic drainage plays a crucial role in the evolution of MM.

  20. [Vedolizumab in the treatment of Crohn's disease].

    Science.gov (United States)

    Gisbert, Javier P; Domènech, Eugeni

    2015-05-01

    The anti-TNFα agents, infliximab and adalimumab, are effective in the treatment of Crohn's disease. Nevertheless, approximately one-third of patients do not initially respond to treatment and a substantial proportion experience loss of efficacy or intolerance to these drugs. Therefore, new drugs are obviously required, aimed at therapeutic targets other than TNFα. Notable among the therapeutic alternatives are drugs targeting integrins. Vedolizumab is a humanized monoclonal antibody that binds specifically to the α4β7 integrin, inhibiting T lymphocytes from binding to adhesion molecules (MAdCAM-1), which are expressed mainly in the small bowel and colon. Consequently, and unlike natalizumab, vedolizumab can be considered a specific intestinal immunosuppressant, making it especially attractive. The present article reviews the role of vedolizumab in Crohn's disease, paying special attention to its pharmacokinetic/pharmacodynamic properties, indications, effectiveness, and safety. Copyright © 2014 Elsevier España, S.L.U. and AEEH y AEG. All rights reserved.

  1. [Macrocheilia, granulomatous cheilitis and Crohn's disease].

    Science.gov (United States)

    Portela Romero, M; Ventura Victoria, M A; Iglesias Otero, M; do Muiño Joga, M; Bugarín González, R

    2013-01-01

    Granulomatous cheilitis is a rare disease included among the orofacial granulomatoses. It is characterized by a idiopathic chronic inflammation of the labial mucosa (macrochelia), which takes the form of episodic and progressive outbreaks. In 10% of patients, it is associated with Crohn's disease. We report the presentation, evaluation and treatment of a case of granulomatous cheilitis which appearted two years after the onset of Crohn's disease. We conclude that granulomatous cheilitis is rare in children, with few reported cases, although probably underdiagnosed because of lack of awareness. The diagnosis of granulomatous cheilitis is clinical, although the histological evaluation is a determining factor. After making the diagnosis a comprehensive assessment of the patient is recommended, to rule out the other associated syndromes described in the literature. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  2. Looking in the mouth for Crohn's disease.

    LENUS (Irish Health Repository)

    Rowland, Marion

    2012-02-01

    It is widely acknowledged among gastroenterologists that the oral cavity may be involved in Crohn\\'s disease (CD). However, the specific manifestations are poorly appreciated. Although oral aphthous ulceration is probably not diagnostically useful in patients with suspected CD, disease-specific manifestations do occur and are particularly common in children presenting with CD. These manifestations can be subtle, often are subclinical, yet commonly harbor diagnostically useful material (granulomas). Orofacial granulomatosis (OFG) is conventionally used to describe patients with overt oral disease without obvious involvement of the gastrointestinal tract. However, many patients with OFG have subclinical intestinal CD or will progress to develop overt intestinal CD with time. The management of severe oral disease is challenging and lacks a clear evidence base.

  3. Looking in the mouth for Crohn's disease.

    LENUS (Irish Health Repository)

    Rowland, Marion

    2010-02-01

    It is widely acknowledged among gastroenterologists that the oral cavity may be involved in Crohn\\'s disease (CD). However, the specific manifestations are poorly appreciated. Although oral aphthous ulceration is probably not diagnostically useful in patients with suspected CD, disease-specific manifestations do occur and are particularly common in children presenting with CD. These manifestations can be subtle, often are subclinical, yet commonly harbor diagnostically useful material (granulomas). Orofacial granulomatosis (OFG) is conventionally used to describe patients with overt oral disease without obvious involvement of the gastrointestinal tract. However, many patients with OFG have subclinical intestinal CD or will progress to develop overt intestinal CD with time. The management of severe oral disease is challenging and lacks a clear evidence base.

  4. A stress management programme for Crohn's disease.

    Science.gov (United States)

    García-Vega, E; Fernandez-Rodriguez, C

    2004-04-01

    The present study was designed to assess the effectiveness of techniques of behavioural assessment and treatment of Crohn's disease (CD). On the assumption that stress events have a pronounced influence on the life of Crohn's patients, we proposed stress management treatment. This is intended to control stress and improve patients' personal and social competence. Forty-five patients with Crohn's disease were randomly assigned to one of three treatment groups, two experimental groups: stress management and self-directed stress management, and a control group: conventional medical treatment. The subjects underwent eight individual sessions which were specific to each condition. All subjects completed symptom monitoring diaries. The subjects who received training in stress management experienced a significant post-treatment reduction of tiredness (P stress management experienced a significant reduction in tiredness (P < 0.1) and abdominal pain (P < 0.5). No significant changes were observed in symptomatology in the conventional medical treatment group. Similar results were obtained in the 12 month follow-up.

  5. Percutaneous abscess drainage in Crohn's disease

    International Nuclear Information System (INIS)

    Strotzer, M.; Manke, C.; Feuerbach, S.; Lock, G.; Bregenzer, N.; Schoelmerich, J.

    1998-01-01

    Purpose: To evaluate the success of percutaneous, CT-guided abscess drainage (PAD) in patients with Crohn's disease. Methods: Within the last 5 years 8 patients with Crohn's disease were treated by PAD for intra-abdominal abscesses. A fistula was determined to be the cause in 4 patients. The abscesses arose spontaneously in 7 patients while one patient had a postperative abscess. We used single lumen 10F- and double lumen 12F- and 14F-catheters for drainage (duration of drainage 8-20 days). Results: In all cases the abscess was successfully drained by PAD. However, an operation-free interval of at least three months was achieved in only two patients. A healing of the fistula was not attained in any of the 4 patients with a proven fistula. No enterocutaneous fistulas arose within the course of PAD. Conclusions: PAD is also useful for patients with Crohn's disease since it improves the starting situation for the necessary operative interventions. In most cases (especially with enterogenic fistulas), however, a long-lasting therapeutic result cannot be expected. (orig.) [de

  6. The auditory organ: active amplifier and highly sensitive measuring system; Das Hoerorgan: Aktiver Schallverstaerker und hochempfindliches Messsystem

    Energy Technology Data Exchange (ETDEWEB)

    Kafka-Luetzow, A. [Univ. Wien (Austria). Inst. fuer Allgemeine und Vergleichende Physiologie

    1997-12-01

    The present paper provides a brief review on topical issues of auditory physiology. Recent data on transduction mechanism and adaptation in hair cells as well as on the possible role of outer hair cells in amplifying basilar membrane motion are presented. Strategies of present physiological research in dealing with sensorineural deafness are discussed. (orig.) [Deutsch] Neuere Erkenntnisse der Hoerphysiologie haben einige der Mechanismen aufgezeigt, welche fuer die hohe Empfindlichkeit, die gute Frequenzdiskrimination und das bei Lautstaerkenerhoehung nicht lineare Verhalten dieses Sinnessystems verantwortlich sein duerften. Demnach haben die 2 Typen akustischer Sinneszellen voellig unterschiedliche Funktionen. Nur ein Typ, die Inneren Haarzellen, duerften Sensoren im engeren Sinn sein, indem sie die wesentliche akustische Information an das Zentralnervensystem liefern. Der zweite Typ, die Aeusseren Haarzellen scheinen vornehmlich als Eingangsverstaerker zu fungieren. Sie setzen die bei Schalleinwirkung auf das Ohr an ihrer Membran auftretende Potentialaenderung in rasche Laengskontraktionen um. Damit verstaerken sie die durch die Schalleinwirkung ausgeloesten Basilarmembranschwingungen. Ausserdem duerften die von den Aeusseren Haarzellen aktiv erzeugten Schwingungen die Quelle der im aeusseren Gehoergang messbaren `otoakustischen Emissionen` sein. Die gegenstaendliche Uebersicht fasst den aktuellen Wissensstand ueber den Transduktionsmechanismus und die Elektromotilitaet der Haarzellen zusammen. Darueber hinaus wird die moegliche auditive Funktion von Haarzellen im Gleichgewichtssystem sowie Befunde aus der in den letzten Jahren entbrannten Diskussion um eine allfaellige Regeneration von Haarzellen aus dem vestibulocochleaeren System von adulten Saeugern diskutiert. Im Zusammenhang mit der Druckausbreitung im Innenohr werden einige morphologische Besonderheiten insbesonders der cochleaeren Fluessigkeitsraeume und ihrer Verbindungen sowie deren funktionelle

  7. [Wilson disease--evaluation of disease-related topics through the eyes of patients by patient-generated paintings--a cooperative study with the German patient organisation Verein morbus Wilson e. V].

    Science.gov (United States)

    Schäfer, M; Weiss, K H; Merle, U; Stremmel, W; Rasp, B

    2010-10-01

    The importance of disease-related topics can vary widely between patients and doctors. Patient organisations such as the German Verein Morbus Wilson e. V. can overcome this discrepancy. The goal of the present cooperative study was the collection of topics important to Wilson patients by asking patients to generate paintings about their disease. Patients with Wilson disease were asked by mail to draw paintings about their disease and to donate them to the Verein Morbus Wilson e. V. 32 paintings from 27 patients were donated. The majority of the patients added written comments to their art work. Disease-related topics included in the paintings were as follows: psychological work-up of the disease 33 % (n = 11), presentation of affected organs (liver/brain) 22 % (n = 6), therapy 19 % (n = 5), diagnostic path 15 % (n = 4), inheritance 15 % (n = 4), copper-related diet 11 % (n = 3). 33 % (n = 11) of the paintings were composed of two parts reflecting before and after the disease or presenting the individual time course of the disease. Psychological aspects of disease acceptance are the prominent topic in the paintings. The timepoint of diagnosis is experienced as major change in life. The paintings enable both the patient organisation and the caretakers to put more focus on the psychological aspects of the disease. Asking for paintings opens a new channel for patient-physician contacts and produces a feeling of interest and competence in patients. © Georg Thieme Verlag KG Stuttgart · New York.

  8. Samtidig debut af kollagen colitis og mb. Crohn

    DEFF Research Database (Denmark)

    Nøjgaard, Camilla; Nielsen, Preben Løvgreen; Rumessen, Jüri J

    2002-01-01

    A case report of a 69-year-old man with synchronous onset and diagnosis of collagenous colitis and Crohn's disease is discussed.......A case report of a 69-year-old man with synchronous onset and diagnosis of collagenous colitis and Crohn's disease is discussed....

  9. Maintenance therapy with certolizumab pegol for Crohn's disease

    DEFF Research Database (Denmark)

    Schreiber, Stefan; Khaliq-Kareemi, Mani; Lawrance, Ian C

    2007-01-01

    pegol maintenance therapy in adults with moderate-to-severe Crohn's disease. As induction therapy, 400 mg of certolizumab pegol was administered subcutaneously at weeks 0, 2, and 4. Patients with a clinical response (defined as reduction of at least 100 from the baseline score on the Crohn's Disease...

  10. Ustekinumab induction and maintenance therapy in refractory Crohn's disease

    NARCIS (Netherlands)

    Sandborn, William J.; Gasink, Christopher; Gao, Long-Long; Blank, Marion A.; Johanns, Jewel; Guzzo, Cynthia; Sands, Bruce E.; Hanauer, Stephen B.; Targan, Stephan; Rutgeerts, Paul; Ghosh, Subrata; de Villiers, Willem J. S.; Panaccione, Remo; Greenberg, Gordon; Schreiber, Stefan; Lichtiger, Simon; Feagan, Brian G.; Haas, T.; Kaser, A.; Vogelsang, H.; Brown, S.; Florin, T.; Gibson, P. G.; Hetzel, D.; Leong, R.; Pavli, P.; Radford-Smith, G.; Sparrow, M.; Baert, F.; D'Haens, G.; D'Heygere, F.; Franchimont, D.; Louis, E.; Mana, F.; Moreels, T.; Vermeire, S.; Anderson, F.; Axler, J.; Greenbloom, S.; Bitton, A.; Fedorak, R. N.; Larkai, E.; Marshall, J.; Singh, R.; Abitbol, V.; Allez, M.; Lemann, Marc; Bonaz, B.; Colombel, J.-F.; Dupas, J.-L.; Hebuterne, X.; Laharie, D.; Lerebours, E.; Moreau, J.; Bokemeyer, B.; Holler, B.; Howaldt, S. P.; Krummenerl, T.; Kucharzik, T.; Ochsenkühn, T.; Raedler, A.; Schiefke, I.; Seidler, U.; Sturm, A.; Zeitz, M.; Eliakim, A.; Fishman, S.; Konikoff, F. M.; Lavy, A.; Niv, Y.; Nussinson, E.; Rachmilewitz, D.; Andriulli, A.; Annese, Vito; Biancone, L.; Corazza, G. R.; Danese, S.; Sturniolo, G. C.; Terrosu, G.; Sorrentino, D.; Hommes, D. W.; Jansen, J. M.; Otten, M. H.; Pierik, M.; Ponsioen, C. Y.; Stokkers, Pieter; van Bodegraven, A. A.; van der Woude, J.; Calvet Calvo, X.; Casellas, F.; Garcia López, S.; Garcia-Planella, E.; Ginard-Vincens, D.; López San Román, A.; Muñoz Nuñez, F.; Pérez Gisbert, J.; Vera, M. I.; Rodrigo, J.; Riestra-Menendez, S.; Arnott, I.; Bloom, S.; Campbell, S. S.; Harbord, M. W.; Mansfield, J. C.; Nwokolo, C.; Parkes, M.; Probert, C. S.; Aberra, F. N.; Abraham, B. P.; Abreu, M. T.; Amontree, J. S.; Barish, C. F.; Barto, A. E.; Behm, B.; Birbara, C. A.; Bologna, S.; Dryden, G. W.; Eisner, M. S.; Ertan, A.; Fogel, R.; Gagneja, H. K.; Ginsburg, P.; Goff, J. S.; Gordon, G.; Hamilton, J. W.; Hanson, J. S.; Hardi, R.; Hemaidan, A.; Higgins, P.; Holderman, W.; Hornbuckle, K.; Ibegbu, E.; Isaacs, K. L.; Katz, J. A.; Katz, S.; Kaufman, B. P.; Kavanaugh, A. F.; Khurana, S. K.; Lashner, B.; Lawrence, S.; Hansen, R. N.; Lee, S.; Leighton, J. A.; Leman, B. I.; Levenson, S. D.; Lowe, J. E.; Marcuard, S. P.; Matsuyama, R. M.; McNair, A. E.; Melmed, G.; Miller, K. M.; Miner, P. B.; Mutlu, E. A.; Keshavarzian, A.; Narayen, V.; Noar, M. D.; Patel, P. H.; Patrick, T. J.; Peck, A.; Peterson, K. A.; Phillips, R. W.; Picco, M. F.; Randall, C.; Richards, R. J.; Safdi, M. A.; Scherl, E. H.; Schwartz, D. A.; Schwartz, H. I.; Schwartz, J. L.; Sedghi, S.; Shafran, I.; Siegel, C. A.; Sninsky, C. A.; Stern, M.; Suiter, D.; Swaminath, A.; Terdiman, J. P.; Mahadevan, Uma; Thomson, C.; Valentine, J.; Vasudeva, R.; Vecchio, J. A.; Wolf, D. C.; Yajnik, V.; Yabkowski, J.; Yen, E.

    2012-01-01

    In patients with Crohn's disease, the efficacy of ustekinumab, a human monoclonal antibody against interleukin-12 and interleukin-23, is unknown. We evaluated ustekinumab in adults with moderate-to-severe Crohn's disease that was resistant to anti-tumor necrosis factor (TNF) treatment. During

  11. Infliximab (Remicade), a new biological treatment for Crohn's disease

    NARCIS (Netherlands)

    D'Haens, G. R.

    1999-01-01

    Tumour necrosis factor plays a pivotal role in Crohn's disease intestinal inflammation. Blocking this cytokine by means of the chimeric monoclonal antibody infliximab has led to a rapid reduction in mucosal inflammation. More than 65% of refractory Crohn's disease patients treated with infliximab

  12. Radiological aspects of Crohn's disease in small intestine: iconographic assay

    International Nuclear Information System (INIS)

    Barros, Nestor de; Juliano, Adriana G.; Polizini, Jose M.R.; Rejtman, Debora; Cerri, Giovanni Guido; Rocha, Manoel de Souza

    1999-01-01

    The authors present the radiological features of Crohn's disease in small intestine as ways of differential diagnosis of others diseases of duodenum and adjacent organs. In this differentiation or confirmation of Crohn's disease the US and TC have proven to be clinically efficacious in the identification of lesions

  13. Multiple doses of intravenous interleukin 10 in steroid-refractory Crohn's disease. Crohn's Disease Study Group

    NARCIS (Netherlands)

    van Deventer, S. J.; Elson, C. O.; Fedorak, R. N.

    1997-01-01

    Interleukin 10 (IL-10) is a cytokine with immunosuppressive and anti-inflammatory activities. Gene-targeted IL-10-deficient mice develop a chronic intestinal inflammatory disease that is reminiscent of Crohn's disease. The present double-blind randomized multicenter trial was designed to evaluate

  14. Active Crohn's disease is associated with low vitamin D levels

    DEFF Research Database (Denmark)

    Jørgensen, Søren Peter; Hvas, Christian Lodberg; Agnholt, Jørgen

    2013-01-01

    BACKGROUND AND AIMS: Crohn's disease prevalence increases with increasing latitude. Because most vitamin D comes from sunlight exposure and murine models of intestinal inflammation have demonstrated beneficial effects of 1,25-(OH)(2) vitamin D treatment, we hypothesised that Crohn's disease...... activity is associated with low vitamin D levels. METHODS: In a cross-sectional study of 182 CD patients and 62 healthy controls, we measured serum 25-OH vitamin D. Stratified analysis was used to compare 25-OH vitamin D levels with Crohn's disease activity index, C-reactive protein, smoking status, intake...... of oral vitamin D supplements and seasonal variation in CD patients and healthy controls. RESULTS: Serum 25-OH vitamin D was inversely associated with disease activity: Median 25-OH vitamin D levels of Crohn's disease in remission, mildly, and moderately active diseases evaluated by Crohn's disease...

  15. Disease outcome for children who present with oral manifestations of Crohn's disease.

    LENUS (Irish Health Repository)

    Hussey, S

    2011-06-01

    To describe the outcome for children with oral Crohn\\'s disease (OCD) at diagnosis, and to determine if there was a difference in the Paediatric Crohn\\'s Disease Activity Index (PCDAI) scores between those with and those without oral lesions at follow-up.

  16. Radiotherapy in early stage dupuytren's contracture; Die Radiotherapie des Morbus Dupuytren im Fruehstadium. Langzeitresultate nach einer medianen Nachbeobachtungszeit von 10 Jahren

    Energy Technology Data Exchange (ETDEWEB)

    Adamietz, B.; Sauer, R. [Erlangen-Nuernberg Univ., Erlangen (Germany). Klinik und Poliklinik fuer Strahlentherapie; Keilholz, L. [Erlangen-Nuernberg Univ., Erlangen (Germany). Klinik und Poliklinik fuer Strahlentherapie; Praxis fuer Strahlentherapie, Klinikum Fuerth (Germany); Gruenert, J. [Abt. fuer Plastische und Handchirurgie der Chirurgischen Universitaetsklinik Erlangen-Nuernberg, Erlangen (Germany)

    2001-11-01

    Purpose: In early stage Dupuytren's contracture radiotherapy was applied to prevent disease progression. Long-term results and late toxicity of this treatment were evaluated in a retrospective analysis. Patients and Methods: Between 1982 and 1994, 99 patients (176 hands) received orthovoltage radiotherapy, which consisted of two courses with 5 x 3 Gy (total dose: 30 Gy, daily fractionated; 120 kV, 4 mm Al), separated by a 6 to 8-week pause. The Dupuytren's contracture was staged according to the classification of Tubiana et al. The long-term outcome was analyzed at last follow-up between July and November 1999. The median follow-up was 10 years (range 7-18 years). Late toxicity was assessed using the LENT-SOMA criteria. Results: In Stage N 84% and Stage N/I 67% of cases remained stable. 65% of the cases in Stage I and 83% in Stage II showed progressive nodules and cords. In case of progression we saw no complications after a second radiotherapy or salvage operation. Conclusion: Radiotherapy effectively prevents disease progression for early stage Dupuytren's contracture (Stage N, N/I). Moreover, in case of disease progression despite radiotherapy salvage surgery is still feasible. (orig.) [German] Hintergrund: Im Fruehstadium des Morbus Dupuytren wird die externe Radiotherapie mit dem Ziel eingesetzt, den progressiven Verlauf der Erkrankung zu verhindern. Eine aktuelle Langzeitverlaufskontrolle soll die Ergebnisse und Nebenwirkungen der Radiotherapie darstellen. Patienten und Methode: Wir untersuchten 99 Patienten (176 Haende), welche sich von 1982-1994 einer Radiotherapie an unserer Klinik unterzogen. Jeder Patient erhielt zwei Serien einer Radiotherapie mit jeweils 5 x 3 Gy (Gesamtdosis 30 Gy, 120 kV, 4 mm Al, Bestrahlungspause von 6-8 Wochen nach 15 Gy). Die Beugekontraktur wurde nach Tubiana et al. eingeteilt. Von Juli bis November 1999 erfolgte nach einer medianen Nachbeobachtungszeit von 10 Jahren (7-18 Jahre) eine Kontrolluntersuchung. Die

  17. Crohn's disease lymphadenopathy: MR imaging findings

    International Nuclear Information System (INIS)

    Gourtsoyianni, Sofia; Papanikolaou, Nickolas; Amanakis, Emmanouil; Bourikas, Leonidas; Roussomoustakaki, Maria; Grammatikakis, John; Gourtsoyiannis, Nicholas

    2009-01-01

    Purpose: To assess mesenteric lymph nodes in patients with different Crohn's disease subtypes identified on MR Enteroclysis. Materials and methods: Thirty-four patients, categorized into three different Crohn's disease subgroups, underwent MR Enteroclysis. A high resolution coronal true FISP sequence with fat saturation was applied to assess mesenteric lymph node anatomic distribution, size and shape. Their enhancement ratio (ER) was calculated by dividing signal intensity of each node to signal intensity of nearby vessel on T1 weighted FLASH images, acquired 75 s after intravenous administration of gadolinium. A one-way analysis of variance statistical test was applied to investigate any significant differences regarding mean ER among different disease subgroups. Results: Two hundred and eighty-three mesenteric lymph nodes were assessed, 231 in patients with active inflammatory (AI) disease, 36 in patients with fibrostenotic (FS) and 16 in patients with fistulizing/perforating (FP) disease. Maximum and minimum diameters were 3.2 and 0.3 cm, respectively. 75% of the lymph nodes presented with an oval shape. The majority were identified as being ileocolic (34%) and paracolic (31%). AI subgroup lymph nodes presented with the highest mean ER (0.783 ± 0.17) followed by FP (0.706 ± 0.1) and FS subgroup (0.652 ± 0.17) lymph nodes. The differences in mean values of ER of mesenteric lymph nodes between AI and FS subtypes were statistically significant (p < 0.0001), while mean ER between nodes of FP and the other two subtypes did not present statistically significant differences. Conclusion: ER of mesenteric lymph nodes identified on MR Enteroclysis may vary across different subtypes of Crohn's disease. Such differences may be valuable in clinical practice.

  18. Intestinal tuberculosis simulating Crohn's disease: Differential diagnosis.

    Science.gov (United States)

    García-Morales, Natalia; García-Campos, María; Cordón, Gisselle; Iborra, Marisa

    2018-03-13

    Tuberculosis is a public health's problema in the world. Its incidence is increasing in our environment due to inmigration and the use of inmunosupressors. It's a systemic disease that can affect rarely the gastrointestinal tract. We should take into account the epidemiological and clinical context of each patient, because the differential diagnosis is broad. It can mimic with other diseases, such as Crohn's disease. We report a case of intestinal tuberculosis, and underline the importance of the differential diagnosis of these patients. Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

  19. Aktiv Undervisning: Et Flipped Læringsdesign af Kursusmoduler på Videregående Uddannelser

    Directory of Open Access Journals (Sweden)

    Mirnes Tulic

    2017-03-01

    Full Text Available Artiklens formål er at undersøge potentialerne i anvendelse af digitale værktøjer i didaktisk design af kursusmoduler på videregående uddannelser med henblik på at fremme læringen og optimere undervisningstiden. Det antages at den digitale revolution, som i dag har stor indflydelse på vores hverdag, har ændret den måde vi tilgår, skaber, deler og udveksler viden, og som konsekvens er den traditionelle forelæsning ikke længere er velegnet til dybdelæring. Der tages udgangspunkt i et kursusmodul ved ingeniøruddannelsen Arkitektur, Design og Mediateknologi, der omhandler bærende konstruktioner i arkitektur. Kurset er struktureret efter den problem- og projekt-baserede lærings-model og intentionen er at udvikle en ny undervisningsform der tager responsen i betragtning, som er modtaget af undervisere og studerende gennem kvalitative og kvantitative undersøgelser af nuværende forhold på kursusmodulet. Artiklen præsentere en ’flipped learning’ tilgang der anvender onlineundervisnings teknologier i kombination med ’gamification’ principper til at danne et stimulerende online læringsmiljø. Ved anvendelse af online undervisning til teoretiske principper og begreber, er det hensigten at transformere den traditionelle præsentationslektion til aktiv læring i forelæsningslokalet, baseret på dialog i plenum.

  20. [New knowledge of the pathogenesis of Crohn's disease].

    Science.gov (United States)

    Ambrůzová, B; Rédová, M; Michálek, J; Sachlová, M; Slabý, O

    2012-04-01

    Crohns disease is a complex chronic inflammatory disease of the gastrointestinal tract with multifactorial pathogenesis. Over the recent years, there has been rather a sharp increase in the incidence of Crohn's disease and, even though this disease had been known for some time, the cause remains unknown. Studies exploring genetic basis of Crohn's disease have provided new knowledge of the pathogenesis of this disease, suggesting that this may be associated with a failure of mechanisms behind symbiosis of gut microflora and intestinal mucosal immune system. Crohn's disease seems to be caused by inadequate immune response to intestinal flora in genetically predisposed individuals. Crohn's disease has been linked to a number of genes. Many of them are related to the modulation of non-specific immune response, defects of which are considered to be key in Crohn's disease pathogenesis. The aim of this review paper is to summarize the new knowledge on the pathogenesis of Crohn's disease at the level of polymorphisms of the NOD2, ATG16L1 genes and the IL23-Th17-lymfocytes signalling pathway genes and to consider further research directions in this disease.

  1. Malignant peritoneal mesothelioma and Crohn disease.

    Science.gov (United States)

    Butnor, Kelly J; Pavlisko, Elizabeth N; Sporn, Thomas A; Roggli, Victor L

    2017-03-01

    Mesothelial reaction simulating peritoneal diffuse malignant mesothelioma (MM) has been reported in the setting of Crohn ileitis. To our knowledge, peritoneal MM arising in patients with inflammatory bowel disease (IBD) has not been reported. The purpose of this study is to report the clinicopathological characteristics of patients with peritoneal MM and IBD. A database of approximately 3800 MM was reviewed for cases of MM in patients with IBD. Three patients (0.08%) with peritoneal MM and Crohn disease (CD) were identified, including two women and one man ranging in age from 56 to 65 years. All had a long-standing history of diarrhoea and an established diagnosis of CD of 3 years or greater duration. Two had epithelial MM and one had biphasic MM. Only one had documented asbestos exposure. Peritoneal MM occurs rarely in patients with IBD, but interestingly, has only been observed in the setting of CD and not in patients with ulcerative colitis. Chronic inflammation has been associated with the development of MM in rare instances and these three cases suggest that CD with transmural inflammation may also be a precursor. The precise role of CD-related transmural inflammation in the carcinogenesis of peritoneal MM remains to be determined. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  2. Magnetic Resonance enteroclysis imaging of Crohn's

    International Nuclear Information System (INIS)

    Masselli, Gabriele; Brizi, Maria Gabriella; Menchini, Laura; Minordi, Laura; Vecchioli Scaldazza, Amorino

    2005-01-01

    Aim.The aim of our prospective study was to evaluate the diagnostic accuracy of MR Enteroclysis (MRE) to assess the extension and complications of Crohn's Disease (CD) in comparison with conventional enteroclysis (CE). Materials and methods. The study comprised 30 consecutive patients affected by Crohn's disease (18 women and 12 men; age range 16-76, mean age 40.6 years), who underwent conventional and MR enteroclysis. The MR enteroclysis protocol includes three sequences: coronal and axial FIESTA and ssFSE sequences and T1-3D-FSPGR sequences before and after intravenous injection of gadolinium, acquired after administration of 1.6-21 of iso-osmolar polyethylene glycol solution via a naso jejunal catheter. Two radiologists blindly scored each sequence for opacification of the lumen, small bowel distension and image quality and evaluated the following parameters: presence of wall ulcers, pseudo polyps, stenoses and fistulae. Results. The accuracy of the FIESTA sequence was significantly higher (p [it

  3. MRI diagnosis of small intestinal Crohn's disease

    International Nuclear Information System (INIS)

    Ren Xiaojun; Zhang Shizheng; Zhang Qiaowei; Liu Hai

    2004-01-01

    Objective: To investigate the value of magnetic resonance imaging (MRI) in the diagnosis of small intestinal Crohn's disease. Methods: The MRI findings in 13 cases of small intestinal Crohn's disease proved by surgery and pathology were analyzed retrospectively. The patients included 12 men and 1 woman, and their age ranged from 17 to 64 years. The MR images were reviewed for the number, location, and mural thickness of diseased bowel segments, for the ratio of signal intensity of diseased bowel wall to normal bowel wall after the IV administration of Gd-DTPA or enhanced ratio of diseased bowel wall, and for the complications (phlegmon, inflammatory mass, abscess, and fistula). Six patients received air-infused MR enteroclysis-enhanced scan was performed directly in the fat saturated coronal and axial plane after about 1000 ml of air was infused into small bowel through a nasoenteric catheter. Another 7 patients received small intestinal hydro-MRI--MR images were obtained in fat saturated enhanced coronal and axial plane as well as in unenhanced coronal plane.Twenty mg of IV anisodamine was given to reduce peristalsis in all patients, and fat saturation was used in all sequences. Results: The diseased bowel segment of every case was demonstrated in MRI. The sensitivity was 100%. Thirty-six inflammatory segments were revealed in all (mean 2.8 segments per patient). The MRI findings of small intestinal Crohn's disease were that the enhancement of diseased bowel wall increased significantly. The ratios of signal intensity of diseased bowel wall to normal bowel wall were 1.9-2.5 (mean, 2.1) in the group of air-infused enteroclysis. The ratios of signal intensity of diseased bowel wall to normal bowel wall were 1.3-2.9 (mean, 1.9) and the enhanced ratios of diseased bowel wall were 96%-223% (mean, 133%), but the enhanced ratios of normal bowel wall were 31%-78% (mean, 59%). Thirty-three segments (92%) of diseased bowel wall thickened (thickness between 5-27 mm), and the

  4. Symptomatic Patency Capsule Retention in Suspected Crohn's Disease

    DEFF Research Database (Denmark)

    Rasmussen, Bjørn; Nathan, Torben; Jensen, Michael Dam

    2016-01-01

    The main limitation of capsule endoscopy is the risk of capsule retention. In patients with suspected Crohn's disease, however, this complication is rare, and if a small bowel stenosis is not reliably excluded, small bowel patency can be confirmed with the Pillcam patency capsule. We present two...... patients examined for suspected Crohn's disease who experienced significant symptoms from a retained patency capsule. Both patients had Crohn's disease located in the terminal ileum. In one patient, the patency capsule caused abdominal pain and vomiting and was visualized at magnetic resonance enterography...

  5. Septic arthritis as a presentation of Crohn's disease.

    Science.gov (United States)

    Zaidi, R; Dala-Ali, B; Dalton, D J N

    2011-09-01

    A 42-year-old man with colonic Crohn's disease presented to the orthopaedic department with septic arthritis of the knee with frank intra-articular pus, which persisted despite repeated joint washouts. This coincided with a symptomatic flare of his colonic Crohns. Imaging revealed a fistulous connection from the proximal sigmoid colon into the pelvis, a psoas abscess, myositis of the musculature around the left pelvic girdle and left thigh and two focal collections almost surrounding the distal femur. The knee symptoms only settled after laparotomy and resection of the diseased sigmoid colon and fistula. This case report demonstrates an unusual presentation of fistulating Crohns disease as septic arthritis.

  6. MR enterography of ileocolovesicular fistula in pediatric Crohn disease

    International Nuclear Information System (INIS)

    Sakala, Michelle D.; Dillman, Jonathan R.; Ladino-Torres, Maria F.; McHugh, Jonathan B.; Adler, Jeremy

    2011-01-01

    Crohn disease, a form of chronic inflammatory bowel disease is characterized by discontinuous inflammatory lesions of the gastrointestinal tract, has a variety of behavioral patterns, including penetrating or fistulous disease. While magnetic resonance enterography (MRE) excellently depicts inflamed bowel segments, it can also be used to assess for a variety of Crohn-disease-related extraintestinal complications, including fistulae. We present the MRE findings of a complex ileocolovesicular fistula in a 14-year-old boy with Crohn disease, where the fistulous tract to the urinary bladder was best delineated on precontrast T1-W imaging because of the presence of fecal material. (orig.)

  7. Maintenance therapy with certolizumab pegol for Crohn's disease

    DEFF Research Database (Denmark)

    Schreiber, Stefan; Khaliq-Kareemi, Mani; Lawrance, Ian C

    2007-01-01

    pegol maintenance therapy in adults with moderate-to-severe Crohn's disease. As induction therapy, 400 mg of certolizumab pegol was administered subcutaneously at weeks 0, 2, and 4. Patients with a clinical response (defined as reduction of at least 100 from the baseline score on the Crohn's Disease....... CONCLUSIONS: Patients with moderate-to-severe Crohn's disease who had a response to induction therapy with 400 mg of certolizumab pegol were more likely to have a maintained response and a remission at 26 weeks with continued certolizumab pegol treatment than with a switch to placebo. (Clinical...

  8. Computed tomography of Crohn's disease - reevaluation

    Energy Technology Data Exchange (ETDEWEB)

    Kleinhaus, U.; Weich, Y.

    1987-12-01

    The indications and CT features of Crohn's disease were reevaluated, based on 48 examinations in 28 patients. Although CT is indicated mostly in the complications of Crohn's disease, it played a major role in the primary diagnosis of Crohn's disease in 8 patients. 5 unsuspected patients had CT for other abdominal indications and 3 had the examinations as part of an elective diagnostic work-up. The following CT features of Crohn's disease are worthy of note: Bowel wall thickening is usually obvious and needs no measurement. Abscesses are often of inhomogenous density and should be differentiated from inflammatory bowel conglomerates. Late CT scans can be helpful in this respect. Fistulae are not well demonstrated directly by CT. The fistulogram remains the examination of choise, when possible. Mesenteric lymphadenopathy is small and discrete. Mesenteric lipomatosis can be massive and is often a cause of bowel separations and mass effect.

  9. Guidelines for treatment with infliximab for Crohn's disease

    NARCIS (Netherlands)

    Hommes, D. W.; Oldenburg, B.; van Bodegraven, A. A.; van Hogezand, R. A.; de Jong, D. J.; Romberg-Camps, M. J. L.; van der Woude, J.; Dijkstra, G.

    2006-01-01

    Infliximab is an accepted induction and maintenance treatment for patients with Crohn's disease. The effectiveness of infliximab has been demonstrated for both active luminal disease and for enterocutaneous fistulisation. In addition, infliximab can be administered for extraintestinal symptoms of

  10. Guidelines for treatment with infliximab for Crohn's disease.

    NARCIS (Netherlands)

    Hommes, D.W.; Oldenburg, B.; Bodegraven, A.A; Hogezand, R.A. van; Jong, D.J. de; Romberg-Camps, M.; Woude, J. van der; Dijkstra, G.

    2006-01-01

    Infliximab is an accepted induction and maintenance treatment for patients with Crohn's disease. The effectiveness of infliximab has been demonstrated for both active luminal disease and for enterocutaneous fistulisation. In addition, infliximab can be administered for extraintestinal symptoms of

  11. Colitis tuberculosa - Crohn's disease - a clinical, radiological and endoscopical task

    International Nuclear Information System (INIS)

    Deu, E.; Ortner, R.; Kratochvil, P.; Brandstaetter, G.; Ratschek, M.

    1986-01-01

    The authors report on a case of multifocal stenosing tuberculosis of the stomach, pointing out the difficulties in differential diagnosis especially against Crohn's disease. The importance of X-ray examination is discussed. (orig.) [de

  12. Giant pseudopolyps in the colon transversum in Crohn's disease

    International Nuclear Information System (INIS)

    Gowin, W.; Fobbe, F.

    1986-01-01

    A case of giant pseudopolyps in the colon transversum in histologically verified Crohn's disease is presented. Giant pseudopolyps are a very rare manifestation in granulomatous colitis. Differential diagnosis espec. for polypous adenocarcinoma is discussed. (orig.) [de

  13. Extraintestinal manifestations in Crohn's disease and ulcerative colitis

    DEFF Research Database (Denmark)

    Isene, Rune; Bernklev, Tomm; Høie, Ole

    2015-01-01

    BACKGROUND: In chronic inflammatory bowel disease (IBD) (Crohn's disease [CD] and ulcerative colitis [UC]), symptoms from outside the gastrointestinal tract are frequently seen, and the joints, skin, eyes, and hepatobiliary area are the most usually affected sites (called extraintestinal...

  14. Crohn's disease presenting as gastric outlet obstruction: a therapeutic challenge?

    Science.gov (United States)

    Inayat, Faisal; Ullah, Waqas; Hussain, Qulsoom; Shafique, Khurram

    2017-04-28

    Isolated gastric Crohn's disease with initial presentation related to gastric outlet obstruction is an unusual clinicopathological entity. We undertake here a literature review of this rare initial presentation of isolated gastric Crohn's disease and discuss the formidable diagnostic and therapeutic challenges encountered in such patients. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  15. Pathogenesis: common pathways between hidradenitis suppurativa and Crohn disease.

    Science.gov (United States)

    García Martínez, F J; Menchén, L

    2016-09-01

    Both hidradenitis suppurativa and Crohn disease are considered chronic inflammatory diseases due to immune dysregulation. The high prevalence of Crohn disease patients diagnosed with hidradenitis suppurativa suggests the existence of common pathogenic links. The present literature review analyses the similarities and differences in the pathogenesis of the two diseases, in the search for new research and knowledge targets. Copyright © 2016 Elsevier España, S.L.U. y AEDV. All rights reserved.

  16. Laparoskopiassisteret ileocøkal resektion ved Crohns sygdom

    DEFF Research Database (Denmark)

    Laursen, Stig Borbjerg; Knudsen, Torben; Poornoroozy, Peiman

    2010-01-01

    Laparoscopic surgery has become more widely used in the treatment of patients with inflammatory bowel disease. The aim of this study is retrospectively to describe the results of laparoscopy-assisted ileocolic resection of nineteen patients with Crohn's disease.......Laparoscopic surgery has become more widely used in the treatment of patients with inflammatory bowel disease. The aim of this study is retrospectively to describe the results of laparoscopy-assisted ileocolic resection of nineteen patients with Crohn's disease....

  17. Is obesity a risk factor for Crohn's disease?

    Science.gov (United States)

    Mendall, Michael A; Gunasekera, A Viran; John, B Joseph; Kumar, Devinder

    2011-03-01

    Obesity is associated with a proinflammatory state. To determine whether obesity at diagnosis is a risk factor for Crohn's disease vs. ulcerative colitis and also vs. community controls and whether there is a U-shaped relationship between body mass index at diagnosis and risk of Crohn's disease versus ulcerative colitis. A total of 524 consecutive inflammatory bowel disease patients attending gastroenterology clinics were administered a questionnaire inquiring about weight at diagnosis and height as well as other risk factors for inflammatory bowel disease. An opportunistic control group of 480 community controls aged 50-70 were randomly selected from the registers of four local general practices as part of another study. Obesity at diagnosis was more common in subjects with Crohn's disease versus ulcerative colitis odds ratio 2.02 (1.18-3.43) p = 0.0096 and also Crohn's disease versus community controls in the 50-70 year age group (odds ratio 3.22 (1.59-6.52) p = 0.001). There was evidence of a 'dose response' with increasing degrees of obesity associated with increased risk. Low BMI at diagnosis was also associated with risk of Crohn's disease versus ulcerative colitis. A U-shaped relationship between BMI and risk of Crohn's was supported by the strong inverse association of BMI at diagnosis (p = 0.0001) and positive association of BMI at diagnosis squared (p = 0.0002) when they were fitted together into the model. Obesity may play a role in the pathogenesis of Crohn's disease and it may be that obesity-related enteropathy is a distinct entity or a sub-type of Crohn's disease.

  18. Targeting Nuclear Receptors to Treat Fibrostenotic Crohn’s Disease

    Science.gov (United States)

    2017-08-01

    AWARD NUMBER: W81XWH-16-1-0137 TITLE: Targeting Nuclear Receptors to Treat Fibrostenotic Crohn’s Disease PRINCIPAL INVESTIGATOR: Simon A...Nuclear Receptors to Treat Fibrostenotic Crohn’s Disease 5a. CONTRACT NUMBER W81XWH-16-1-0137 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6...Public Release; Distribution Unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT While current therapies are effective in many patients with Crohn’s disease

  19. Pulmonary necrobiotic nodules: a rare extraintestinal manifestation of Crohn's disease

    Directory of Open Access Journals (Sweden)

    G. Warwick

    2009-03-01

    Full Text Available The present article reports the case of a 22-yr-old female with new onset Crohn's colitis, anterior uveitis and multiple pulmonary nodules which, on histological examination, were necrobiotic nodules. This is a rare but recognised pulmonary extraintestinal manifestation of Crohn's disease and only the fourth reported case. The present case report is followed by a brief review of the relevant literature.

  20. Postural kyfose og morbus Scheuermann

    DEFF Research Database (Denmark)

    Pedersen, Jens Brahe; Al-Aubaidi, Zaid

    2012-01-01

    Scheuermann's kyphosis is the most frequent structural kyphosis in adolescents. There are gaps in the knowledge of epidemiology, aetiology and treatment. There are strong genetic and mechanical factors in the aetiology. Treatment options depend on the cobb's angle measured and the skeletal maturi...

  1. Diagnosis and treatment of fistulising Crohn's disease

    DEFF Research Database (Denmark)

    Hvas, Christian Lodberg; Dahlerup, Jens Frederik; Jacobsen, Bent Ascanius

    2011-01-01

    /MRI for complete anatomical definition. Any abscess should be drained, and the disease extent throughout the entire gastrointestinal tract should be evaluated. Treatment goals for perianal fistulas include reduced fistula secretion or none, evaluated by clinical examination; the absence of abscesses; and patient......A fistula is defined as a pathological connection between the intestine and an inner (bladder or other intestine) or outer (vagina or skin) epithelial surface. Fistulas are discovered in up to 25% of all Crohn's disease patients during long-term follow-up examinations. Most are perianal fistulas...... satisfaction. MR imaging is required to demonstrate definitive fistula closure. Fistulotomy is considered for simple perianal fistulas. In complex perianal fistulas, antibiotics and azathioprine or 6-mercaptopurine, which are often combined with a loose seton, constitute the first-line medical therapy...

  2. Biologic therapy and surgery for crohn disease.

    Science.gov (United States)

    Paulson, E Carter

    2013-06-01

    In 1998, infliximab, an antitumor necrosis factor alpha (anti-TNF-α) antibody, was approved for use in the treatment of Crohn disease (CD). Since then, other biologic therapies, including adalimumab and certolizumab pegol (newer anti-TNF-α antibodies), and natalizumab, an antibody against alpha-4 integrin, have also been approved. Here, we review the published studies that examine the relationship between pre- and postoperative biologic therapy and postoperative complications in patients with CD. This body of literature is composed of numerous small, retrospective, heterogeneous studies that demonstrate conflicting and varied results. Overall, the receipt of biologic therapy in the pre- or postoperative period does not appear to significantly increase the risk of postoperative complications. It is, however, difficult to draw any firm conclusions based on the existing level of data. In the future, larger prospective studies are needed to better elucidate the true risks, if any, that the use of biologic therapy poses to patients with CD requiring operation.

  3. Aortitis and aortic occlusion in Crohn disease.

    Science.gov (United States)

    Delay, Charline; Schwein, Adeline; Lejay, Anne; Gaertner, Sébastien; Aleil, Boris; Thaveau, Fabien; Georg, Yannick; Chakfe, Nabil

    2015-02-01

    Patients with Crohn disease (CD) or ulcerative colitis are known to be at increased risk of arterial thromboembolic complications. We report the case of a 33-year-old woman suffering from CD for 19 years who presented lower limb claudication. Computed tomography scan revealed an aortoiliac occlusion extending from the level of the inferior mesenteric artery to both iliac bifurcations. Endovascular recanalization was attempted as a first option but failed. We then performed an aortobi-femoral bypass through a left retroperitoneal approach that allowed a total relief of the symptoms. Histologic study of the aorta demonstrated a nonspecific aortitis with lymphohistiocytic cell infiltration in the media and adventitia tunica. There was no signs of associated vasculitis. At the light of a literature review, we discussed our surgical strategy and the inflammation of the aortic wall as local factor of thrombosis that has never been previously described. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Infliximab dependency in children with Crohn's disease

    DEFF Research Database (Denmark)

    Duricova, D; Pedersen, N; Lenicek, M

    2009-01-01

    BACKGROUND: Recently, infliximab dependency has been described. AIM: To assess frequency of ID in 82 consecutive Crohn's disease children treated with infliximab 2000-2006 and to describe clinical and genetic predictors of long-term infliximab response. METHODS: A phenotype model of infliximab....../partial response. In long-term outcome, 22% maintained prolonged response, 12% had no response, while 66% became infliximab dependent. Perianal disease and no previous surgery were associated with infliximab dependency (OR 5.34, 95% CI: 1.24-22.55; OR 6.7, 95% CI: 1.67-26.61). No association was found with studied...... polymorphisms. The cumulative probability of surgery 50 months after starting infliximab was 10% in infliximab dependency, 30% in prolonged responders and 70% in nonresponders (P = 0.0002). CONCLUSIONS: Sixty-six per cent of children became infliximab dependent. Perianal disease and no surgery prior...

  5. Laparoscopic Surgery for Recurrent Crohn's Disease

    Directory of Open Access Journals (Sweden)

    Antonino Spinelli

    2012-01-01

    Full Text Available In spite of the recent improvements in drug therapy, surgery still represents the most frequent treatment for Crohn's disease (CD complications. Laparoscopy has been widely applied over the last twenty years in colorectal surgery and was associated with lower postoperative pain, shorter hospitalization, faster return to daily activities, and better cosmetic results. Laparoscopy experienced a slower diffusion in inflammatory bowel disease surgery than in oncologic colorectal surgery, but proved to be safe and effective, and is currently considered the gold standard for the treatment of primary uncomplicated ileocolic CD. Indications for laparoscopy in CD have recently been widened to embrace more complicated or recurrent CD. This paper reviews the available data on the subset of recurrent CD patients. The reported results indicate that laparoscopy may be safely applied even in selected recurrent CD cases in hands of IBD surgeons with broad laparoscopic experience.

  6. Hidradenitis suppurativa and perianal Crohn disease: differential diagnosis.

    Science.gov (United States)

    Bassas-Vila, J; González Lama, Y

    2016-09-01

    The first description of perianal fistulas and complications in Crohn disease was made 75 years ago by Penner and Crohn. Published studies have subsequently confirmed that perianal fistulas are the most common manifestations of fistulising Crohn disease. Hidradenitis suppurativa was described in 1854 by a French surgeon, Aristide Verneuil. It is a chronic, inflammatory, recurrent and debilitating disease of the pilosebaceous follicle, that usually manifests after puberty with deep, painful and inflamed lesions in the areas of the body with apocrine glands, usually the axillary, inguinal and anogenital regions. The differential diagnosis between hidradenitis suppurativa and Crohn disease can be challenging, especially when the disease is primarily perianal. When they occur simultaneously, hidradenitis suppurativa and Crohn disease show severe phenotypes and patients can respond to anti-tumour necrosis factor therapy, although adalimumab is currently the only treatment with demonstrated efficacy in hidradenitis suppurativa and Crohn disease. In addition, there is sometimes a need for different complementary surgical procedures. Copyright © 2016 Elsevier España, S.L.U. y AEDV. All rights reserved.

  7. Antibiotic use and the development of Crohn's disease.

    Science.gov (United States)

    Card, T; Logan, R F A; Rodrigues, L C; Wheeler, J G

    2004-02-01

    Few environmental determinants of Crohn's disease are well established. Some observational data exist to implicate antibiotic use as a risk factor but these are derived from studies using questionnaires to assess reported antibiotic use that were susceptible to recall bias. We have therefore explored this relationship in prospectively gathered data. We selected incident cases of Crohn's disease from the General Practice Research Database with at least five years of data prior to diagnosis. Controls with five years of complete data were randomly selected. Data were extracted on smoking, drug prescriptions, age, sex, and a variety of symptoms and diagnoses that might be indicative of occult Crohn's disease. Logistic regression was used to investigate the relationship between antibiotic use and Crohn's disease. A total of 587 Crohn's disease cases and 1460 controls were available for analysis. We found that antibiotic use 2-5 years pre-diagnosis occurred in 71% of cases compared with 58% of controls (poral contraceptive, cardiovascular, and neurological drugs. We found a statistically significant association between Crohn's disease and prior antibiotic use. This cannot be explained by recall bias, but due to lack of specificity it is unclear whether it is causal.

  8. Doença de Crohn metastática para axila Metastatic Crohn's disease to the axilla

    Directory of Open Access Journals (Sweden)

    Flávia Balsamo

    2007-03-01

    Full Text Available Relata-se um caso de doença de Crohn com manifestação cutânea axilar extremamente rara, bem como suas peculiaridades em relação ao diagnóstico e tratamento.The description of a case of metastatic Crohn's disease, a rare skin manifestation to the axillar region with diagnostic features and treatment schedules.

  9. Plain abdominal radiographs in patients with Crohn's disease: radiological findings and diagnostic value.

    LENUS (Irish Health Repository)

    O'Regan, K

    2012-08-01

    To determine the diagnostic yield and clinical value of plain film of the abdomen (PFA) in Crohn\\'s disease (CD) patients and to determine whether performance of PFA yields definitive diagnostic information or whether additional imaging examinations are required.

  10. Biological therapy in the management of recent-onset Crohn's disease

    NARCIS (Netherlands)

    Lowenberg, Mark; Peppelenbosch, Maikel; Hommes, Daniel

    2006-01-01

    Crohn's disease is a chronic inflammatory bowel disease that may involve any part of the gastrointestinal tract. Conventional therapy consists of corticosteroids, azathioprine or methotrexate, but the clinical management of Crohn's disease is significantly hampered by adverse effects. With the

  11. Biological therapy in the management of recent-onset Crohn's disease: why, when and how?

    NARCIS (Netherlands)

    Löwenberg, Mark; Peppelenbosch, Maikel; Hommes, Daniel

    2006-01-01

    Crohn's disease is a chronic inflammatory bowel disease that may involve any part of the gastrointestinal tract. Conventional therapy consists of corticosteroids, azathioprine or methotrexate, but the clinical management of Crohn's disease is significantly hampered by adverse effects. With the

  12. Is it time to re-classify Crohn's disease?

    Science.gov (United States)

    Fedorak, Richard N

    2004-01-01

    From the original anatomic classification of Crohn's disease in 1975, there have been three subsequent published classifications. The most recent, the Vienna Classification arose from a 1998 World Congress of Gastroenterology Working Party that attempted to prospectively design a simple and objective Crohn's disease phenotypic classification that encompassed components of age at onset, anatomic location and disease behavior. Subsequent application of the Vienna Classification to clinical practice has demonstrated that the Crohn's disease phenotype changes markedly over time, with nearly 80% of inflammatory disease ultimately evolving into a stricturing or penetrating pattern of behavior, and 15% undergoing a change in anatomic location. Furthermore, in controlled studies, the ability of inflammatory bowel disease experts to similarly identify the disease phenotypes, using the Vienna classification, ranges from poor to fair. Taken together, these failings markedly limit the utilization of the Vienna classification of Crohn's disease in clinical trails or disease management. Recent advances in determining the genetic linkages associated with Crohn's disease will undoubtedly lead to a revised Crohn's disease classification that will combine genotype with phenotype. Nevertheless, before this new classification can become a reality we will need to reconcile a number of key elements, including; (1) localization and grouping of all inflammatory bowel disease(IBD) gene mutations, (2) discovering the function of the IBD genes, (3) understanding the impact of the environment on phenotypic expression, and, (4) linking to well-defined phenotypic databases that will permit accurate prediction of disease natural history and therapeutic response. Indeed, the consistency of the phenotypic data available may be the greatest single challenge in unraveling the complexities of inflammatory bowel disease and developing a new classification of Crohn's disease.

  13. Oral contraceptive use and the clinical course of Crohn's disease: a prospective cohort study

    OpenAIRE

    Cosnes, J; Carbonnel, F; Carrat, F; Beaugerie, L; Gendre, J

    1999-01-01

    BACKGROUND—Women with Crohn's disease are usually advised not to take oral contraceptives, but, unlike smoking, there is no clear association between current oral contraceptive use and more severe disease.
AIM—To assess the effect of oral contraceptive use on the clinical course of Crohn's disease.
PATIENTS—331 women, aged 16-50 years, with Crohn's disease and Crohn's disease activity index

  14. Diagnostic accuracy of computed tomography using lower doses of radiation for patients with Crohn's disease.

    LENUS (Irish Health Repository)

    Craig, Orla

    2012-08-01

    Magnetic resonance and ultrasonography have increasing roles in the initial diagnosis of Crohn\\'s disease, but computed tomography (CT) with positive oral contrast agents is most frequently used to identify those with acute extramural complications. However, CT involves exposure of patients to radiation. We prospectively compared the diagnostic accuracy of low-dose CT (at a dose comparable to that used to obtain an abdominal radiograph) with conventional-dose CT in patients with active Crohn\\'s disease.

  15. Are pancreatic autoantibodies associated with azathioprine-induced pancreatitis in Crohn's disease?

    NARCIS (Netherlands)

    Weersma, Rinse K; Batstra, Manou R; Kleibeuker, Jan H; van Dullemen, Hendrik M

    2008-01-01

    CONTEXT: Azathioprine is frequently used in the treatment of Crohn's disease. A severe side effect is acute pancreatitis, which is specific for Crohn's disease. Autoantibodies against exocrine pancreas occur in about 30% of Crohn's disease cases but not in other inflammatory diseases. Pancreatic

  16. Investigation of the type, frequency, and sex distribution of fistulas in Crohn's disease

    International Nuclear Information System (INIS)

    Kulke, H.; Kasper, H.; Auer, I.

    1987-01-01

    Various types of fistula development are described in a population of 206 patients with a pravious diagnosis of Crohn's disease. In addition, the frequency of occurence of Crohn's disease in a population and the frequency of Crohn's reoccurrence for a given patient is reported. Furthermore a subdivision of patients with respect to sex is possible. (orig.) [de

  17. Quality of life and uncertainty in Crohn's disease.

    Science.gov (United States)

    Niv, Galia; Bar Josef, Simona; Ben Bassat, Ofer; Avni, Irit; Lictenstein, Lev; Niv, Yaron; Barnoy, Sivia

    2017-06-01

    Crohn's disease impairs patients' perception of health and has a negative impact on health-related quality of life. Although it is apparent that uncertainty is a significant factor that decreases quality of life, it has never been studied in patients with Crohn's disease. The objective of the present study was to examine the association between level of certainty, self-epistemic authority, Internet information gathering habits, and health-related quality of life. A cross-sectional study of 105 Crohn's disease patients was conducted. Data were collected using a questionnaire composed of five parts: (1) demographic and clinical information; (2) health-related quality of life; (3) level of certainty; (4) self-epistemic authority; and (5) Internet information gathering habits regarding Crohn's disease. A significant positive correlation was demonstrated between levels of certainty and health-related quality of life. Self-epistemic authority correlated positively with certainty, while information gathering via the Internet was related to decreased certainty. Multiple regression analysis for factors associated with health-related quality of life showed a positive association with the level of certainty, while negative associations were found between Internet information seeking and disease activity with the quality of life. Level of certainty proved an important variable associated with health-related quality of life in Crohn's disease patients. Improving patients' self-epistemic authority can increase certainty and, thus, improve health-related quality of life.

  18. Colonic Crohn's disease and use of oral contraception.

    Science.gov (United States)

    Rhodes, J M; Cockel, R; Allan, R N; Hawker, P C; Dawson, J; Elias, E

    1984-02-25

    The prevalence of use of oral contraception before the onset of disease was established in 100 consecutive women attending follow up clinics for inflammatory bowel disease. A significant excess of women with Crohn's disease confined to the colon had taken oral contraceptives in the year before developing symptoms (10/16 (63%] compared with women with small-intestinal Crohn's disease (12/49 (24%); p less than 0.02) and women with ulcerative colitis (3/35 (9%); p less than 0.0005). When the patient groups were matched for age and year of onset of disease usage of oral contraception before the onset of disease was still more common among women with isolated colonic Crohn's disease (9/12, 75%) than among those with ulcerative colitis (2/12 (17%); p less than 0.02) and was also more common than would be expected from reported figures for oral contraception in England and Wales (31.4% of women aged under 41; p less than 0.005). A survey of current patient records showed that isolated colonic disease was at least twice as common among women with Crohn's disease (63/218, 29%) compared with men (25/181, 14%; p less than 0.001). These data support the suggestion made previously that oral contraceptives may predispose to a colitis that resembles colonic Crohn's disease.

  19. Recent advances in the management of Crohn's disease.

    Science.gov (United States)

    Caprilli, R; Angelucci, E; Clemente, V

    2008-09-01

    In the last 10 years many advances have been achieved in the treatment of patients with Crohn's disease, particularly in the field of biological agents. Infliximab, a tumour necrosis factor alpha antagonist, has been recently added to the therapeutic armamentarium for Crohn's disease and has greatly improved our treatment options. Infliximab has demonstrated efficacy in the induction and maintenance of remission in luminal and fistulizing Crohn's disease both in adults and children. However, the potential development of autoantibodies and the risk of serious adverse events limit the possibility of a wider use of infliximab. Searching for less immunogenicity and higher effectiveness in the last years a number of biological agents have been developed. Adalimumab, a fully human monoclonal antibody anti tumour necrosis factor alpha, has resulted effective and safe in patients with Crohn's disease, both naive and refractory to infliximab, presenting also the advantage of subcutaneous way of administration. Natalizumab also showed promising results in terms of efficacy but its safety is still under investigation. To date no particular advances have been recently appeared in the literature concerning conventional immunosuppressive drugs. Surgery remains a valid resort for refractory patients. Autologous stem cell transplantation represents a new hope as rescue treatment for patients with severe refractory Crohn's disease.

  20. Omega-3 fatty acids as adjunctive therapy in Crohns disease.

    Science.gov (United States)

    Macdonald, Angie

    2006-01-01

    Crohns disease is an inflammatory bowel disease that can have a significant impact on the health of those afflicted. The etiology of the disease is unknown, but genetic, environmental, dietary, and immunological factors are thought to be involved. Multiple nutrients can become depleted during active disease due to inadequate intake or malabsorption. Preventing these deficiencies is paramount in the care of those suffering from Crohns disease. Often the traditional treatments (medications) have limited effectiveness and negative side effects that inhibit their use. Enteral nutrition has promising therapeutic benefits, but its use is often limited to the pediatric population due to poor patient acceptability. Omega-3 fatty acids have been investigated for their anti-inflammatory properties as an alternative to traditional care. This article reviews the etiology of Crohns disease, nutritional deficiencies, traditional treatments, and the use of omega-3 fatty acids in the prevention of Crohns recurrence. The results from clinical trials have been conflicting, but a new fish oil preparation that limits the side effects of traditional fish oil therapy shows promise as an adjunctive treatment for Crohns disease. Continued research is needed to validate these findings.

  1. Ovarian involvement in Crohn's disease: a rare complication

    Directory of Open Access Journals (Sweden)

    Rosa Saborit

    2016-02-01

    Full Text Available Background: The transmural condition of Crohn's disease predisposes to fistulae or abscesses. The internal fistula incidence is about 15%. Among them, enteroovarian fistula is rarely described on the literature. Herein, the authors present three cases of enteroovarian fistulas. Case reports: Two women are diagnosed with ileal Crohn's disease that presented a pelvic abscess diagnosed by ultrasound and CT. On surgery, an inflammatory mass involving the ileum and the ovary was found. The third woman was operated because of a tuboovarian abscess and was diagnosed with ileal Crohn's disease afterwards. In the three cases, the histopathological analysis of the ovary showed granulomas with abscess compatible with Crohn's disease. In one of the cases, multinucleated giant cells were found in the foreign body reaction to vegetable matter. A right ileocolectomy and an adnexectomy were performed in all three cases. No further involvement of the contralateral ovary or other gynaecological complications was observed. Discussion: The treatment of Crohn's disease complications should be individualized. In the case of ovarian involvement, surgical treatment should include adnexectomy.

  2. Early and delayed indium 111 leukocyte imaging in Crohn's disease

    International Nuclear Information System (INIS)

    Navab, F.; Boyd, C.M.; Diner, W.C.; Subramani, R.; Chan, C.

    1987-01-01

    Twenty-seven patients with Crohn's disease were studied for the presence and location of activity by both early (4 h) and delayed (18-24 h) indium 111 leukocyte imaging. The results were compared with other parameters of disease activity including Crohn's disease activity index, barium studies, and endoscopy. There was a correlation between early images and Crohn's disease activity index (r = 0.78) and between delayed images and index (r = 0.82). Based upon the corresponding Crohn's disease activity index, the sensitivity of early and delayed imaging was 81.0% and 95.2%, respectively. Specificity of early and delayed imaging was 75.0% and 87.0%, respectively. Presence of activity on the early and delayed imaging agreed with activity on barium studies and colonoscopy in approximately 80% of cases. Correlation of location of disease by leukocyte imaging and x-ray was observed in 58.9% of early scans and 55.0% of delayed scans. Correlation of the location of disease by imaging and endoscopy was observed in 71.4% of early and 75.0% of delayed studies. Because of the possibility of occurrence of false-negative results in early images, delayed imaging should always be included in evaluation of disease activity in patients with Crohn's disease who are suspected of having mild activity. Delayed imaging is not required if the early imaging study clearly shows activity

  3. Optimization of biologic therapy in Crohn's disease.

    Science.gov (United States)

    Razvi, Mohammed; Lazarev, Mark

    2018-03-01

    Crohn's disease (CD) is a manifestation of inflammatory bowel disease (IBD), which can result in significant morbidity. Biologic therapy with anti-TNF medication has been effective in treating inflammation and reducing complications in CD. It is important for clinicians to have better knowledge of the various biologic therapies including mechanisms of action and optimization strategies. Areas covered: The review describes optimization of biologic therapy in CD including different mechanisms of loss of response, therapeutic drug monitoring in CD, clinical implications and management strategies which utilize drug monitoring, and areas of future development and research in optimization of biologic therapy. Expert opinion: Achieving adequate levels of the drug (antibody unbound) is one of the most important determinants of attaining clinical remission and mucosal healing. Drug level is also critical in determining if a patient requires combination therapy with an immunomodulator. Certain populations, including those with active perianal disease, may require higher serum levels to achieve healing or closure. Treat to target level is an algorithm that is not universally accepted and more data is need. Additionally, there are numerous assays that don't always correlate, especially regarding measuring anti-drug antibodies.

  4. [Osteopenia in patients with Crohn disease].

    Science.gov (United States)

    Cheour, Elhem; Hamdi, Wafa; Sahli, Héla; Landolsi, Faten; Fekih, Monia; Meddeb, Nihel; Boubaker, Jalel; Filali, Azza; Sellami, Slaheddine

    2007-11-01

    Osteoporosis and osteopenia are frequently reported during chronic inflammatory bowel diseases, particularly in Crohn disease (CD). To determine the frequency of osteoporosis and osteopenia of patients with CD and to study associated risk factors. A forward-looking study was performed about 56 cases of CD, 34 men and 22 women, aged 32 + 10.4 years (18-54 years), with no other disorders affecting osseous metabolism. A biphotonic X-rays absorptiometry densitometry (DEXA) was performed at femoral neck and lumbar spine. A multivariate statistical analysis was performed to check for risk factors in osseous mineral density. Osteoporosis and osteopenia are noticed with respective frequency of 35.7 % and 23.2 %. A statistically significant association is found between low osseous density on one hand and physical mass index (IMC), localisation on large bowel of the disease and corticotherapy on the other hand. The IMC was a risk factor independent from the two other factors. Under nutrition, with IMC 18 kg/m (p = 0.03, Odds ratio = 3.4). Among risk factors involved in the osteoporosis during CD, the nutritional status plays an important role which must be taken into account in the treatment of these patients.

  5. Obesity/Bariatric Surgery and Crohn's Disease.

    Science.gov (United States)

    Korelitz, Burton I; Sonpal, Niket; Schneider, Judy; Swaminath, Arun; Felder, Joseph; Roslin, Mitchell; Aronoff, Jeffrey

    2018-01-01

    Crohn's disease (CD) following bariatric surgery has been previously described. It is not clear whether the clinical entity is due to rapid metabolism of fat, change in the bacterial milieu of the bowel, the loss of defense mechanisms of the stomach, or even a coincidence. To present observations which might serve to sort out these various etiologies. We present 5 cases of colitis, ileocolitis or enteritis, some with fistula formation, with clinical onset following bariatric surgery and add these to the 7 cases previously identified as CD reported elsewhere. We provide the clinical features of these 12 cases to reconcile with causative mechanisms. It remains possible that the onset of CD (or other inflammatory bowel disease) precedes the bariatric surgery which then accelerates the clinical manifestations described. Furthermore, without controls the association could remain a coincidence. We review the evidence for release of proinflammatory cells and cytokines contained in fat following the bariatric surgery, and also consider the roles that the surgical resection of stomach and shortening of the bowel may also bring about this syndrome. The earlier onset is more likely due to surgical loss of defenses of the stomach and the later onset to a metabolic alteration of the presurgical obesity, involving fat metabolism, and/or the microbiome. The role of characteristic creeping fat of CD is also addressed.

  6. MR enterography findings in abdominopelvic extraintestinal complications of Crohn's disease.

    Science.gov (United States)

    Mazziotti, Silvio; Blandino, Alfredo; Scribano, Emanuele; Gaeta, Michele; Mileto, Achille; Fries, Walter; Bombaci, Francesco; Ascenti, Giorgio

    2013-05-01

    MR of the small bowel is a useful technique for the evaluation of both intraluminal and extraluminal pathologic involvement of the small bowel in patients with Crohn's disease. Crohn's disease is associated with a range of extraintestinal complications that sometimes may be the initial presenting symptoms. Some of these extraintestinal complications may not correlate with disease activity, but in general, they tend to follow the clinical course of disease and may have a high impact on life quality, morbidity, and even mortality in these patients. Our purpose is to describe some abdominopelvic extraintestinal complications of Crohn's disease, such as hepatopancreatobiliary, genitourinary, musculoskeletal, peritoneal, and lymph-nodal, detectable at MR enterography. Copyright © 2012 Wiley Periodicals, Inc.

  7. Advances in imaging to allow personalized medicine in Crohn's disease.

    Science.gov (United States)

    Neurath, Markus F

    2015-08-01

    Crohn's disease is a destructive inflammatory bowel disease of unknown origin that may lead to various complications such as strictures, stenosis, fistulas and colitis-associated neoplasias. However, the course of the disease varies substantially among patients and disease behaviour may also change with time. At diagnosis behaviour is inflammatory in the majority of patients, while penetrating or structuring behaviour become more prominent at later time points. Thus, medication in Crohn's disease needs frequent optimization over time. Therefore, new strategies for prediction of response to therapy are urgently needed. Here, recent advantages in imaging techniques for personalized medicine in Crohn's disease are reviewed. Such advantages include ultrasonography, computed tomography, magnetic resonance imaging and new endoscopic approaches such as molecular endoscopy. It is expected that these novel techniques will lead to marked improvements in the assessment of disease behaviour and the prediction of response to clinical therapy with biologicals. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Ramiprilate inhibits functional matrix metalloproteinase activity in Crohn's disease fistulas

    DEFF Research Database (Denmark)

    Efsen, Eva; Saermark, Torben; Hansen, Alastair

    2011-01-01

    Increased expression of matrix metalloproteinase (MMP)-2, -3 and -9 has been demonstrated in Crohn's disease fistulas, but it is unknown whether these enzymes are biologically active and represent a therapeutic target. Therefore, we investigated the proteolytic activity of MMPs in fistula tissue...... and examined the effect of inhibitors, including clinically available drugs that beside their main action also suppress MMPs. Fistula specimens were obtained by surgical excision from 22 patients with Crohn's disease and from 10 patients with fistulas resulting from other causes. Colonic endoscopic biopsies......-diamine-tetraacetic acid (EDTA), the synthetic broad-spectrum inhibitor, GM6001, the angiotensin-converting enzyme (ACE) inhibitor, ramiprilate, and the tetracycline, doxycycline. In Crohn's disease fistulas, about 50% of the total protease activity was attributable to MMP activity. The average total MMP activity...

  9. Ileum Histoplasmosis Mimicking Intestinal Tuberculosis and Crohn's Disease.

    Science.gov (United States)

    Ai, Xin-Bo; Wang, Zhen-Jiang; Dong, Qi-Chao; Lin, Xu; Chen, Yu-Ping; Gong, Fei-Yue; Liang, Hui

    2018-01-01

    Gastrointestinal histoplasmosis (GIH) without pulmonary and bone marrow involvement is very rare worldwide. It can be misdiagnosed as intestinal tuberculosis or Crohn's disease. There are just few case reports of GIH in patients with a positive HIV antibody test. Here, we report a patient who presented to our hospital with repeated intestinal obstruction. The suspicious diagnosis was intestinal tuberculosis or Crohn's disease due to unspecific clinical manifestations and radiologic images. Our patient's HIV antibody test was negative. She had no medical prescriptions. Therefore, our differential diagnosis needed to include ileum histoplasmosis besides intestinal lymphoma, intestinal tuberculosis, and Crohn's disease. Finally, the patient was diagnosed with ileum histoplasmosis due to surgical resection. It is important to be aware of potential infectious diseases, such as ileum histoplasmosis, when making a differential diagnosis. Moreover, surgical resection might be the final approach for small-intestine stricture with fibrosis.

  10. Wireless capsule endoscopy years after Michelassi stricturoplasty for Crohn's disease.

    Science.gov (United States)

    Sciaudone, G; Pellino, G; Guadagni, I; Pezzullo, A; Selvaggi, F

    2010-01-01

    The use of wireless capsule endoscopy in Crohn's disease has been a matter of debate. We report the case of a 27-year-old woman operated for Crohn's disease with a Michelassi stricturoplasty presenting with anaemia. We tested the patient with a patency capsule before undertaking a wireless capsule endoscopy. Although the absorbable capsule was successfully expelled, the wireless capsule was retained next to the distal edge of the Michelassi stricturoplasty, where it revealed an otherwise undetected stenotic recurrence. We successfully treated the recurrence with a Heineke-Mikulicz stricturoplasty on the stenotic outlet of the previous Michelassi, extracting the capsule. We found our treatment effective. We believe that capsule endoscopy can be performed in patients operated on for Crohn's disease, although further studies are needed to clarify its role in patients with long-stricturoplasties and to establish which examination could be the most effective in selecting patients.

  11. Hyaline-Vascular Type Castleman's Disease, Sarcoidosis, and Crohns Disease.

    Science.gov (United States)

    Gupta, Arjun; Ayyar, Balaji; Zia, Hamid; Chen, Weina; Harris, Samar; Naina, Harris V

    2016-06-01

    Sarcoidosis and Crohns disease have been associated with increased long term risk of lymphoproliferative disorders, including lymphomas. Newly developed lymphadenopathy in a patient with these disorders should prompt pathological evaluation. Castleman's disease is a lymphoproliferative disorder characterized by enlarged hyperplastic lymph nodes with regressed follicles surrounded by expanded mantle zones of small lymphocytes, and interfollicular vascular proliferation in the hyaline-vascular type. Similar to sarcoidosis and Crohns disease, its etiology is incompletely understood, although immune dysregulation, genetic factors and infectious and environmental factors are thought to play a role in all three diseases. Interleukin-6 is a possible pathological common factor between these three disease processed. Unicentric, hyaline-vascular type Castleman's disease can be treated successfully with complete surgical resection. We report a patient with long history of sarcoidosis and Crohns disease with newly developed lymphadenopathy which was found to be due to Castleman's disease.

  12. Inherited determinants of Crohn's disease and ulcerative colitis phenotypes

    DEFF Research Database (Denmark)

    Cleynen, Isabelle; Boucher, Gabrielle; Jostins, Luke

    2016-01-01

    BACKGROUND: Crohn's disease and ulcerative colitis are the two major forms of inflammatory bowel disease; treatment strategies have historically been determined by this binary categorisation. Genetic studies have identified 163 susceptibility loci for inflammatory bowel disease, mostly shared...... between Crohn's disease and ulcerative colitis. We undertook the largest genotype association study, to date, in widely used clinical subphenotypes of inflammatory bowel disease with the goal of further understanding the biological relations between diseases. METHODS: This study included patients from 49...... centres in 16 countries in Europe, North America, and Australasia. We applied the Montreal classification system of inflammatory bowel disease subphenotypes to 34,819 patients (19,713 with Crohn's disease, 14,683 with ulcerative colitis) genotyped on the Immunochip array. We tested for genotype...

  13. Granulomatous Tracheo-Bronchitis Associated With Crohn's Disease

    Science.gov (United States)

    Xia, Kai; Wolf, Jacqueline; Friedman, Sonia

    2004-01-01

    We report a rare case of diffuse tracheo-bronchitis as a complication of Crohn's disease. A young man with a long-standing history of Crohn's enterocolitis initially presented with epigastric pain and melena. Upper endoscopy revealed erythematous, edematous, and friable mucosa with erosions, particularly in the pyloric channel, causing gastric outlet obstruction, and a nonbleeding ulcer in the corpus of stomach. Biopsy of these lesions showed chronic gastritis and a noncaseating epithelioid granuloma, consistent with active Crohn's disease. The patient was treated with a course of corticosteroids and the gastric symptoms resolved. A few months later, he developed fever, cough, hemoptysis, and rash. Bronchoscopy demonstrated a markedly thickened and very inflamed trachea with extensive friable, whitish lesions and ulcerations. Histology showed severe noncaseating granulomatous inflammation. The patient improved with a 6-week oral, followed by an additional 4-week inhaled, corticosteroid treatment. Since then, he has been doing well without relapse of pulmonary symptoms for 2 years. PMID:15208530

  14. Enterohepatic fistula in a Crohn's disease patient: A case report.

    Science.gov (United States)

    Van Backer, Justin T; Lee, Edward C

    2017-01-01

    Fistulous tracts are a hallmark of Crohn's Disease. However, solid organ to intestinal fistulas are rare with previously few case reports of colosplenic fistulas and one case report of an enterohepatic fistula. We review the available literature and present the first case report of an enterohepatic fistula in a female with Crohn's Disease to be treated operatively. The patient did well postoperatively with complete resolution of her fistula. Crohn's Disease is an inflammatory bowel disease that can present with fistulas. However, a fistula between the liver and bowel is exceedingly rare with only one previous case report. This is the first report of an enteroheptic fistula that has been managed successfully with an operation. Not all enteroenteric fistulas are apparent preoperatively. When discovered, laparoscopic enterohepatic fistula takedown is feasible for this rare disease process manifestation. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  15. Role of HLA typing on Crohn's disease pathogenesis

    Directory of Open Access Journals (Sweden)

    Batool Mutar Mahdi

    2015-09-01

    Full Text Available Crohn's disease (CD is the main type of chronic inflammatory bowel disease of unknown etiology. Evidence from family and twin studies suggests that genetics plays a significant role in predisposing an individual to develop Crohn's disease. A susceptibility locus for Crohn's disease has been mapped 3 to chromosome 16: a frameshift variant and two missense variants of NOD2, encoding a member of the Apaf-1/Ced-4 superfamily of apoptosis regulators which is expressed in hematopoietic compartment cells and intestinal epithelial cells as well as in paneth cells, where NOD2 may play an important role in the pathogenesis of Crohn disease in the gastrointestinal system. This leads to alteration the structure of either the leucine-rich repeat domain of the protein or the adjacent region. NOD2 activates nuclear factor NF-kB; this activating function is regulated by the carboxy-terminal leucine-rich repeat domain, which has two functions, first an inhibitory role and also acts as an intracellular receptor for components of microbial pathogens. Thus, NOD2 gene product confers susceptibility to Crohn's disease by altering the recognition of these components and/or by over-activating NF-kB in intestinal epithelial cells as well as in paneth cells. Further confirmation of a genetic predisposition comes from studies of the association between the human leukocyte antigen (HLA system and CD. The immunogenetic predisposition may be considered an important requirement for the development of CD, as several alleles of human major histocompatibility complex had an association with CD. Although it is difficult to estimate the importance of this region in determining overall genetic susceptibility in a population, studies of HLA allele sharing within families suggest that this region contributes between 10% and 33% of the total genetic risk of Crohn's disease.

  16. Intestinal tuberculosis versus crohn's disease: Clinical and radiological recommendations

    Directory of Open Access Journals (Sweden)

    Raju Sharma

    2016-01-01

    Full Text Available Intestinal tuberculosis is a common clinical problem in India. The clinical features of this disease are nonspecific and can be very similar to Crohn's disease. Radiological evaluation of the small bowel has undergone a paradigm shift in the last decade. This long tubular organ that has traditionally been difficult to evaluate can now be well-visualized by some innovative imaging and endoscopic techniques. This article highlights the state-of-the-art evaluation of ulceroconstrictive diseases of the bowel and provides recommendations for the differentiation of intestinal tuberculosis from Crohn's disease.

  17. [Risk factors in the etiology of Crohn disease].

    Science.gov (United States)

    Katschinski, B; Goebell, H

    1990-07-01

    So far the aetiology of Crohn's disease remains unclear. Besides a genetic predisposition a causal role of environmental factors has been taken into consideration within the last time period. A number of case-control studies have consistently reported about an increased consumption of dietary sugar in patients with Crohn's disease as compared with controls. Furthermore cigarette smoking and the use of oral contraceptive drugs have been shown to increase disease risk. While the role of the former can be regarded as established the role of the latter still remains controversial.

  18. Billeddiagnostiske og endoskopiske metoder ved Crohns sygdom i tyndtarmen

    DEFF Research Database (Denmark)

    Jensen, Michael Dam; Kjeldsen, Jens; Nathan, Torben

    2009-01-01

    Diagnosing Crohn's disease in the small intestine can be troublesome. Traditionally, the small bowel is evaluated by ileocolonoscopy and small bowel follow-through or enteroclysis. In recent years MRI, CT, ultrasound and capsule endoscopy have emerged. All are validated and implemented in clinical...... practice. Double-balloon enteroscopy, PET-CT and SPECT are newer methods, which are still being evaluated in clinical trials. The purpose of this article is to review clinical studies focusing on the validity of modalities for diagnosing Crohn's disease of the small intestine. Udgivelsesdato: 2009-Aug-17...

  19. Stages of Crohn's disease examined by X-ray

    International Nuclear Information System (INIS)

    Kulke, H.; Braun, H.

    1986-01-01

    Since X-ray examination of patients with Crohn's disease are not only used for initial diagnostic purposes, but also to follow the course of the disease, exact criteria for interpreting X-ray findings are required. In the past, X-ray criteria have been arbitravily chosen by various investigation resulting in large differences in diagnostic interpretation. In order to develop standardized criteria for diagnostic interpretation, patients with Crohn's disease were classified in 8 stages of disease. The bases for this staging were the frequency of recurrent disease and the intestinal anatomy causing the X-ray findings. (orig.) [de

  20. Fistulas of the lesser pelvis in patients with Crohn disease

    International Nuclear Information System (INIS)

    Majer, M.C.; Schmiedl, U.; Koelbel, G.; Weber, P.; Hess, C.F.

    1988-01-01

    Sixty-eight patients with Crohn disease of the lesser pelvis were studied prospectively with computed tomography (CT) (DR3; Siemens, Erlangen, West Germany), before and after intravenous bolus injection of contrast material. The CT findings were compared to results obtained by means of rectosigmoidoscopy, sinography, ultrasound, and clinical examination. The presence of fistulas was shown in 47 patients by CT and correctly excluded in 27 patients. In 39 patients, CT provided valuable information about the location and extension of the fistulas with respect to the adjacent organs. Contrast material-enhanced CT is now used routinely in the authors' institution for the assessment of patients with Crohn manifestations of the pelvic floor

  1. Ulkus Aftosa Kompleks Manifestasi Penyakit Crohn

    Directory of Open Access Journals (Sweden)

    Bernadeta Esti Chrismawaty

    2012-06-01

    Full Text Available Latar Belakang: Ulkus aftosa kompleks mengacu pada ulkus mulut kronis berkaitan dengan gangguan sistemik. Kondisi tersebut, selain menimbulkan rasa sakit dan gangguan fungsi, dapat memperburuk kualitas hidup penderitanya. Tujuan: penulisan ini bertujuan untuk melaporkan keterkaitan antara ulkus aftosa kompleks dengan gangguan gastrointestinal, yaitu penyakit crohn. Kasus dan penanganannya: laki-laki 73 tahun mengeluhkan nyeri mulut sejak 3 bulan lalu, yang disertai dengan perut sebah, kembung dan terkadang nyeri ringan disertai dengan sakit kepala. Saat pemeriksaan, tampak adanya ulkus dengan dasar bergranuler, tepi sedikit meninggi dan tertutup lapisan putih pada mukosa lipatan mukobukal, pipi, dasar mulut dan palatum. Permukaan mukosa bibir dan pipi memberikan gambaran seperti batu bata (cobblestoning. Mengacu pada gejala dan temuan klinis, ditegakkan diagnosis kerja ulkus aftosa kompleks manifestasi gangguan gastrointestinal, susprk penyakit crohn. Terapi awal berupa kombinasi spiramycin-metronidazole, methyl-prednisolone, parasetamol dan larutan kumur perhidrol. Satu minggu kemudian, tampak adanya perbaikan lesi dan aktifitas fungsional. Berdasarkan pemerikasaan dari poli penyakit dalam Rumah Sakit Umum Sardjito (RSS, pasien mendapatkan medikasi lanzoprazole, ulsidex dan enzyplex. Terapi lanjutan berupa methyl-prednisolone dengan dosis tapering, anti jamur topical nistatin untuk mencegah infeksi ikutan dan larutan kumur yeng mengandung Benzydamine HCI untuk mengurangi nyeri. Kesimpulan: Ulkus mulut manifestasi penyakit Chohn mempunyai karakteristik unik dan dapat dibedakan dari ulkus mulut kronis lainnya. Dalam penegakan diagnosis ulkus aftosa kompleks, identifikasi etiologi gangguan sistemik yang tepat akan sangat membantu dalam menetapkan perawatan lesi mulut yang sesuai.   Background: complex aphthous refers to chronic oral ulceration, which is related to systemic diseases. This condition can cause oral discomfort, alter the normal oral

  2. Problemática sanitaria y conflictos políticos en una ciudad del centro de Veracruz: la epidemia de cólera morbus de 1833 en Xalapa

    Directory of Open Access Journals (Sweden)

    Rogelio Jiménez Marce

    2015-01-01

    Full Text Available El objetivo de este trabajo es mostrar las acciones que las autoridades del Ayuntamiento de Xalapa realizaron, en materia de políticas sanitarias, para evitar que el cólera morbus provocara graves daños en la ciudad. El que el Cabildo tomara en sus manos el control de la política sanitaria preventiva evidenciaba una nueva visión de la sociedad, en la que el Estado buscaba convertirse en el eje rector de las acciones. Antes de la llegada de la enfermedad, las autoridades municipales dispusieron una serie de medidas tendentes a preservar la salubridad pública, como la publicación de bandos y la formación de comisiones tendentes a preservar la tranquilidad pública, pero una de ellas, su decisión de cambiar la ubicación de los hospitales entre ellos el militar, les generaría conflictos con las autoridades castrenses. La disputa por la posesión del Cuartel Grande, que tanto unos como otros consideraban propio, evidenciaba una lucha de poder, pues las autoridades civiles buscaban imponer sus decisiones sobre las militares.

  3. Endoscopy and cross-sectional imaging for assessing Crohn׳s disease activity.

    Science.gov (United States)

    Stidham, Ryan W; Cross, Raymond K

    2016-07-01

    Crohn's disease (CD) is principally characterized by chronic and recurrent inflammation of the gastrointestinal tract, most commonly found in the ileo-colonic region. The chronicity and severity of intestinal inflammation together contribute to progressive, cumulative, deep, transmural intestinal damage, including stricturing, obstruction, abscesses, and fistulae. Both intestinal inflammation and its chronic complications result in a range of symptoms subsequently leading to patient presentations with diarrhea, abdominal pain, and anemia related to intestinal blood loss. Measuring disease activity and severity are essential for decision of treatment intensity early in the disease course and longitudinal monitoring of therapeutic efficacy. This review will summarize the transition from subjective symptoms driving disease activity indices, into increasingly objective and quantitative measures of intestinal injury by direct mucosal assessment (endoscopy), cross-sectional imaging, and surrogate biomarkers. Specific commentary on intestinal stricture and perianal fistula assessment and management are presented in accompanying sections of this series.

  4. Nutrition management in the adult patient with Crohn's disease ...

    African Journals Online (AJOL)

    Malnutrition, nutrient deficiencies and osteoporosis are common in patients with Crohn's disease, regardless of disease activity. While the role of diet in the pathogenesis of the disease remains inconclusive, upon diagnosis, nutrition therapy plays an integral role in patient care. Successful nutrition intervention involves ...

  5. Current status of endoscopic balloon dilation for Crohn's disease

    Directory of Open Access Journals (Sweden)

    Fumihito Hirai

    2017-04-01

    Full Text Available The therapeutic target in Crohn's disease (CD has been raised to the achievement of mucosal healing. Although effective treatments that target cytokines and other molecules has been widely used for CD, intestinal strictures are still a major cause of surgery. Endoscopic balloon dilation (EBD is known to be an effective and safe intervention for intestinal strictures in CD. Since frequent intestinal resection often results in short bowel syndrome and can decrease the quality of life, EBD can help avoid surgery. EBD with a conventional colonoscope for Crohn's strictures of the colon and ileo-colonic anastomosis has established efficacy and safety. In addition, EBD using balloon-assisted enteroscopy has recently been applied for small bowel Crohn's strictures. Although the evidence is not strong, EBD may become an alternative to surgery in small bowel strictures in CD. EBD and other new methods such as self-expanding stent implantation for Crohn's strictures may be useful and safe; however, it is important to address several issues regarding these interventions and to establish a protocol for combined therapies.

  6. Endoscopic lesions in Crohn's disease early after ileocecal resection

    NARCIS (Netherlands)

    Tytgat, G. N.; Mulder, C. J.; Brummelkamp, W. H.

    1988-01-01

    Fifty patients with Crohn's disease were studied endoscopically 6 weeks to 6 months (median 9 weeks) after ileocecal or ileocolonic resection for evidence of non-resected abnormality. Only 8 of the 50 patients were endoscopically free of abnormalities. Microscopic examination of the surgical

  7. Advances in biologic therapy for ulcerative colitis and Crohn's disease

    NARCIS (Netherlands)

    D'Haens, Geert; Daperno, Marco

    2006-01-01

    The medical management of inflammatory bowel disease (IBD) has changed considerably since the advent of biologic treatments. In this review we offer a critical evaluation of controlled studies with biologic agents for the management of both Crohn's disease (CD) and ulcerative colitis (UC). Biologics

  8. The Association between Hidradenitis Suppurativa and Crohn's Disease

    DEFF Research Database (Denmark)

    van der Zee, Hessel H; Horvath, Barbara; Jemec, Gregor B E

    2016-01-01

    Hidradenitis suppurativa is a chronic, autoinflammatory skin disease. Shalom et al. demonstrate in a large cross-sectional study an association between Crohn's disease and hidradenitis suppurativa, but not with ulcerative colitis. This association supports the hypothesis that a similar pathogenic...

  9. Crohn's disease and intestinal endometriosis: an intriguing co-existence

    NARCIS (Netherlands)

    Craninx, M.; D'Haens, G.; Cokelaere, K.; Baert, F.; Penninckx, F.; D'Hoore, A.; Ectors, N.; Rutgeerts, P.; Geboes, K.

    2000-01-01

    We present a series of eight female patients who came to surgery for complicated Crohn's disease of the terminal ileum (n = 7) or colon (n = 1). Indications for surgery were medically intractable disease in three, steroid dependence in four and ileal perforation in one. Histological examination

  10. Laparoscopic ileocolic resection for Crohn's disease associated with midgut malrotation.

    Science.gov (United States)

    Fiorani, Cristina; Biancone, Livia; Tema, Giorgia; Porokhnavets, Kristina; Tesauro, Manfredi; Gaspari, Achille L; Sica, Giuseppe S

    2014-01-01

    Midgut malrotation is an anomaly of fetal intestinal rotation. Its incidence in adults is rare. A case of midgut malrotation in a 51-year-old man with complicated Crohn's disease of the terminal ileum is presented. Symptoms, diagnosis, and treatment are reviewed. Preoperative workup led to correct surgical planning that ultimately allowed a successful laparoscopic resection.

  11. Oral contraceptive use and cigarette smoking in Crohn's disease.

    Science.gov (United States)

    Katschinski, B; Fingerle, D; Scherbaum, B; Goebell, H

    1993-09-01

    Previous studies have consistently found strong positive associations between smoking and Crohn's disease. The association between oral contraceptive use and Crohn's disease remains, however, controversial. In order to analyze whether smoking and oral contraceptive use are independent risk factors, a case-control study was performed. In 90 women with Crohn's disease and 90 community controls information was assessed about their smoking habits and their use of oral contraceptives. Smoking and oral contraceptive use were associated with one another. After adjusting for oral contraceptive use, the relative risk for smokers compared with nonsmokers was 3.0 (1.3-6.8). After controlling for smoking, the relative risk estimates for oral contraceptive use were for no use, 1-3 years, and > 3 years of use 1.0, 2.5 (1.0-6.6), and 4.3 (1.3-14.4), respectively. When oral contraceptive use was stratified by smoking habits, the data show that oral contraceptives only increased the risk for Crohn's disease in nonsmokers. From the lack of increase in risk for combined exposure, it is concluded that both factors might act through a common mechanism.

  12. Active learning based segmentation of Crohns disease from abdominal MRI

    NARCIS (Netherlands)

    Mahapatra, Dwarikanath; Vos, Franciscus M.; Buhmann, Joachim M.

    2016-01-01

    This paper proposes a novel active learning (AL) framework, and combines it with semi supervised learning (SSL) for segmenting Crohns disease (CD) tissues from abdominal magnetic resonance (MR) images. Robust fully supervised learning (FSL) based classifiers require lots of labeled data of different

  13. [Liver abscesses as a complication of Crohn's disease

    NARCIS (Netherlands)

    Bokhoven, M.M. van; Drenth, J.P.H.; Nagengast, F.M.

    2005-01-01

    Liver abscesses were found in two women aged 23 and 34 years who suffered from Crohn's disease. The first patient was seen because of fever and thoracic pain and had been treated with infliximab. The second patient, who was pregnant, presented with abdominal pain that was thought to be due to an

  14. Intestinal tuberculosis and Crohn: A clinician’s diagnostic dilemma

    Directory of Open Access Journals (Sweden)

    Seema Pavaman Sindgikar

    2016-03-01

    Full Text Available A 12 year old girl with altered bowel habits, hematochezia and growth failure was evaluated for intestinal tuberculosis and inflammatory bowel disease and was ultimately diagnosed to have Crohn disease. This case is being reported to highlight the difficulty in differentiating inflammatory bowel disease from gastrointestinal tuberculosis in Asia Pacific region.

  15. Magnetic resonance imaging of peritoneal pseudocyst associated with Crohn's disease

    International Nuclear Information System (INIS)

    Urbanski, S.R.; De Lange, E.E.; Frierson, H.F. Jr

    1991-01-01

    Clinically and intraoperative nonpancreatic pseudocysts of the abdomen are often confused with other cystic masses occurring within the mesentary and the omentum. The authors report their findings of MRI of peritoneal pseudocysts associated with Crohn's disease. (author). 6 refs.; 3 figs

  16. The use of adalimumab in severe fistulising Crohn's disease

    DEFF Research Database (Denmark)

    Bang, U.C.; Nielsen, Anette Mertz

    2008-01-01

    So far infliximab is the only approved anti-TNF-alpha antibody for patients with Crohn's disease. Development of antibodies to infliximab may result in allergic reactions or reduced effect. We report three patients who received adalimumab, which induced longstanding remission in all three patients...

  17. Radiologic and endoscopic diagnosis of ulcerative colitis and Crohn's disease

    International Nuclear Information System (INIS)

    Pausch, J.; Holstege, A.; Brambs, J.

    1986-01-01

    The indication for radiologic or endoscopic examinations in ulcerative colitis and Crohn's disease depends on the stage of the disease. Advantages of the colonoscopy are the possibility of observation of colour and the avoidance of X-rays in the management of young patients. Radiology is superior to endoscopy in estimating shortening of the bowel, stenoses and fistulas. (orig.) [de

  18. Disease phenotype at diagnosis in pediatric Crohn's disease

    DEFF Research Database (Denmark)

    de Bie, Charlotte I; Paerregaard, Anders; Kolacek, Sanja

    2013-01-01

    It has been speculated that pediatric Crohn's disease (CD) is a distinct disease entity, with probably different disease subtypes. We therefore aimed to accurately phenotype newly diagnosed pediatric CD by using the pediatric modification of the Montreal classification, the Paris classification....

  19. Crohn's Disease in Transvaal Blacks: A REPORT OF THREE ...

    African Journals Online (AJOL)

    Crohn's disease is rarely seen in Transvaal Blacks. Three cases are presented. The pathology and radiological features are discussed. The difficulty of diagnosing the extent of the disease in the acute stage both clinically and radiologically is emph,!lsised. The acute case should be recognised at operation and nothing ...

  20. Computed tomography of Crohn's disease and ulcerative colitis

    International Nuclear Information System (INIS)

    Klein, H.M.; Wein, B.; Adam, G.; Ruppert, D.; Guenther, R.W.

    1995-01-01

    We analysed the CT examinations of 109 patients with 197 involved bowel locations. 81 patients suffered from Crohn's disease, 28 from ulcerative colitis. Diagnosis was based on the combination of clinical, endoscopic and histopathologic findings. Three radiologists evaluated the CT series concerning the presence of morphologic changes analogous to conventional radiographic findings. In Crohn's disease, we found irregular outer contours in 26% of cases. The bowel wall was thickened in 82%. In acute phases, the bowel wall was thickened in 100%. Abscess and fistula as complications of inflammatory disease were present in 26 and 14% respectively. In ulcerative colitis, a target sign of the bowel wall was present in 40%, whereas in Crohn's disease a homogeneous wall density was present in all but two cases. Reduced attenuation due to submucosal fat deposits was found in 16% and mucosal tunneling in 27% of cases with ulcerative colitis. Even if severe mucosal destructions were found, the outer contour of the gut was smooth and regular in 95% of the ulcerative colitis cases. CT can provide additional information on acuity, extent and complications in inflammatory bowel disease. In combination with conventional radiographic findings a three-step classification for Crohn's disease and ulcerative colitis (early changes, acute and chronic phase) can be proposed. (orig./MG) [de

  1. Circulating microRNAs as biomarkers of adult Crohn's disease

    DEFF Research Database (Denmark)

    Jensen, Michael D; Andersen, Rikke F; Christensen, Henry

    2015-01-01

    OBJECTIVE: Previous studies have found a differential expression of microRNAs (miRNAs) in the blood of patients with Crohn's disease (CD) compared with healthy controls. The aim of this study was to identify circulating miRNAs expressed in CD and assess their performance as biomarkers in patients...

  2. Crohn's disease presenting as a recurrent perianal fistula: A case ...

    African Journals Online (AJOL)

    Crohn's disease (CD) is a multifactorial polygenic disease characterized by chronic inflammation of the gastrointestinal tract (GIT), often complicated by the development of intestinal strictures and/or formation of fistulas. Several diagnostic criteria have been proposed, usually relying on clinical, endoscopic, radiological or ...

  3. Kirurgisk behandling af anale fistler ved Crohns sygdom

    DEFF Research Database (Denmark)

    Heyckendorff-Diebold, Tina; Maeda, Yasuko; Buntzen, Steen

    2012-01-01

    The treatment of transsphincteric anal fistulas in Crohn's disease is a balance between the elimination of the sepsis and the functional outcome. Loose setons can be used as a preoperative drainage or chronic treatment. Fibrin glue and the anal fistula plug are methods with excellent functional...

  4. Postoperative recurrence of Crohn's disease: pathogenesis and prevention

    NARCIS (Netherlands)

    D'Haens, G. R.; Rutgeerts, P. J.

    1994-01-01

    Postoperative recurrence of Crohn's disease is very common and almost invariably appears at the ileal side of the ileocolonic anastomosis. Luminal factors are believed to play an essential role in triggering the earliest inflammatory events. The characteristics of recurrent disease are often very

  5. Onercept for moderate-to-severe Crohn's disease

    DEFF Research Database (Denmark)

    Rutgeerts, Paul; Sandborn, William J; Fedorak, Richard N

    2006-01-01

    BACKGROUND AND AIMS: Onercept is a recombinant, soluble human p55 receptor to tumor necrosis factor-alpha. METHODS: A randomized, double-blind, placebo-controlled, dose-ranging trial was performed to evaluate the efficacy of onercept induction therapy in patients with Crohn's disease (CD). Patients...

  6. Ulcerative Colitis and Crohn's Disease: Implications for College Health Programs

    Science.gov (United States)

    Gelphi, A. P.

    1977-01-01

    The author reviews clinical patterns of inflammatory bowel disorders, establishes a perspective for recognizing ulcerative colitis, ulcerative proctitis, and Crohn's disease in relation to other bowel inflammations, and suggests some epidemiologic strategies for studying etiology, pathogenesis, and natural history of the diseases. (MJB)

  7. Mongersen, an oral SMAD7 antisense oligonucleotide, and Crohn's disease.

    Science.gov (United States)

    Monteleone, Giovanni; Neurath, Markus F; Ardizzone, Sandro; Di Sabatino, Antonio; Fantini, Massimo C; Castiglione, Fabiana; Scribano, Maria L; Armuzzi, Alessandro; Caprioli, Flavio; Sturniolo, Giacomo C; Rogai, Francesca; Vecchi, Maurizio; Atreya, Raja; Bossa, Fabrizio; Onali, Sara; Fichera, Maria; Corazza, Gino R; Biancone, Livia; Savarino, Vincenzo; Pica, Roberta; Orlando, Ambrogio; Pallone, Francesco

    2015-03-19

    Crohn's disease-related inflammation is characterized by reduced activity of the immunosuppressive cytokine transforming growth factor β1 (TGF-β1) due to high levels of SMAD7, an inhibitor of TGF-β1 signaling. Preclinical studies and a phase 1 study have shown that an oral SMAD7 antisense oligonucleotide, mongersen, targets ileal and colonic SMAD7. In a double-blind, placebo-controlled, phase 2 trial, we evaluated the efficacy of mongersen for the treatment of persons with active Crohn's disease. Patients were randomly assigned to receive 10, 40, or 160 mg of mongersen or placebo per day for 2 weeks. The primary outcomes were clinical remission at day 15, defined as a Crohn's Disease Activity Index (CDAI) score of less than 150, with maintenance of remission for at least 2 weeks, and the safety of mongersen treatment. A secondary outcome was clinical response (defined as a reduction of 100 points or more in the CDAI score) at day 28. The proportions of patients who reached the primary end point were 55% and 65% for the 40-mg and 160-mg mongersen groups, respectively, as compared with 10% for the placebo group (P<0.001). There was no significant difference in the percentage of participants reaching clinical remission between the 10-mg group (12%) and the placebo group. The rate of clinical response was significantly greater among patients receiving 10 mg (37%), 40 mg (58%), or 160 mg (72%) of mongersen than among those receiving placebo (17%) (P=0.04, P<0.001, and P<0.001, respectively). Most adverse events were related to complications and symptoms of Crohn's disease. We found that study participants with Crohn's disease who received mongersen had significantly higher rates of remission and clinical response than those who received placebo. (Funded by Giuliani; EudraCT number, 2011-002640-27.).

  8. High-utilizing Crohn's disease patients under psychosomatic therapy*

    Science.gov (United States)

    Deter, Hans-Christian; von Wietersheim, Jörn; Jantschek, Günther; Burgdorf, Friederike; Blum, Brigitta; Keller, Wolfram

    2008-01-01

    Objective Few studies have been published on health care utilization in Crohn's disease and the influence of psychological treatment on high utilizers. Methods The present sub study of a prospective multi center investigation conducted in 87 of 488 consecutive Crohn's disease (CD) patients was designed to investigate the influence of the course of Crohn's disease on health care utilization (hospital days (HD) and sick leave days (SLD) collected by German insurance companies) and to examine the conditions of high-utilizing patients. Predictors of health care utilization should be selected. Based on a standardized somatic treatment, high health care utilizing patients of the psychotherapy and control groups should be compared before and after a one-year treatment. Results Multivariate regression analysis identified disease activity at randomization as an important predictor of the clinical course (r2 = 0.28, p < 0.01). Health care utilization correlated with duration of disease (p < 0.04), but the model was not significant (r2 = 0.15, p = 0.09). The patients' level of anxiety, depression and lack of control at randomization predicted their health-related quality of life at the end of the study (r2 = 0.51, p < 0.00001). Interestingly, steroid intake and depression (t1) predicted the combined outcome measure (clinical course, HRQL, health care utilization) of Crohn's disease at the end of the study (r2 = 0.22, p < 0.001). Among high utilizers, a significantly greater drop in HD (p < 0.03) and in mean in SLD were found in the treatment compared to the control group. Conclusion The course of Crohn's disease is influenced by psychological as well as somatic factors; especially depression seems important here. A significant drop of health care utilization demonstrates the benefit of psychological treatment in the subgroup of high-utilizing CD patients. Further studies are needed to replicate the findings of the clinical outcome in this CD subgroup. PMID:18851749

  9. Predictive factors of small bowel patency in Crohn's disease patients

    Directory of Open Access Journals (Sweden)

    Andreia Albuquerque

    2016-02-01

    Full Text Available Background: Patency capsule was developed to avoid small bowel video capsule endoscopy retention, namely in patients with Crohn's disease. Aims: To evaluate the predictive factors of small bowel patency in Crohn's disease patients. Patients and methods: Retrospective analysis including 151 Crohn's disease patients submitted to patency capsule (Agile® Patency Capsule from 2011 to 2012. Patients that excreted the intact patency capsule were classified as having a patent small bowel (without patency capsule retention, other patients were considered to have negative patency of the small bowel (patency capsule retention. Results: Patients had a mean age of 41±14 years, 54% were female and 25% had been previously submitted to surgery. Stricturing disease was seen in 20% of cases and penetrating disease in 16% of cases. Left-sided colonic lesions and ileal strictures were observed at colonoscopy in 13% and 9% of patients, respectively. In our sample, 28% of patients had negative patency of the small bowel (patency capsule retention. In multivariate analysis, independent factors that were associated with negative patency of the small bowel in Crohn's disease patients were stricturing (OR 10.16, p < 0.001 and penetrating phenotypes (OR 11.73, p = 0.001, left-sided colonic lesions (OR 3.77, p = 0.038, ileal stricture (OR 9.76, p = 0.003; previous intestinal surgery was found to be protective (OR 0.16, p = 0.006. Conclusions: Stricturing or penetrating disease, ileal strictures, no previous surgery and left-sided colonic lesions were the factors associated with negative small bowel patency in Crohn's disease patients.

  10. Safety and efficacy of recombinant human interleukin 10 in chronic active Crohn's disease. Crohn's Disease IL-10 Cooperative Study Group

    NARCIS (Netherlands)

    Schreiber, S.; Fedorak, R. N.; Nielsen, O. H.; Wild, G.; Williams, C. N.; Nikolaus, S.; Jacyna, M.; Lashner, B. A.; Gangl, A.; Rutgeerts, P.; Isaacs, K.; van Deventer, S. J.; Koningsberger, J. C.; Cohard, M.; LeBeaut, A.; Hanauer, S. B.

    2000-01-01

    Interleukin (IL)-10 is a cytokine with potent anti-inflammatory properties. We investigated the safety and efficacy of different doses of human recombinant (rhu)IL-10 in patients with Crohn's disease (CD). A prospective, multicenter, double-blind, placebo-controlled study was conducted in 329

  11. Lower extremity necrotizing fasciitis: A unique initial presentation of Crohn's disease

    Directory of Open Access Journals (Sweden)

    Anna Weiss

    2015-09-01

    Full Text Available Crohn's disease is a disease of the bowel, typically presenting with diarrhea, weight loss, and abdominal pain. Complications such as abscesses, fistulas, and strictures may require surgical intervention. We would like to report a patient with Crohn's disease who presented for the first time with left lower extremity necrotizing fasciitis. There are very few reports of necrotizing fasciitis in Crohn's disease as the initial presentation.

  12. Crohn's Disease Associated with Sweet's Syndrome and Sjögren's Syndrome Treated with Infliximab

    Directory of Open Access Journals (Sweden)

    Erina N. Foster

    2005-01-01

    Full Text Available The association of Crohn's disease (CD and Sweet's syndrome is rare and the presence of Sjögren's syndrome in Crohn's disease is even rarer, with only three reports found in the literature. We describe two cases of Crohn's disease associated with Sweet's syndrome, one of which is the first case of CD and Sweet's concomitantly associated with Sjögren's syndrome. Both cases responded rapidly to Infliximab therapy with complete resolution of the skin lesions.

  13. Cryptogenic Organizing Pneumonia With Lung Nodules Secondary to Pulmonary Manifestation of Crohn Disease

    Directory of Open Access Journals (Sweden)

    Taufiq Zaman

    2017-05-01

    Full Text Available Crohn disease is an immune-mediated inflammatory condition with gastrointestinal and extraintestinal manifestations in patients. Pulmonary involvement of Crohn disease is one manifestation. There have been case reports which have shown Crohn disease and lung nodules which were noted to be histopathological as cryptogenic organizing pneumonia (COP. In our case, a 22-year-old woman with Crohn disease was seen with complaints of chest pain and cough. Computed tomographic scan of chest showed multiple bilateral lung nodules, for which biopsy was done, which showed COP. The case study is followed by a deeper discussion of COP and the extraintestinal manifestation seen in inflammatory bowel disease.

  14. Crohn's disease: ultrastructure of interstitial cells in colonic myenteric plexus

    DEFF Research Database (Denmark)

    Rumessen, Jüri Johs.; Vanderwinden, Jean-Marie; Horn, Thomas

    2011-01-01

    -MP and other interstitial cells in the myenteric region of the colon are lacking for CD. In the present study, we characterized the ultrastructure of interstitial cells, nerves, and glial cells in the myenteric region in Crohn's colitis (CC). In comparison with controls, varicosities of the myenteric bundles...... were dilated and appeared to be empty. Lipid droplets and lipofuscin-bodies were prominent in glial cells and neurons. ICC-MP were scanty but, as in controls, had caveolae, prominent intermediate filaments, cytoplasmic dense bodies, and membrane-associated dense bands with a patchy basal lamina. ICC......The role of the interstitial cells of Cajal (ICC) in chronic inflammatory bowel disease, i.e., ulcerative colitis (UC) and Crohn's disease (CD), remains unclear. Ultrastructural alterations in ICC in the colonic myenteric plexus (ICC-MP) have been reported previously in UC, but descriptions of ICC...

  15. Contrast-Enhanced Ultrasonography in Crohn's Disease Diagnostics.

    Science.gov (United States)

    Białecki, Marcin; Białecka, Agnieszka; Laskowska, Katarzyna; Liebert, Ariel; Kłopocka, Maria; Serafin, Zbigniew

    2015-06-01

    The chronic nature of Crohn's disease (CD) implicates necessity of multiple control assessments throughout patient's life. It is accepted that in patients with CD requiring disease monitoring, magnetic resonance enterography (MRE) and computed tomography enterography (CTE) are--apart from endoscopy--imaging studies of first choice. In practice, diagnostic imaging of patients with CD is troublesome, since MRE is an expensive and complicated study, and CTE exposes patients to high doses of ionizing radiation. Therefore, there is a need for new, both non-invasive and effective, methods of imaging in CD. Contrast-Enhanced Ultrasonography (CEUS) is a relatively new method using gas-filled microbubbles serving as contrast agent. It allows for detailed assessment of blood perfusion within intestine wall and peri-intestinal tissues, which enables detection and monitoring of inflammation and its qualitative assessment. The purpose of this paper is to describe CEUS examination technique and its clinical applications in patients with Crohn's disease.

  16. Ramiprilate inhibits functional matrix metalloproteinase activity in Crohn's disease fistulas

    DEFF Research Database (Denmark)

    Efsen, Eva; Saermark, Torben; Hansen, Alastair

    2011-01-01

    Increased expression of matrix metalloproteinase (MMP)-2, -3 and -9 has been demonstrated in Crohn's disease fistulas, but it is unknown whether these enzymes are biologically active and represent a therapeutic target. Therefore, we investigated the proteolytic activity of MMPs in fistula tissue...... from six controls were also included. Total functional MMP activity was measured by a high-pressure liquid chromatography (HPLC)-based, fluorogenic MMP-substrate cleavage assay, and the specific activity of MMP-2, -3 and -9 by the MMP Biotrak Activity Assay. The MMP inhibitors comprised ethylene......-9.83) compared with non-Crohn's fistulas, [0.32 ng/ml, range 0-2.66, (p MMP-9 activity [0.64 ng/ml, range 0-5.66 and 0.17 ng/ml, range 0-1.1, respectively (p MMP activity level by 42% and suppressed the specific MMP-3...

  17. Multifocal choroiditis - an unusual finding in Crohns disease.

    Science.gov (United States)

    Vianna, R N G; Ozdal, P C; Deschnes, J

    To report a patient with Crohns disease and acute decreased vision in one eye secondary to multifocal choroiditis and serous retinal detachment. A complete ocular examination, including fluorescein angiography, was performed. Fundus biomicroscopy disclosed multifocal, deep, discretely elevated yellowish lesions at the posterior pole of the affected eye. Fluorescein angiographic study of these lesions revealed early hypofluorescence followed by late yperfluorescence. Subtenonian injection of corticosteroids rapidly induced remission of the choroidal lesions. Chorioretinal involvement in patients with Crohns disease may or may not be related to reactivation of this disorder. Therefore, even patients without gastrointestinal symptoms who present with posterior segment inflammation must be informed of this. The chorioretinal inflammatory lesions do seem to respond promptly to periocular injection of corticosteroids. (Eur J Ophthalmol 2004; 14: 345-9).

  18. Radiologic and endoscopic correlation in Crohn's disease of the colon

    International Nuclear Information System (INIS)

    Czembirek, H.; Poetzi, R.; Tscholakoff, D.; Salomonowitz, E.; Wittich, G.; Vienna Univ.; Vienna Univ.

    1983-01-01

    A comparative assessment was carried out in 47 patients with double-contrast irrigoscopy (DCI), colonos-copy and edoscopy, the confirmed diagnosis being Crohn's disease in each of the patients. However, the histological finding of Crohn's disease was established in 19% only of the endoscopic biopsies. DCI enabled a more comprehensive assessment of the entire colon than was possible via endoscopy, since the right half of the colon could be visualized in less than 50% of the patients by the endoscopic method, whereas roentgenologic visualization of this part of the colon was possible in more than 90% of the patients. There was good agreement in respect of parts of the colon visualized both via endoscopy and via X-ray examination. As far as the assessment of deeper mucosal lesions was concerned, radiology proved superior, whereas endoscopy offered advantages in respect of changes on the level of the mucosa. (orig.) [de

  19. Crohn's Disease Is Associated With Restless Legs Syndrome

    OpenAIRE

    Weinstock, Leonard B.; Bosworth, Brian P.; Scherl, Ellen J.; Li, Ellen; Iroku, Ugonna; Munsell, Melissa A.; Mullen, Gerald E.; Walters, Arthur S.

    2010-01-01

    Extraintestinal manifestations of Crohn's disease (CD) have not previously included the central nervous system (CNS). Restless legs syndrome (RLS) is a CNS disorder that is either idiopathic or secondary to a number of diseases. The aim of this study was to determine if RLS was associated with CD because both are associated with iron deficiency, inflammation, and bacterial overgrowth. Consecutive CD outpatients (N=272) were prospectively surveyed at 4 centers for criteria for RLS. Incidence (...

  20. Pediatric Crohn's disease presenting with a large calcified pelvic mass

    Directory of Open Access Journals (Sweden)

    Dominic C. Grimberg, BS

    2017-07-01

    Full Text Available Small bowel Crohn's disease classically presents with symptoms of abdominal pain, diarrhea, and weight loss in the pediatric population. However, there is no published literature on its presentation associated with a dystrophically calcified pelvic mass. We present a case of a 15-year-old female presenting with four weeks of inflammatory bowel disease (IBD symptoms as well as a large calcified pelvic mass suggestive of chronic, organized inflammatory process versus a calcifying fibrous tumor.

  1. Cutaneous polyarteritis nodosa in a patient with Crohn's disease.

    Science.gov (United States)

    Komatsuda, Atsushi; Kinoshita, Koji; Togashi, Masaru; Maki, Nobuki; Masai, Rie; Niitsu, Hidetaka; Ohtani, Setsuya; Sageshima, Masato; Sawada, Ken-ichi; Wakui, Hideki

    2008-01-01

    A 19-year-old Japanese woman with a 4-year history of Crohn's disease (CD) developed high fever, polyarthralgia, and painful subcutaneous nodules of the legs. A skin biopsy showed panarteritis with fibrinoid necrosis in the deep dermis. Endoscopic examination showed aphthous lesions in the entire colon. She was diagnosed with cutaneous polyarteritis nodosa (PAN) associated with CD. Steroid therapy improved her symptoms. To our knowledge, this is the first Japanese case of cutaneous PAN associated with CD.

  2. High-utilizing Crohn's disease patients under psychosomatic therapy*

    Directory of Open Access Journals (Sweden)

    Jantschek Günther

    2008-10-01

    Full Text Available Abstract Objective Few studies have been published on health care utilization in Crohn's disease and the influence of psychological treatment on high utilizers. Methods The present sub study of a prospective multi center investigation conducted in 87 of 488 consecutive Crohn's disease (CD patients was designed to investigate the influence of the course of Crohn's disease on health care utilization (hospital days (HD and sick leave days (SLD collected by German insurance companies and to examine the conditions of high-utilizing patients. Predictors of health care utilization should be selected. Based on a standardized somatic treatment, high health care utilizing patients of the psychotherapy and control groups should be compared before and after a one-year treatment. Results Multivariate regression analysis identified disease activity at randomization as an important predictor of the clinical course (r2 = 0.28, p 2 = 0.15, p = 0.09. The patients' level of anxiety, depression and lack of control at randomization predicted their health-related quality of life at the end of the study (r2 = 0.51, p 2 = 0.22, p Among high utilizers, a significantly greater drop in HD (p Conclusion The course of Crohn's disease is influenced by psychological as well as somatic factors; especially depression seems important here. A significant drop of health care utilization demonstrates the benefit of psychological treatment in the subgroup of high-utilizing CD patients. Further studies are needed to replicate the findings of the clinical outcome in this CD subgroup.

  3. [Constant flow alimentation in Crohn's disease of children].

    Science.gov (United States)

    Saint-Raymond, A; Arnaud-Battandier, F; Schmitz, J

    1988-11-01

    Enteral nutrition in children with Crohn's disease is a preferred treatment of acute attacks. When maintained for three months, it effectively acts on digestive symptoms, makes possible the resumption of growth and onset of a delayed puberty. In contrast, it does not appear to modify the long-term course of the disease: 7 out of 10 patients had relapses 3 to 6 months after interruption of enteral nutrition.

  4. [Strictureplasty in the surgical treatment of complicated Crohn's disease].

    Science.gov (United States)

    Sampietro, G M; Sartani, A; Danelli, P; Ghizzoni, M; Sposito, C; Maconi, G; Parente, E; Taschieri, A M

    2003-01-01

    Crohns disease is a panintestinal chronic inflammatory condition. Its remitting-relapsing behaviour may require in the single patient repeated surgeries, with the aim of resolving the complications of the disease. The awereness that surgery cannot resolve the disease has led, in the last years, to the development of new "conservative surgical techniques", which preserve as much of the intestinal tissue as possible. These techniques are minimal resection and strictureplasty (SP). Aim of the study was to perform a prospective analysis of the long-term outcome of SP in a consecutive series of patients undergoing surgery for complicated Crohns Disease at the Division of general surgery, L. Sacco University Hospital, Milano, Italia. During the period of October 1992 to June 2002, 286 patients underwent surgical procedures for jejunoileal Crohns disease. 116 of them underwent SP resulting in a total of 217 procedures, of which: 111 Heineke-Mikulicz SP (51.2%), 36 ileoileal side-to-side SP (16.6%), 40 ileoceacal SP (18.4%) and the remaining 30 ileocolic SP (13.8%), as previously described by A.M. Taschieri. Fiftyone of the patients (23.5%) had concomitantly a minimal bowel resection. Postoperative mortality was nil, while in 3 cases (2.59%) repeated surgery was necessary due to postsurgical complications. Time-to-event estimates were performed using the Kaplan-Meier function. mortality, morbidity, and long-term results in this population of patients who underwent SP are encouraging and in line with reports in the international literature. It is suggested that SP together with minimal bowel resections, may be considered as first line surgical therapy in patients with Crohns Disease.

  5. Effectiveness of infliximab after adalimumab failure in Crohn's disease.

    Science.gov (United States)

    Chaparro, María; Andreu, Montserrat; Barreiro-de Acosta, Manuel; García-Planella, Esther; Ricart, Elena; Domènech, Eugeni; Esteve, María; Merino, Olga; Nos, Pilar; Peñalva, Mireia; Gisbert, Javier P

    2012-10-07

    To evaluate the effectiveness of infliximab as a second-line therapy in Crohn's disease patients after adalimumab failure. A historical cohort study in a community-based gastroenterology practice evaluated Crohn's disease patients treated with infliximab (induction plus maintenance) after adalimumab failure. Patients were identified using a large Spanish database (ENEIDA). We included 15 Crohn's disease patients who received infliximab after adalimumab failure. Five patients discontinued adalimumab due to loss of response, 3 due to adverse events and 7 due to partial response. After infliximab therapy was started, all patients who had interrupted adalimumab due to loss of efficacy regained response. All patients who discontinued adalimumab due to adverse events responded to infliximab and maintained this response; one of these patients had an uneventful course on infliximab, but 2 developed adverse events. None of the 7 patients who interrupted adalimumab due to partial response reached remission with infliximab. Switching from adalimumab to infliximab may be useful in patients who develop adverse effects or loss of response, however, the benefit of infliximab in primary nonresponders was not established.

  6. Prioritisation and network analysis of Crohn's disease susceptibility genes.

    Directory of Open Access Journals (Sweden)

    Daniele Muraro

    Full Text Available Recent Genome-Wide Association Studies (GWAS have revealed numerous Crohn's disease susceptibility genes and a key challenge now is in understanding how risk polymorphisms in associated genes might contribute to development of this disease. For a gene to contribute to disease phenotype, its risk variant will likely adversely communicate with a variety of other gene products to result in dysregulation of common signaling pathways. A vital challenge is to elucidate pathways of potentially greatest influence on pathological behaviour, in a manner recognizing how multiple relevant genes may yield integrative effect. In this work we apply mathematical analysis of networks involving the list of recently described Crohn's susceptibility genes, to prioritise pathways in relation to their potential development of this disease. Prioritisation was performed by applying a text mining and a diffusion based method (GRAIL, GPEC. Prospective biological significance of the resulting prioritised list of proteins is highlighted by changes in their gene expression levels in Crohn's patients intestinal tissue in comparison with healthy donors.

  7. Vedolizumab as a Treatment for Crohn's Disease and Ulcerative Colitis.

    Science.gov (United States)

    Ha, Christina; Kornbluth, Asher

    2014-12-01

    The management of Crohn's disease and ulcerative colitis has become increasingly complex. With the current utilization of immunosuppressive therapies earlier in the disease course for patients presenting with moderate to severe disease, there is a great need for additional biologic agents targeting inflammatory mediators other than anti-tumor necrosis factor-α (anti-TNF) agents. Although anti-TNF agents have positively impacted the treatment of inflammatory bowel disease, many patients can lose their response or develop intolerance to these agents over time through the formation of antidrug antibodies. Furthermore, a sizeable percentage of patients are primary nonresponders to anti-TNF drugs. Vedolizumab (Entyvio, Takeda Pharmaceuticals), a monoclonal antibody to the α4β7 integrin, inhibits gut lymphocyte trafficking and has been demonstrated to be an effective and safe agent for the treatment of both Crohn's disease and ulcerative colitis. This article reviews the clinical trial evidence and rationale for the use of vedolizumab in moderate to severe Crohn's disease and ulcerative colitis.

  8. Ultrasound and magnetic resonance imaging in Crohn's disease: a comparison

    International Nuclear Information System (INIS)

    Potthast, S.; Rieber, A.; Wruk, D.; Brambs, H.-J.; Tirpitz, C. von; Adler, G.

    2002-01-01

    The objective of this retrospective study was to compare MRI of the abdomen with ultrasound of the abdomen and gastrointestinal tract in patients with Crohn's disease. Forty-six patients were included in the study. We analyzed the localization of Crohn's lesions, the number of affected bowel segments, the number of stenoses, and the presence of abscesses, fistulae, and any additional findings. Findings were verified by means of one or more of the following: enteroclysis; surgical findings; and colonoscopy. The results show that MRI is superior to ultrasound in the localization of affected bowel segments (sensitivity: MRI 97.5%; US 76%) and in recognizing fistulae (sensitivity: MRI 87%; US 31%), stenoses (sensitivity: MRI 100%; US 58%) and abscesses (sensitivity: MRI 100%; US 89%). Magnetic resonance imaging of the abdomen should be obtained to clarify discrepant clinical and sonographic findings. In addition, despite its higher cost, MRI of the abdomen is justified in patients in whom Crohn's lesions are known or suspected in anatomic areas proximal to the terminal or neoterminal ileum and in cases with suspicion of fistulae and abscesses. (orig.)

  9. Treatment of Crohn's disease with cannabis: an observational study.

    Science.gov (United States)

    Naftali, Timna; Lev, Lihi Bar; Yablecovitch, Doron; Yablekovitz, Doron; Half, Elisabeth; Konikoff, Fred M

    2011-08-01

    The marijuana plant cannabis is known to have therapeutic effects, including improvement of inflammatory processes. However, no report of patients using cannabis for Crohn's disease (CD) was ever published. To describe the effects of cannabis use in patients suffering from CD. In this retrospective observational study we examined disease activity, use of medication, need for surgery, and hospitalization before and after cannabis use in 30 patients (26 males) with CD. Disease activity was assessed by the Harvey Bradshaw index for Crohn's disease. Of the 30 patients 21 improved significantly after treatment with cannabis. The average Harvey Bradshaw index improved from 14 +/- 6.7 to 7 +/- 4.7 (P cannabis use, but only 2 required surgery during an average period of 3 years of cannabis use. This is the first report of cannabis use in Crohn's disease in humans. The results indicate that cannabis may have a positive effect on disease activity, as reflected by reduction in disease activity index and in the need for other drugs and surgery. Prospective placebo-controlled studies are warranted to fully evaluate the efficacy and side effects of cannabis in CD.

  10. Prognostic biomarkers to identify patients destined to develop severe Crohn?s disease who may benefit from early biological therapy: protocol for a systematic review, meta-analysis and external validation

    OpenAIRE

    Halligan, Steve; Boone, Darren; Bhatnagar, Gauraang; Ahmad, Tariq; Bloom, Stuart; Rodriguez-Justo, Manuel; Taylor, Stuart A.; Mallett, Susan

    2016-01-01

    Background It is believed increasingly that patients with severe Crohn?s disease are best treated early with biological therapy, which may ameliorate subsequent disease course and diminish long-term complications. However, we cannot predict currently which new presentations of Crohn?s disease are destined to develop severe disease so treatment cannot be targeted to the most appropriate patients. Accordingly, via systematic review and meta-analysis we aim to identify if biomarkers of disease a...

  11. Therapeutic efficacy of cyclic home elemental enteral alimentation in Crohn's disease: Japanese cooperative Crohn's disease study.

    Science.gov (United States)

    Matsueda, K; Shoda, R; Takazoe, M; Hiwatashi, N; Bamba, T; Kobayashi, K; Saito, T; Terano, A; Yao, T

    1995-11-01

    Crohn's disease (CD) often flares up and requires frequent hospitalization and/or surgery. Cyclic home elemental enteral alimentation (C-HEEA) was developed to prevent flare-up of CD and to minimize patient hospitalization. However, its therapeutic efficacy has not been studied in a large patient population. Therefore, questionnaires were sent to members of the Inflammatory Bowel Disease (IBD) Research Group of Japan to evaluate the therapeutic efficacy of C-HEEA and to define the factors that may affect the efficacy of the treatment. Data for 410 patients (C-HEEA-treated n = 322; drug-treated n = 88) were collected from 29 institutions and analysis showed the following results. The cumulative remission and non-hospitalization rates of the C-HEEA treated group were significantly higher than the rates of the drug-treated group in all patients and in those with ileitis and ileo-colitis (P < 0.0001, P < 0.001, and P < 0.01, respectively), but no significant difference was noted in patients with colitis. Cumulative remission and non-hospitalization rates were also influenced by the daily calorie content of the elemental diet (ED); more than 1200 kcal of the ED per day was found to be more effective than lower amounts to maintain remission and to prevent hospitalization. The therapeutic efficacy of C-HEEA was shown to be superior to that of drug treatment in patients with CD with ileal involvement, and it is suggested that more than 1200kcal per day should be supplied by the ED to enhance its therapeutic efficacy.

  12. Glutamine for induction of remission in Crohn's disease.

    Science.gov (United States)

    Akobeng, Anthony K; Elawad, Mamoun; Gordon, Morris

    2016-02-08

    Crohn's disease is a chronic relapsing condition of the alimentary tract with a high morbidity secondary to bowel inflammation. Glutamine plays a key role in maintaining the integrity of the intestinal mucosa and has been shown to reduce inflammation and disease activity in experimental models of Crohn's disease. To evaluate the efficacy and safety of glutamine supplementation for induction of remission in Crohn's disease. We searched the following databases from inception to November 15, 2015: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and the Cochrane IBD Group Specialised Register. Study references were also searched for additional trials. There were no language restrictions. Randomised controlled trials (RCTs) that compared glutamine supplementation administered by any route to a placebo, active comparator or no intervention in people with active Crohn's disease were considered for inclusion. Two authors independently extracted data and assessed the methodological quality of the included studies. The Cochrane risk of bias tool was used to assess methodological quality. The primary outcome measure was clinical or endoscopic remission. Secondary outcomes included intestinal permeability, clinical response, quality of life, growth in children and adverse events. Risk ratios and 95% confidence intervals were calculated for dichotomous outcomes. The overall quality of the evidence supporting the primary outcome was evaluated using the GRADE criteria. Two small RCTs (total 42 patients) met the inclusion criteria and were included in the review. One study (18 patients) compared four weeks of treatment with a glutamine-enriched polymeric diet (42% amino acid composition) to a standard polymeric diet (4% amino acid composition) with low glutamine content in paediatric patients ( 18 years of age) with acute exacerbation of inflammatory bowel disease. The paediatric study was rated as low risk of bias. The study in adult patients was rated as

  13. Effect of childbirth on the course of Crohn's disease; results from a retrospective cohort study in the Netherlands

    NARCIS (Netherlands)

    Smink, M.; Lotgering, F.K.; Albers, L.; Jong, D.J. de

    2011-01-01

    BACKGROUND: Pregnant women with Crohn's disease needs proper counselling about the effect of pregnancy and childbirth on their disease. However, Literature about the effect of childbirth on Crohn's disease is limited. This study examined the effect of childbirth on the course of Crohn's disease and

  14. Inhibition of stress-activated MAP kinases induces clinical improvement in moderate to severe Crohn's disease

    NARCIS (Netherlands)

    Hommes, Daan; van den Blink, Bernt; Plasse, Terry; Bartelsman, Joep; Xu, Cuiping; Macpherson, Bret; Tytgat, Guido; Peppelenbosch, Mailkel; van Deventer, Sander

    2002-01-01

    Background & Aims: We investigated if inhibition of mitogen-activated protein kinases (MAPKs) was beneficial in Crohn's disease. Methods: Inhibition of JNK and p38 MAPK activation with CNI-1493, a guanylhydrazone, was tested in vitro. Twelve patients with severe Crohn's disease (mean baseline, CDAI

  15. Dynamic contrast-enhanced MRI in patients with luminal Crohn's disease

    NARCIS (Netherlands)

    Ziech, M. L. W.; Lavini, C.; Caan, M. W. A.; Nio, C. Y.; Stokkers, P. C. F.; Bipat, S.; Ponsioen, C. Y.; Nederveen, A. J.; Stoker, J.

    2012-01-01

    Objectives: To prospectively assess dynamic contrast-enhanced (DCE-)MRI as compared to conventional sequences in patients with luminal Crohn's disease. Methods: Patients with Crohn's disease undergoing MRI and ileocolonoscopy within 1 month had DCE-MRI (3T) during intravenous contrast injection of

  16. Certolizumab pegol in patients with moderate to severe Crohn's disease and secondary failure to infliximab

    NARCIS (Netherlands)

    Sandborn, William J.; Abreu, Maria T.; D'Haens, Geert; Colombel, Jean-Frédéric; Vermeire, Severine; Mitchev, Krassimir; Jamoul, Corinne; Fedorak, Richard N.; Spehlmann, Martina E.; Wolf, Douglas C.; Lee, Scott; Rutgeerts, Paul

    2010-01-01

    Patients with moderate to severe Crohn's disease who receive infliximab may experience secondary failure (loss of response and/or hypersensitivity). Data on the utility of switching to certolizumab pegol in these patients are limited. A total of 539 patients with active Crohn's disease and secondary

  17. Vitamin D deficiency in Crohn's disease: prevalence, risk factors and supplement use in an outpatient setting.

    LENUS (Irish Health Repository)

    Suibhne, Treasa Nic

    2012-03-01

    Vitamin D deficiency impacts on bone health and has potential new roles in inflammation. We aimed to determine the prevalence of and risk factors for vitamin D deficiency and to explore vitamin D supplement usage in patients with Crohn\\'s disease (CD) in an outpatient setting, compared with controls.

  18. Infliximab for the treatment of fistulas in patients with Crohn's disease

    NARCIS (Netherlands)

    Present, D. H.; Rutgeerts, P.; Targan, S.; Hanauer, S. B.; Mayer, L.; van Hogezand, R. A.; Podolsky, D. K.; Sands, B. E.; Braakman, T.; DeWoody, K. L.; Schaible, T. F.; van Deventer, S. J.

    1999-01-01

    Enterocutaneous fistulas are a serious complication of Crohn's disease and are difficult to treat. Infliximab, a chimeric monoclonal antibody to tumor necrosis factor alpha, has recently been developed as a treatment for Crohn's disease. We conducted a randomized, multicenter, double-blind,

  19. A 5-year prospective observational study of the outcomes of international treatment guidelines for Crohn's disease.

    LENUS (Irish Health Repository)

    Cullen, Garret

    2012-02-01

    BACKGROUND & AIMS: Therapeutic strategies for patients with Crohn\\'s disease are based on American and European guidelines. High rates of corticosteroid dependency and low remission rates are identified as weaknesses of this therapy and as justification for early introduction of biologic agents (top-down treatment) in moderate\\/severe Crohn\\'s disease. We reviewed outcomes and corticosteroid-dependency rates of patients with moderate-to-severe disease who were treated according to the international guidelines. METHODS: Consecutive patients (102) newly diagnosed with Crohn\\'s disease in 2000-2002 were identified from a prospectively maintained database. Severity of disease was scored using the Harvey-Bradshaw Index (HBI). Disease was classified by Montreal classification. Five-year follow-up data were recorded. RESULTS: Seventy-two patients had moderate\\/severe disease at diagnosis (HBI >8). Fifty-four (75%) had nonstricturing, nonpenetrating disease (B1). Sixty-four (89%) received corticosteroids, and 44 (61%) received immunomodulators. Twenty-one patients (29%) received infliximab. Thirty-nine patients (54%) required resection surgery. At a median of 5 years, 66 of 72 (92%) patients with moderate\\/severe disease were in remission (median HBI, 1). Twenty-five patients (35%) required neither surgery nor biologic therapy. CONCLUSIONS: When international treatment guidelines are strictly followed, Crohn\\'s disease patients can achieve high rates of remission and low rates of morbidity at 5 years. Indiscriminate use of biologic agents therefore is not appropriate for all patients with moderate-to-severe disease.

  20. Comparison of Techniques for Monitoring Infliximab and Antibodies Against Infliximab in Crohn's Disease

    DEFF Research Database (Denmark)

    Steenholdt, Casper; Ainsworth, Mark A; Tovey, Michael

    2013-01-01

    Several techniques are used to measure infliximab (IFX) and anti-IFX antibodies (Abs) in Crohn's disease. The aim of this study was to compare different assays for this purpose.......Several techniques are used to measure infliximab (IFX) and anti-IFX antibodies (Abs) in Crohn's disease. The aim of this study was to compare different assays for this purpose....

  1. Crohn's disease co-existing with bleeding peptic ulcer disease - a ...

    African Journals Online (AJOL)

    Crohn's disease is a chronic idiopathic inflammatory condition of the gastrointestinal tract, which rarely affects the oesophagus and stomach together. The usual sites of involvement are the terminal ileum and proximal colon. It is rarer still for gastric Crohn's disease to present for the first time with haematemesis resulting from ...

  2. Stem cell transplantation as rescue therapy for refractory Crohn's disease: a sytematic review.

    Science.gov (United States)

    Labidi, Asma; Serghini, Meriem; Ben Mustapha, Nadia; Fekih, Monia; Boubaker, Jalel; Filali, Azza

    2014-11-01

    Crohn's disease is a chronic relapsing- remitting affection. It has a strong immunologic component which represent the target of standard therapies including immunosppressants and biological therapies. However, many patients remain refracory or intolerant to these therapies. The aim of this review is to determine the effects of stem cell transplantation in patients with refractory Crohn's disease. Systematic review of observational studies, clinical trials and case reports that focused on the effectiveness and safety of stem cell transplantation in patients with refractory Crohn's disease. Hematopoietic stem cell transplantation seems to be efficient in maintaining clinical and endoscopic remission in patients with Crohn's disease refractory or intolerant to current therapies. However, it has been associated to high morbidity and mortality due to chemotherapy. Mesenchymal stem cell transplantation could induce remission in patients with fistulising refractory Crohns disease with no severe side effects. Its impact on luminal Crohns disease is still controversial. Stem cell transplantation seems to hold promising in patients with refractory Crohn's disease. However, because of the high morbidity and mortality related to chemotherapy, hematopoietic stem cell transplantation should be used as last resort to control this disease. Effectiveness of mesenchymal stem cell transplantation in luminal Crohn's disease has yet to be proven.

  3. Updated German S3-guideline regarding the diagnosis of Crohn's disease. Implementation of radiological modalities

    International Nuclear Information System (INIS)

    Schreyer, A.G.; Ludwig, D.; Koletzko, S.; Hoffmann, J.C.; Preiss, J.C.; Zeitz, M.; Stange, E.; Herrlinger, K.R.

    2010-01-01

    The recently updated German S3-guideline regarding the diagnosis and treatment of Crohn's disease incorporates several changes concerning the radiological approach compared to the former guideline. This article focuses on guideline-based radiological imaging techniques for patients with Crohn's disease. The new guideline is also compared to former European and German guidelines in the context of recently published radiological literature. (orig.)

  4. Urological complications of Crohn's disease: entero-vesical fistula and ureteric obstruction

    International Nuclear Information System (INIS)

    Raaijmakers, P.A.M.; Boetes, C.; Strijk, S.P.; Boer, H.H.M. de; Debruyne, F.M.J.; Rosenbusch, G.

    1983-01-01

    Crohn's disease has a tendency to form fistulae and abscesses, which may lead directly to urological complications. Three patients were seen who had entero-vesical fistulae; only one of these could be demonstrated radiologically. There were also seven patients with Crohn's disease who had ureteric obstruction. (orig.) [de

  5. Problems in the Surgical Management of Crohn's Disease of the Colon

    African Journals Online (AJOL)

    Differences in the natural history of ulcerative colitis and colonic Crohn's disease which influence the choice and type of surgical treatment are discussed. The progressive nature of Crohn's disease is stressed. Drugs employed in the medical management of the disease are described with particular attention being drawn to ...

  6. CT enterography with polyethylene glycol electrolyte solution for diagnosis of Crohn's disease

    International Nuclear Information System (INIS)

    Ohana, Masaya; Mima, Atsushi; Sonoyama, Hiroki

    2012-01-01

    This study aimed to assess the diagnostic usefulness of CT enterography (CTE) in Crohn's disease in Japanese patients. A total of 32 cases with bowel symptoms underwent CT enterography with polyethylene glycol electrolyte solution as oral contrast medium, among which 18 were clinically diagnosed as Crohn's disease and 14 were not: ulcerative colitis 1, Bechet disease 1, simple ulcer 1, inflammatory bowel disease without definite diagnosis 5 and bowel symptoms of unknown origin 6. The incidence of bowel wall thickening, mural hyperenhancement, ''the comb sign'', mesenteric lymph nodes swelling, and stenosis were significantly higher in Crohn's disease than in other disease. Moreover, uneven bowel wall thickening and unilateral mural hyperenhancement on CTE were characteristic features of Crohn's disease, which our original quantitative evaluation with imaging analysis could support. Consequently, CTE is useful in Japanese patients with Crohn's disease. (author)

  7. Uveitis as first manifestation of probably Crohn's disease Uveíte como primeira manifestação de provável doença de Crohn

    Directory of Open Access Journals (Sweden)

    Ieda Maria Alexandre Barreira

    2012-12-01

    Full Text Available Extraintestinal manifestations of Crohn's disease are common. Although ocular complications of Crohn's disease are infrequent, most ocular manifestations include iritis, uveitis, episcleritis, scleritis and conjuntivitis. We report a patient who developed uveitis two years before diagnose of Crohn's disease.Manifestações extraintestinais da doença de Crohn são comuns. As manifestações oculares são infrequentes e caracterizam-se em sua maioria por irite, uveíte, episclerite, esclerite e conjuntivite. Relatamos o caso de uma paciente que desenvolveu uveíte dois anos antes de firmado o diagnóstico de doenca de Crohn.

  8. MR enteroclysis versus conventional enteroclysis in Crohn disease

    International Nuclear Information System (INIS)

    Gourtsoyiannis, N.

    2006-01-01

    Full text: Conventional enteroclysis is well established as a modality of choice for imaging evaluation of the small intestine. Its main limitation is the inability to demonstrate exoenteric pathology associated with small intestinal diseases. Cross sectional imaging has been complementary utilized to evaluate mural and extra mural abnormalities and complications of Crohn's disease. The main advantages of Magnetic Resonance Imaging (MRI) of the small bowel include excellent soft-tissue contrast and absence of radiation exposure. Different approaches have been adopted for studying the small bowel with MRI. The most promising is termed MR Enteroclysis (MRE), and includes duodenal intubation and administration of a maximum amount of 21 of contrast agent with the patient lying on prone position inside the magnet. An iso-osmotic water solution with polyethylene glycol and electrolytes (PEG) may be used as intestinal contrast. In our experience, the ideal examination protocol of the small bowel with MRI should comprise two kinds of sequences: (a) T2 weighted sequences for detecting bowel wall thickening and evaluating the exoenteric complications or the extent of the disease and (b) post Gadolinium T1 weighted sequences for characterizing the lesions. In the first group the most suitable sequences are the true FISP and HASTE which offer excellent anatomical depiction of the small bowel (HASTE) and the mesenteries (true FISP). In the second group, a 3d FLASH sequence can provide high resolution images of the bowel wall (512 matrix and 2 mm thin slices), where after Gadolinium injection and fat suppression techniques it is possible to characterize the disease (i.e. activity in Crohn's disease). The most important clinical application of MRE is Crohn disease. The characteristic ulcerations of Crohn's disease can be demonstrated on MRE and are better seen using the true FISP sequence, but they can also be appreciated on HASTE images. Longitudinal or transverse deep linear

  9. Pediatric Crohn's disease: epidemiology and emerging treatment options

    Directory of Open Access Journals (Sweden)

    Kansal S

    2014-07-01

    Full Text Available Shivani Kansal,1–3 Anthony G Catto-Smith1,2 1Department of Paediatrics, University of Melbourne, 2Department of Gastroenterology, The Royal Children's Hospital Melbourne, 3Murdoch Children's Research Institute, Melbourne, VIC, Australia Abstract: There has been a dramatic increase in the incidence of Crohn's disease over the last two to three decades worldwide, which has affected both the developed world and increasingly also the developing world. Crohn's disease is a disease of youth and can have a profound effect on the growing child, both in terms of growth and skeletal health as well psychosocial maturation. Environmental risk factors appear to be crucially important, but it is not clear at present whether improved hygiene, especially in childhood, influences immunological conditioning, or whether there is a direct impact on the gut from a disturbed gut microbiota. Genetic variation appears to relate to how the host interacts with its microbiota, determining susceptibility rather than causation. The outcome is a sustained immune response, clinically presenting as a relapsing/remitting disease process. There is no current cure for Crohn's disease; treatments are designed to reduce symptoms and control inflammation, initially by inducing a remission, then trying to maintain it. Historical therapies have included 5-aminosalicylic acid-based drugs, corticosteroids, and immunomodulators. Two approaches which are gaining increasing interest are the use of exclusive enteral nutrition and biologicals. Enteral nutrition is a remarkably effective approach, though there is a limited understanding of its mechanism and difficulties in acceptance among the medical community. Biologicals are a class of drugs which specifically target molecules and pathways central to the inflammatory process; they are also very effective, but patients can develop a secondary loss of response as a result of antibodies to the biological agent. Infection and the development

  10. Surgical recurrence in Crohn's disease: Are we getting better?

    Science.gov (United States)

    Kristo, Ivan; Stift, Anton; Bergmann, Michael; Riss, Stefan

    2015-05-28

    Crohn's disease (CD) still remains a challenging chronic inflammatory disorder, both for colorectal surgeons and gastroenterologists. The need for recurrent surgery following primary intestinal resection is still considerable, though recent evidence suggested a declining rate of recurrence. Several conflicting surgical parameters have been identified that might impact on the postoperative outcome positively, such as access to the abdomen, anastomotic configuration or type of disease. Additionally, promising results have been achieved with the increased use of immunosuppressive medications in CD. Consequently, the question arises if we are getting better as a result of novel medical and surgical strategies.

  11. Vedolizumab as induction and maintenance therapy for Crohn's disease.

    Science.gov (United States)

    Sandborn, William J; Feagan, Brian G; Rutgeerts, Paul; Hanauer, Stephen; Colombel, Jean-Frédéric; Sands, Bruce E; Lukas, Milan; Fedorak, Richard N; Lee, Scott; Bressler, Brian; Fox, Irving; Rosario, Maria; Sankoh, Serap; Xu, Jing; Stephens, Kristin; Milch, Catherine; Parikh, Asit

    2013-08-22

    The efficacy of vedolizumab, an α4β7 integrin antibody, in Crohn's disease is unknown. In an integrated study with separate induction and maintenance trials, we assessed intravenous vedolizumab therapy (300 mg) in adults with active Crohn's disease. In the induction trial, 368 patients were randomly assigned to receive vedolizumab or placebo at weeks 0 and 2 (cohort 1), and 747 patients received open-label vedolizumab at weeks 0 and 2 (cohort 2); disease status was assessed at week 6. In the maintenance trial, 461 patients who had had a response to vedolizumab were randomly assigned to receive placebo or vedolizumab every 8 or 4 weeks until week 52. At week 6, a total of 14.5% of the patients in cohort 1 who received vedolizumab and 6.8% who received placebo were in clinical remission (i.e., had a score on the Crohn's Disease Activity Index [CDAI] of ≤150, with scores ranging from 0 to approximately 600 and higher scores indicating greater disease activity) (P=0.02); a total of 31.4% and 25.7% of the patients, respectively, had a CDAI-100 response (≥100-point decrease in the CDAI score) (P=0.23). Among patients in cohorts 1 and 2 who had a response to induction therapy, 39.0% and 36.4% of those assigned to vedolizumab every 8 weeks and every 4 weeks, respectively, were in clinical remission at week 52, as compared with 21.6% assigned to placebo (P<0.001 and P=0.004 for the two vedolizumab groups, respectively, vs. placebo). Antibodies against vedolizumab developed in 4.0% of the patients. Nasopharyngitis occurred more frequently, and headache and abdominal pain less frequently, in patients receiving vedolizumab than in patients receiving placebo. Vedolizumab, as compared with placebo, was associated with a higher rate of serious adverse events (24.4% vs. 15.3%), infections (44.1% vs. 40.2%), and serious infections (5.5% vs. 3.0%). Vedolizumab-treated patients with active Crohn's disease were more likely than patients receiving placebo to have a remission, but

  12. [Benign multicystic peritoneal mesothelioma in a patient with Crohn disease].

    Science.gov (United States)

    Fluxá, Daniela; Kronberg, Udo; Lubascher, Jaime; O'Brien, Andrés; Las Heras, Facundo; Ibáñez, Patricio; Quera, Rodrigo

    2016-12-01

    Benign multicystic peritoneal mesothelioma is an uncommon lesion arising from the peritoneal mesothelium. It is asymptomatic or presents with unspecific symptoms. Imaging techniques may reveal it, however the final diagnosis can only be made by histopathology. Surgery is the only effective treatment considering its high recurrence rate. We report a 19 years old male with Crohn’s disease. Due to persistent abdominal pain, an abdominal magnetic resonance imaging was performed, showing a complex cystic mass in the lower abdomen. The patient underwent surgery and the lesion was completely resected. The pathological study reported a benign multicystic peritoneal mesothelioma.

  13. Laminated Intestinal Calculi – A Rare Complication of Crohn's Disease

    Directory of Open Access Journals (Sweden)

    Hugh J Freeman

    1995-01-01

    Full Text Available A 59-year-old male with a 36-year history of Crohn's disease and repeated resections for small intestinal strictures developed anemia and symptoms of an intermittent partial bowel obstruction. Barium studies showed recurrent small intestinal strictures as well as filling defects in a dilated loop proximal to a stenosed segment. Subsequent abdominal films and a computed tomographic study suggested laminated radiopaque calculi with peripheral calcification in the dilated small intestinal loop. Resection of the strictured segment confirmed the presence of intestinal enterolithiasis.

  14. X-ray diagnosis of Crohn's disease in the intestine

    International Nuclear Information System (INIS)

    Schuster, R.; Erkelenz, I.

    1980-01-01

    The article describes the essential roentgenologic findings associated with Crohn's disease in the intestine, manifested as stenoses, thickening of the walls, fistula formation and pseudodiverticula or appearance of Bodart's intermediary segment, on the basis of characteristic findings, followed by valuation in respect of the exclusive possibility of diagnosis via radiology. The article goes into details in respect of differential diagnosis criteria, particularly whithin the frame of tumour diagnosis. Differentiation can be effected with the help of findings in peritoneal carcinosis and intestinal changes induced by radiation. (orig.) [de

  15. Cannabis finds its way into treatment of Crohn's disease.

    Science.gov (United States)

    Schicho, Rudolf; Storr, Martin

    2014-01-01

    In ancient medicine, cannabis has been widely used to cure disturbances and inflammation of the bowel. A recent clinical study now shows that the medicinal plant Cannabis sativa has lived up to expectations and proved to be highly efficient in cases of inflammatory bowel diseases. In a prospective placebo-controlled study, it has been shown what has been largely anticipated from anecdotal reports, i.e. that cannabis produces significant clinical benefits in patients with Crohn's disease. The mechanisms involved are not yet clear but most likely include peripheral actions on cannabinoid receptors 1 and 2, and may also include central actions. © 2013 S. Karger AG, Basel.

  16. Assessment of Crohn's disease activity by Doppler sonography of the superior mesenteric artery, clinical evaluation and the Crohn's Disease activity index: A prospective study

    International Nuclear Information System (INIS)

    Byrne, Michael F.; Farrell, Michael A.; Abass, Suzanne; Fitzgerald, Anthony; Varghese, Jose C.; Thornton, Frank; Murray, Frank E.; Lee, Michael J.

    2001-01-01

    AIM: Recent data have shown that superior mesenteric artery (SMA) flow rates are significantly increased in active Crohn's disease, suggesting that SMA flow may be a useful, non-invasive index of disease activity. The aim of this prospective study was to evaluate the use of SMA Doppler sonography as an indicator of Crohn's disease activity and to compare with clinical evaluation and the Crohn's disease activity index (CDAI). MATERIALS AND METHODS: Patients with active Crohn's (n = 19), inactive Crohn's (n = 17) and control subjects (n = 17) were evaluated. Categorization of disease activity was based on a reference standard. CDAI scores were also calculated independently. The SMA flow parameters evaluated were resistive index, pulsatility index, end diastolic velocity, peak systolic velocity, time averaged maximum velocity, cross-sectional area and maximum flow volume. RESULTS: Using a three-group ANOVA for each of peak systolic velocity (PSV) (P = 0.01), end-diastolic velocity (EDV) (P = 0.04), pulsatility index (PI) (P = 0.003), time-averaged maximum velocity (TAMV) (P = 0.05), and maximum flow volume (TAMV.CSA) (P = 0.01), there was a significant effect of group. Using post-hoc tests, only EDV (P = 0.01), TAMV (P = 0.02) and TAMV.CSA (P 0.003) were significantly different between active and inactive Crohn's disease, though with considerable overlap of values for EDV and TAMV. The mean CDAI scores were significantly different between patients with active Crohn's (287) and inactive Crohn's (71) (P = 0.0001) and correlated well with the reference standard. CONCLUSION: Only three of several parameters previously described as allowing Crohn's disease activity assessment actually did so in our study. However, for two of these parameters (EDV, TAMV), there was overlap between the measurements in the active and inactive groups, thus limiting the ability to discriminate disease activity in practice. The degree of overlap for maximum flow volume (TAMV.CSA) between active

  17. Clinical course of Crohn's disease first diagnosed at surgery for acute abdomen.

    Science.gov (United States)

    Latella, G; Cocco, A; Angelucci, E; Viscido, A; Bacci, S; Necozione, S; Caprilli, R

    2009-04-01

    The severity of clinical activity of Crohn's disease is high during the first year after diagnosis and decreases thereafter. Approximately 50% of patients require steroids and immunosuppressants and 75% need surgery during their lifetime. The clinical course of patients with Crohn's disease first diagnosed at surgery has never been investigated. To assess the clinical course of Crohn's disease first diagnosed at surgery for acute abdomen and to evaluate the need for medical and surgical treatment in this subset of patients. Hospital clinical records of 490 consecutive Crohn's disease patients were reviewed. Patients were classified according to the Vienna criteria. Sex, extraintestinal manifestations, family history of inflammatory bowel diseases, appendectomy, smoking habit and medical/surgical treatments performed during the follow-up period were assessed. Kaplan-Meier survival method and Cox proportional hazards regression model. Of the 490 Crohn's disease patients, 115 had diagnosis of Crohn's disease at surgery for acute abdomen (Group A) and 375 by conventional clinical, radiological, endoscopic and histologic criteria (Group B). Patients in Group A showed a low risk of further surgery (Log Rank test pacute abdomen showed a low risk for reintervention and less use of steroids and immunosuppressants during follow-up than those not operated upon at diagnosis. Early surgery may represent a valid approach in the initial management of patients with Crohn's disease, at least in the subset of patients with ileal and complicated disease.

  18. Smoking and Crohn's disease: active modification of an independent risk factor (education alone is not enough).

    Science.gov (United States)

    Kennelly, Rory P; Subramaniam, Thava; Egan, Larry J; Joyce, Myles R

    2013-09-01

    Smoking can induce the onset of Crohn's disease in genetically susceptible patients and may accelerate progression and disease severity. There is a paucity of information as to patient knowledge of the impact of smoking on disease progression. The aim of this study was to assess patient awareness, initiate smoking cessation therapy and monitor the effectiveness of an active smoking cessation programme in patients with Crohn's disease. All patients with a diagnosis of Crohn's disease over a ten year period were identified from a prospectively managed database. Details of smoking history and patient knowledge of the link between Crohn's disease and smoking were collected through a telephone questionnaire. Current smokers who wished to quit were enrolled in a smoking cessation programme and followed prospectively for 12 months. 340 patients were identified with 281 eligible for inclusion. 181 patients agreed to a telephone survey (64.4% patient uptake). Smokers had an increased incidence of surgical intervention (OR 2.2; CI 1.02, 4.78 P=0.043). Awareness of the link between smoking and Crohn's disease was highest in the current smoking cohort and lowest in the non-smoking cohort (CS:NS; 79.5%:43% pCrohn's disease, information alone is ineffective at achieving smoking cessation. Good cessation rates are achievable if information is supported by active smoking cessation therapy. Copyright © 2012 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

  19. The impact of pregnancy on surgical Crohn disease: an analysis of the Nationwide Inpatient Sample.

    Science.gov (United States)

    Hatch, Quinton; Champagne, Bradley J; Maykel, Justin A; Davis, Bradley R; Johnson, Eric K; Bleier, Joshua I; Francone, Todd D; Steele, Scott R

    2014-07-01

    The impact of pregnancy on the course of Crohn disease is largely unknown. Retrospective surveys have suggested a variable effect, but there are limited population-based clinical data. We hypothesized pregnant women with Crohn disease will have similar rates of surgical disease as a nonpregnant Crohn disease cohort. International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify female Crohn patients from all patients admitted using the Nationwide Inpatient Sample (1998-2009). Women were stratified as either pregnant or nonpregnant. We defined Crohn-related surgical disease as peritonitis, gastrointestinal hemorrhage, intra-abdominal abscess, toxic colitis, anorectal suppuration, intestinal-intestinal fistulas, intestinal-genitourinary fistulas, obstruction and/or stricture, or perforation (excluding appendicitis). Of the 92,335 women admitted with a primary Crohn-related diagnosis, 265 (0.3%) were pregnant. Pregnant patients were younger (29 versus 44 y; PCrohn disease had higher rates of intestinal-genitourinary fistulas (23.4% versus 3.0%; Pdisease (59.6% versus 39.2%; Pdisease (OR, 2.9; 95% CI, 2.3-3.7; PCrohn disease is a significant risk factor for Crohn-related surgical disease, in particular, anorectal suppuration and intestinal-genitourinary fistulas. Published by Elsevier Inc.

  20. Genetic polymorphisms associated with smoking behaviour predict the risk of surgery in patients with Crohn's disease.

    Science.gov (United States)

    Lang, B M; Biedermann, L; van Haaften, W T; de Vallière, C; Schuurmans, M; Begré, S; Zeitz, J; Scharl, M; Turina, M; Greuter, T; Schreiner, P; Heinrich, H; Kuntzen, T; Vavricka, S R; Rogler, G; Beerenwinkel, N; Misselwitz, B

    2018-01-01

    Smoking is a strong environmental factor leading to adverse outcomes in Crohn's disease, but a more benign course in ulcerative colitis. Several single nucleotide polymorphisms (SNPs) are associated with smoking quantity and behaviour. To assess whether smoking-associated SNPs interact with smoking to influence the clinical course of inflammatory bowel diseases. Genetic and prospectively obtained clinical data from 1434 Swiss inflammatory bowel disease cohort patients (821 Crohn's disease and 613 ulcerative colitis) were analysed. Six SNPs associated with smoking quantity and behaviour (rs588765, rs1051730, rs1329650, rs4105144, rs6474412 and rs3733829) were combined to form a risk score (range: 0-12) by adding the number of risk alleles. We calculated multivariate models for smoking, risk of surgery, fistula, Crohn's disease location and ulcerative colitis disease extent. In Crohn's disease patients who smoke, the number of surgeries was associated with the genetic risk score. This translates to a predicted 3.5-fold (95% confidence interval: 2.4- to 5.7-fold, Prisk alleles than individuals with the lowest risk. Patients with a risk score >7 had a significantly shorter time to first intestinal surgery. The genetic risk score did not predict surgery in ulcerative colitis or occurrence of fistulae in Crohn's disease. SNP rs6265 was associated with ileal disease in Crohn's disease (Prisk for surgery in Crohn's disease patients who smoke. Our data provide an example of genetics interacting with the environment to influence the disease course of inflammatory bowel disease. © 2017 John Wiley & Sons Ltd.

  1. Operative and environmental risk factors for recurrence of Crohn's disease.

    Science.gov (United States)

    Moskovitz, D; McLeod, R S; Greenberg, G R; Cohen, Z

    1999-11-01

    This retrospective study determined whether a hand-sewn or stapled anastomosis leads to a greater recurrence rate in patients undergoing ileocecal resection for terminal ileal Crohn's disease. The effects of oral contraceptive use, smoking, and age at onset of disease were also examined. Ninety-two patients with Crohn's disease of the terminal ileum whose first operation was an ileocecal resection (terminal ileum and right colon up to but not including the hepatic flexure) were studied for symptomatic and operative recurrence. The symptomatic recurrence rates were 15% at 1 year, 31% at 2 years, and 45% at 3 years. The operative recurrence rates were 6% at 1 year, 14% at 2 years, and 22% at 3 years. The type of anastomosis, whether hand-sewn or stapled, did not affect the rates of symptomatic (P = 0.3) or operative (P = 0.6) recurrence. After the initial resection smoking affected both symptomatic (P = 0.03, risk ratio = 2.380) and operative (P = 0.041, risk ratio = 3.13) recurrence, but there was no effect of age at onset of disease or use of the birth control pill.

  2. Factors influencing first relapse in patients with Crohn's disease.

    Science.gov (United States)

    Wright, J P

    1992-07-01

    To determine whether information available at time of diagnosis of Crohn's disease can predict initial clinical course, I followed 239 patients prospectively from time of diagnosis to initial relapse. The patient's sex, smoking habits, contraceptive usage, disease extent, and presence of granulomas in the first histological specimen were recorded. No association was found between this demographic data and the interval between onset of symptoms and diagnosis, the severity of symptoms at presentation, or the time to relapse. The type of relapse, however, was influenced by the type of the first attack; 70% of relapses were of the same type as the initial attack. Cigarette smoking was associated with ileocolitis (p = 0.028). There was a trend for oral contraceptive users to have ileocolitis, whereas the presence of granulomas in the first histological specimen was not associated with a specific disease distribution. Patients with ileocolitis had more inflammatory attacks than those with ileitis or colitis (p = 0.001). There was also a trend for cigarette smokers and those on oral contraceptives to have more inflammatory attacks, but the presence of granulomas had no effect on the type of relapse. There is little to assist in prognosis of early disease when the diagnosis of Crohn's disease is first made, although the types of attacks tend to repeat themselves.

  3. Lactobacillus GG in inducing and maintaining remission of Crohn's disease

    Directory of Open Access Journals (Sweden)

    Vanderhoof Jon A

    2004-03-01

    Full Text Available Abstract Background Experimental studies have shown that luminal antigens are involved in chronic intestinal inflammatory disorders such as Crohn's disease and ulcerative colitis. Alteration of the intestinal microflora by antibiotic or probiotic therapy may induce and maintain remission. The aim of this randomized, placebo-controlled trial was to determine the effect of oral Lactobacillus GG (L. GG to induce or maintain medically induced remission. Methods Eleven patients with moderate to active Crohn's disease were enrolled in this trial to receive either L. GG (2 × 109 CFU/day or placebo for six months. All patients were started on a tapering steroid regime and received antibiotics for the week before the probiotic/placebo medication was initiated. The primary end point was sustained remission, defined as freedom from relapse at the 6 months follow-up visit. Relapse was defined as an increase in CDAI of >100 points. Results 5/11 patients finished the study, with 2 patients in each group in sustained remission. The median time to relapse was 16 ± 4 weeks in the L. GG group and 12 ± 4.3 weeks in the placebo group (p = 0.5. Conclusion In this study we could not demonstrate a benefit of L. GG in inducing or maintaining medically induced remission in CD.

  4. Gastroparesis in patients with inactive Crohn's disease: a case series

    Directory of Open Access Journals (Sweden)

    Oyen Wim JG

    2007-03-01

    Full Text Available Abstract Background Few studies have described patients with foregut dysmotility in inflammatory bowel disease. The aim of this case series was to evaluate clinical characteristics of 5 patients with inflammatory bowel disease and symptoms and signs of upper gut dysmotility. Case presentations We describe a series of four patients with Crohn's disease and one with indeterminate colitis who presented with severe symptoms and signs of gastroparesis. We reviewed medical records of all cases. Gastric emptying of a solid meal was assessed by scintigraphy. Small bowel enteroclysis, gastroduodenoscopy and colonoscopy with biopsies were performed to estimate the activity of the disease and to exclude organic obstruction. None of the patients had any signs of active inflammation or stricture. All of the patients had markedly delayed gastric emptying with a mean t 1/2 of 234 minutes (range 110–380 minutes; normal values 54–94 minutes. Conclusion Clinicians should consider impaired gastric emptying when evaluating patients with Crohn's disease and severe symptoms of upper gut dysmotility, which cannot be attributed to active inflammation or organic obstruction of the digestive tract. Symptoms in these patients are refractory to various therapeutic interventions including tube feeding and gastric surgery.

  5. Genome analysis of E. coli isolated from Crohn's disease patients.

    Science.gov (United States)

    Rakitina, Daria V; Manolov, Alexander I; Kanygina, Alexandra V; Garushyants, Sofya K; Baikova, Julia P; Alexeev, Dmitry G; Ladygina, Valentina G; Kostryukova, Elena S; Larin, Andrei K; Semashko, Tatiana A; Karpova, Irina Y; Babenko, Vladislav V; Ismagilova, Ruzilya K; Malanin, Sergei Y; Gelfand, Mikhail S; Ilina, Elena N; Gorodnichev, Roman B; Lisitsyna, Eugenia S; Aleshkin, Gennady I; Scherbakov, Petr L; Khalif, Igor L; Shapina, Marina V; Maev, Igor V; Andreev, Dmitry N; Govorun, Vadim M

    2017-07-19

    Escherichia coli (E. coli) has been increasingly implicated in the pathogenesis of Crohn's disease (CD). The phylogeny of E. coli isolated from Crohn's disease patients (CDEC) was controversial, and while genotyping results suggested heterogeneity, the sequenced strains of E. coli from CD patients were closely related. We performed the shotgun genome sequencing of 28 E. coli isolates from ten CD patients and compared genomes from these isolates with already published genomes of CD strains and other pathogenic and non-pathogenic strains. CDEC was shown to belong to A, B1, B2 and D phylogenetic groups. The plasmid and several operons from the reference CD-associated E. coli strain LF82 were demonstrated to be more often present in CDEC genomes belonging to different phylogenetic groups than in genomes of commensal strains. The operons include carbon-source induced invasion GimA island, prophage I, iron uptake operons I and II, capsular assembly pathogenetic island IV and propanediol and galactitol utilization operons. Our findings suggest that CDEC are phylogenetically diverse. However, some strains isolated from independent sources possess highly similar chromosome or plasmids. Though no CD-specific genes or functional domains were present in all CD-associated strains, some genes and operons are more often found in the genomes of CDEC than in commensal E. coli. They are principally linked to gut colonization and utilization of propanediol and other sugar alcohols.

  6. Management of Crohn's disease in poor responders to adalimumab

    Directory of Open Access Journals (Sweden)

    de Boer NKH

    2014-04-01

    Full Text Available Nanne KH de Boer,1 Mark Löwenberg,2 Frank Hoentjen3 1Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, the Netherlands; 2Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands; 3Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands Abstract: Anti-tumor necrosis factor therapy with adalimumab is an effective therapy for the induction and maintenance of remission in moderate to severe Crohn's disease. Although a large proportion of patients show a favorable clinical response to adalimumab, therapy failure is common. In this review, we provide a practical overview of adalimumab therapy in patients with Crohn's disease, with a specific focus on the clinical management of adalimumab failure. In the case of inadequate efficacy, a thorough assessment is required to confirm inflammatory disease activity and rule out noninflammatory causes. Evaluation may include biomarkers (fecal calprotectin and serum C-reactive protein, colonoscopy, and/or magnetic resonance enterography/enteroclysis. Furthermore, adalimumab trough levels and antibodies to adalimumab are informational after the confirmation of active inflammation. In the case of low or undetectable adalimumab trough levels, dose escalation to 40 mg weekly is recommended, whereas high antibody titers or adverse events frequently require switching to an alternative anti-TNF agent such as infliximab. Active inflammation despite therapeutic adalimumab trough levels requires alternative strategies such as switching to drugs with a different mode of action or surgical intervention. Keywords: anti-TNF, biological, inflammatory bowel disease, loss of response, infliximab

  7. Spontaneous gas gangrene in a patient with Crohn's disease.

    Science.gov (United States)

    Vaidya, Yash P; Vaidya, Tanvi P

    2012-01-01

    Spontaneous gas gangrene is necrosis of muscles in the absence of trauma, causing an acutely painful and potentially fatal condition. However, the occurrence of this condition in Crohn's disease has been very rarely documented. In this extremely rare case we describe an occurrence of spontaneous gas gangrene, in a known case of Crohn's disease. The patient presented with fever and pain in the left arm and abdomen. After admission and initial management with antibiotics, the patient developed crepitus in the arm and myonecrosis necessitating a fasciotomy and later an emergency amputation of his left upper limb. The pathogenesis of gas gangrene in inflammatory bowel disease is not fully understood. Management includes aggressive antibiotic administration followed by amputation of the non-salvageable limb. A high index of suspicion of such rare complications is a must and surgical intervention is life saving; however, the efficacy of anti-gas gangrene serum is controversial. We recommend use of a multipronged approach in such cases with high mortality rates.

  8. [Coexistence of Crohn disease and Wegener granulomatosis in a 15-year-old patient].

    Science.gov (United States)

    Sieczkowska, Agnieszka; Lewandowski, Piotr; Szumera, Małgorzata; Kamińska, Barbara

    2011-01-01

    Crohn disease is being diagnosed more and more frequently in children and teenagers. Clinical symptoms are mainly related to the gastrointestinal tract, however there are many reports in the literature about the coexistence of Crohn disease with other autoimmunological disorders such as celiac disease, autoimmune hypothyroidism, systemic lupus erythematosus and Wegener granulomatosis. We report a 15-year-old patient with Crohn disease who also developed Wegener granulomatosis. The presented case illustrates the difficulties in establishing the diagnosis when symptoms of the original disease are superimposed on symptoms of a different disorder.

  9. Canadian Association of Gastroenterology Clinical Practice Guidelines: The Use of Infliximab in Crohn's Disease

    Directory of Open Access Journals (Sweden)

    Remo Panaccione

    2004-01-01

    Full Text Available These guidelines are presented as a follow-up to the original Canadian Association of Gastroenterology Clinical Practice Guidelines: The use of infliximab in Crohn's disease, published in the Canadian Journal of Gastroenterology (1. The original guidelines represented publications between 1998 and 2000. The current guidelines have been updated to reflect knowledge gained from two pivotal randomized clinical trails, with the use of infliximab in the maintenance of inflammatory Crohn's disease in remission (2 and in the maintenance of fistulous Crohn's disease in remission (3.

  10. Experience with granulocytapheresis in Crohn's disease Experiencia con la granulocitoaféresis en la enfermedad de Crohn

    Directory of Open Access Journals (Sweden)

    F. Cuenca

    2004-07-01

    Full Text Available Objective: to describe our experience with granulocyte apheresis to induce remission in patients with active Crohn's disease refractory to conventional treatment. We summarize the results previously obtained with this technique. Conclusions: granulocyte apheresis is a safe and well tolerated therapeutic modality that can be a valid therapeutic alternative in the induction of remission in inflammatory bowel disease, although controlled clinical trials must be conducted to define long-term efficacy, as well as to establish “optimal patient” selection, re-treatment interval, and number of sessions.Objetivo: describir nuestra experiencia con la granulocitoaféresis para inducir la remisión en pacientes con enfermedad de Crohn activa refractarios al tratamiento convencional. Realizamos un resumen de los resultados previos obtenidos con esta técnica. Conclusiones: la granulocitoaféresis es una modalidad terapéutica segura y bien tolerada que puede ser una alternativa terapéutica válida en la inducción de la remisión en la enfermedad inflamatoria intestinal, siendo necesaria la realización de ensayos clínicos controlados para poder definir su eficacia a largo plazo, la selección del "paciente óptimo", intervalos de retratamiento y número de sesiones.

  11. Nutrition interventions in patients with Crohn´s disease

    Directory of Open Access Journals (Sweden)

    Eva Beňová

    2016-10-01

    Full Text Available Crohn's disease is a chronic non-specific inflammatory bowel disease of any part of the digestive tract. The seriousness of the disease requires a multi-disciplinary approach when providing patients with secondary and tertiary care. Patients also have specific problems from the nursing perspective that require intervention of nurses, e.g. in the area of nutrition. The role of a nurse in a specific community lies in supporting public health in the field of prevention, health education, group educational activities and care of the acutely or chronically ill. The regulation tool of nursing practice when providing community care is the documented form of nursing data expressed by means of expert terminology. The Omaha System is a standardised terminology for multi-disciplinary teams providing community care. The objective of the research is to draw attention to the possibility of using standardised terminology of the Omaha System when supporting public health in patients with Crohn's disease with nutrition problems. The research was divided into 3 stages: in the first stage we assessed the nutrition problem in 100 patients dispensarised in gastroenterology counselling centres using a form from the Omaha System. Out of these, identified 42 patients suffered from Crohn's disease and had problems with nutrition; in the second stage we chose interventions for nutrition from the Intervention Scheme of the Omaha System: their efficiency in patients was assessed by a nurse/nutritionist in the third stage of the research when the patients came to the gastroenterology counselling centre using Problem Rating Scale for Outcomes. When comparing the initial and final nutrition assessment with socio-demographic indicators we found a statistically significant difference (p = 0.000 between the status assessment where women scored a more remarkable advance than men when comparing the initial and the final assessment. With respect to age groups, education and jobs

  12. Septic knee arthritis in Crohn's disease biological therapy-free patient. Case report.

    Science.gov (United States)

    Pop, C; Calagiu, D; Jantea, P; Nemes, R

    2015-01-01

    A 52-year-old woman with Crohn's disease presented with septic arthrtis of the knee. This condition coincided with a symptomatic flare of her Crohn's disease due to an ileal inflammatory stenosis, manifested as a phlegmonous mass palpable in the right lower quadrant and a small bowel obstruction. Results of synovial fluid cultures showed the presence of Gram-negative bacillus, Klebsiella pneumoniae and the CT scan images were highly suggestive of abdominal abscess within Crohn's disease. The patient's condition improved after following an antibiotic treatment and after the initiation of Anti-TNF-alpha agent Adalimumab, with no further exacerbation. Septic arthritis in Crohn's disease should be considered to have a communicating source of sepsis consisting of an abdominal abscess or fistula. Anti-TNF-alpha agent = anti tumor necrosis factor alpha agent, 5-ASA = 5-aminosalicylic acid.

  13. Endpoints for clinical trials evaluating disease modification and structural damage in adults with Crohn's disease

    NARCIS (Netherlands)

    D'Haens, Geert R.; Fedorak, Richard; Lémann, Marc; Feagan, Brian G.; Kamm, Michael A.; Cosnes, Jacques; Rutgeerts, Paul J.; Marteau, Philippe; Travis, Simon; Schölmerich, Jürgen; Hanauer, Steven; Sandborn, William J.

    2009-01-01

    The management of Crohn's disease is rapidly changing. The advent of potent immunomodulatory and biologic therapies has led to more demanding endpoints for clinical trials than only clinical response and remission. Complete withdrawal of corticosteroids, healing of endoscopically visible lesions,

  14. Reduced fat oxidation rates during submaximal exercise in adolescents with Crohn's disease

    NARCIS (Netherlands)

    Nguyen, Thanh; Ploeger, Hilde E.; Obeid, Joyce; Issenman, Robert M.; Baker, Jeff M.; Takken, Tim; Parise, Gianni; Timmons, Brian W.

    2013-01-01

    Children with Crohn's disease (CD) suffer from malnutrition. Understanding substrate utilization during exercise may help patients with CD sustain a healthy active lifestyle without compromising nutrition. The aim of this study was to determine whether substrate utilization and bioavailability

  15. Comparison of outcomes parameters for induction of remission in new onset pediatric Crohn's disease

    DEFF Research Database (Denmark)

    Levine, Arie; Turner, Dan; Pfeffer Gik, Tamar

    2014-01-01

    BACKGROUND: Robust evaluation of induction therapies using both clinical and inflammatory outcomes in pediatric Crohn's disease (CD) are sparse. We attempted to evaluate clinical, inflammatory, and composite outcomes of induction of remission therapies (normal C reactive protein [CRP] remission) ...

  16. Endoscopic balloon dilatation for Crohn's strictures of the gastrointestinal tract is feasible

    DEFF Research Database (Denmark)

    Karstensen, John Gásdal; Hendel, Jakob; Vilmann, Peter

    2012-01-01

    Despite optimized medical treatment, Crohn´s disease can cause gastrointestinal (GI) strictures, which requires surgical intervention. Lately, endoscopic balloon dilatation has been established as an alternative to surgery. In the following, we report our experiences with endoscopic dilatation...

  17. Constitutive STAT3 activation in intestinal T cells from patients with Crohn's disease

    DEFF Research Database (Denmark)

    Lovato, Paola; Brender, Christine; Agnholt, Jørgen

    2003-01-01

    Via cytoplasmic signal transduction pathways, cytokines induce a variety of biological responses and modulate the outcome of inflammatory diseases and malignancies. Crohn's disease is a chronic inflammatory bowel disease of unknown etiology. Perturbation of the intestinal cytokine homeostasis is ...

  18. Atorvastatin reduces plasma levels of chemokine (CXCL10) in patients with Crohn's disease.

    Science.gov (United States)

    Grip, Olof; Janciauskiene, Sabina

    2009-01-01

    In Crohn's disease high tissue expression and serum levels of chemokines and their receptors are known to correlate with disease activity. Because statins can reduce chemokine expression in patients with coronary diseases, we wanted to test whether this can be achieved in patients with Crohn's disease. We investigated plasma levels of chemokines (CCL2, CCL4, CCL11, CCL13, CCL17, CCL22, CCL26, CXCL8, CXCL10) and endothelial cytokines (sP-selectin, sE-selectin, sICAM-3, thrombomodulin) in ten Crohn's disease patients before and after thirteen weeks' daily treatment with 80 mg atorvastatin. Of the 13 substances investigated, only CXCL10 was found to be significantly reduced (by 34%, p = 0.026) in all of the treated patients. Levels of CXCL10 correlated with C-reactive protein (r = 0.82, pCrohns disease in the future. (ClinicalTrials.gov) NCT00454545.

  19. Current X-ray diagnosis of Crohn's disease of the small intestine

    International Nuclear Information System (INIS)

    Portnoj, L.M.; Isakov, V.A.; Kazantseva, I.A.; Petukhova, N.Yu.; Stashuk, G.A.; Gaganov, L.E.

    2001-01-01

    The paper evaluates the patients for x-ray diagnosis of Crohn's disease of the small intestine in 18 patients using the new barium contrast medium Entero-VU intended for examination of the small intestine. The authors provide a detailed description of the examination technique, x-ray appearance of Crohn's disease and make a comparative analysis of the diagnostic potential for the use of the common barium suspension and the contrast agent Entero-VU. The cases of Crohn's disease analyzed in the paper encompass its different stages and sites in the small intestine. The group of patients presenting with Crohn's disease accrued subjects who had undergone surgical treatment followed by reexamination of the small intestine using Entero-VU [ru

  20. Biodegradable stents for the treatment of bowel strictures in Crohn's disease

    DEFF Research Database (Denmark)

    Karstensen, John Gásdal; Risager Christensen, Katrine; Brynskov, Jørn

    2016-01-01

    BACKGROUND AND STUDY AIMS: In patients with Crohn's disease, the idea of biodegradable stents for treatment of bowel strictures with limited effect of endoscopic balloon dilation is tempting and initial results have been promising. The aim of this study was to evaluate the technical and clinical...... success of biodegradable stents for treatment of inflamed Crohn's strictures refractory to endoscopic balloon dilatation. PATIENTS AND METHODS: Consecutive patients treated with biodegradable stents due to Crohn's disease and inflamed bowel strictures refractory to endoscopic balloon dilatation were...... collapse (n = 1). CONCLUSIONS: In Crohn's disease, it is technically feasible to treat bowel strictures with biodegradable stents. However, we have stopped using biodegradable stents due to lack of clinical success and side effects such as mucosal overgrowth and stent collapse....

  1. Elemental diet as primary treatment of acute Crohn's disease: a controlled trial.

    OpenAIRE

    O'Moráin, C; Segal, A W; Levi, A J

    1984-01-01

    Acute exacerbations of Crohn's disease are usually treated with prednisolone or potentially more toxic immunosuppressive drugs or by surgery. In pilot studies replacing the normal diet by a protein free elemental diet also induced remission. A controlled trial was therefore conducted in which 21 patients acutely ill with exacerbations of Crohn's disease were randomised to receive either prednisolone 0.75 mg/kg/day or an elemental diet (Vivonex) for four weeks. Assessment at four and 12 weeks ...

  2. Mycobacterium avium subsp. Paratuberculosis (MAP) as a modifying factor in Crohn's disease.

    LENUS (Irish Health Repository)

    Sibartie, Shomik

    2010-02-01

    Crohn\\'s disease (CD) is a multifactorial syndrome with genetic and environmental contributions. Mycobacterium avium subspecies paratuberculosis (MAP) has been frequently isolated from mucosal tissues of patients with CD but the cellular immune response to this bacterium has been poorly described. Our aim was to examine the influence of MAP on T-cell proliferation and cytokine responses in patients with inflammatory bowel disease (IBD).

  3. Ischemic colitis in a patient with Crohn's disease taking an oral contraceptive and an ergotamine alkaloid.

    Science.gov (United States)

    Rutgeerts, L; Ghillebert, G; Drognee, W; Tanghe, W; Vuylsteke, P; Decoster, M

    1993-01-01

    A 22-year-old woman developed transient left-sided ischemic colitis with submucosal oedema and bleeding, six weeks after an uneventful right hemicolectomy for Crohn's disease. The thrombogenic properties of the contraceptive pill and the concomitant use of an ergotamine alkaloid were thought to be the cause of this complication in a patient at risk. An increase of procoagulant activity and underlying vascular injury has been described in Crohn's disease.

  4. Mutations in CARD15 and smoking confer susceptibility to Crohn's disease in the Danish population

    DEFF Research Database (Denmark)

    Ernst, Anja; Jacobsen, Bent Ascanius; Østergaard, Mette

    2007-01-01

    Three CAspase Recruitment Domain (CARD15) mutations have shown to predispose to Crohn's disease in Caucasian populations. The aim of this study was to investigate the mutation frequency in patients with inflammatory bowel disease and in healthy controls in Denmark.......Three CAspase Recruitment Domain (CARD15) mutations have shown to predispose to Crohn's disease in Caucasian populations. The aim of this study was to investigate the mutation frequency in patients with inflammatory bowel disease and in healthy controls in Denmark....

  5. Stereomicroscopic examination of stained rectal biopsies in ulcerative colitis and Crohn's disease

    DEFF Research Database (Denmark)

    Poulsen, Steen Seier

    1980-01-01

    Rectal biopsy samples from 22 healthy control subjects, 54 patients with ulcerative colitis, and 34 with Crohn's disease with involvement of the colon or rectum were investigated in a stereomicroscopic study. Samples were stained as whole mounts with Alcian Green before the stereomicroscopic...... the stereomicroscopic findings and the clinical disease activity, the sigmoidoscopic findings, and the histologic activity. Apart from the stereomicroscopic observation of small superficial erosions in one fourth of the biopsies, no changes of diagnostic value were observed in Crohn's disease....

  6. [Magnetic resonance enterography: technique and indications. Findings in Crohn's disease].

    Science.gov (United States)

    Torregrosa, A; Pallardó, Y; Hinojosa, J; Insa, S; Molina, R

    2013-09-01

    Radiology with oral contrast, or enteroclysis, have traditionally been the techniques of choice in the examination of the small intestine, due to the excellent visualisation of the mucosal pattern. However, the absence of extra-luminal information and the use of ionising radiation have replaced these examinations with sectional techniques which enable the abdominal cavity to be viewed with good resolution. Magnetic resonance enterography is a simple technique, with no ionising radiation, provided quality images, distends the intestinal lumen well by the administration of non-reabsorbable oral substances, minimises peristalsis, and establishes a protocol which includes sequences with intravenous contrast. These properties can be used in patients with Crohn's disease, achieving good diagnostic precision in the assessment of activity and monitoring of treatment, in intestinal obstruction, in the suspicion of small intestine tumours, and in paediatric patients due to it being harmless. Copyright © 2011 SERAM. Published by Elsevier Espana. All rights reserved.

  7. An immunological link between Candida albicans colonization and Crohn's disease.

    Science.gov (United States)

    Gerard, Romain; Sendid, Boualem; Colombel, Jean-Frederic; Poulain, Daniel; Jouault, Thierry

    2015-06-01

    The etiology of Crohn's disease (CD), an autoimmune, inflammatory bowel disease (IBD) which affects approximately one million people in Europe, is still unclear. Nevertheless, it is widely accepted that CD could result from an inappropriate inflammatory response to intestinal microorganisms in a genetically susceptible host. Most studies to date have concerned the involvement of bacteria in disease progression. In addition to bacteria, there appears to be a possible link between the commensal yeast Candida albicans and disease development. In this review, in an attempt to link the gut colonization process and the development of CD, we describe the different pathways that are involved in the progression of CD and in the host response to C. albicans, making the yeast a possible initiator of the inflammatory process observed in this IBD.

  8. CROHN'S DISEASE: GENERAL CHARACTERISTICS AND TREATMENT WITH ADALIMUMABE BIOPHARMACEUTICAL

    Directory of Open Access Journals (Sweden)

    S. A. Marques

    2018-02-01

    Full Text Available Crohn's Disease (CD is a chronic inflammatory disease that affects the gastrointestinal system. The etiology is not fully understood, however, genetic, immunological, microbiological and environmental factors are related to its genesis. The most common manifestations of this disease are diarrhea, abdominal pain, ulcers and fistulas. In the absence of adequate treatment it can evolve into extra intestinal complications and is also an important risk factor for colon and rectal cancer. The treatment of the disease is palliative and there is no cure for the disease, being considered only the period of remission of symptoms, as a good prognosis. The biopharmaceutical, Adalimumabe, produced by recombinant DNA technology has demonstrated efficacy in the treatment of this disease, as it prevents the action of TNF-α, a cytokine involved in inflammation and is abundant in individuals with CD. Although Adalimumabe has good results, its use leads to side effects that can be mild or fatal, such as the activation of tuberculosis.

  9. Does smoking reduce infliximab's effectiveness against Crohn's disease?

    Science.gov (United States)

    Narula, Neeraj; Fedorak, Richard N

    2009-02-01

    Crohn's disease (CD) is an idiopathic inflammatory bowel disease and has no known cure. CD symptoms are treated using an array of medicines, including biological agents such as infliximab. However, infliximab therapy is expensive; therefore, identifying variables that can help predict response to infliximab is worthwhile. The present article reviews the impact of tobacco smoking on the efficacy of infliximab in CD. Earlier studies have speculated that smoking has a negative effect on the response to infliximab in CD, but the current literature is largely unable to identify a significant relationship between the two. Although smoking is known to have a negative effect on the course of CD, as well as other organ systems, presently, a CD patient's smoking status should not influence treatment decisions regarding infliximab therapy.

  10. Metabolomics reveals metabolic biomarkers of Crohn's disease

    Energy Technology Data Exchange (ETDEWEB)

    Jansson, J.K.; Willing, B.; Lucio, M.; Fekete, A.; Dicksved, J.; Halfvarson, J.; Tysk, C.; Schmitt-Kopplin, P.

    2009-06-01

    The causes and etiology of Crohn's disease (CD) are currently unknown although both host genetics and environmental factors play a role. Here we used non-targeted metabolic profiling to determine the contribution of metabolites produced by the gut microbiota towards disease status of the host. Ion Cyclotron Resonance Fourier Transform Mass Spectrometry (ICR-FT/MS) was used to discern the masses of thousands of metabolites in fecal samples collected from 17 identical twin pairs, including healthy individuals and those with CD. Pathways with differentiating metabolites included those involved in the metabolism and or synthesis of amino acids, fatty acids, bile acids and arachidonic acid. Several metabolites were positively or negatively correlated to the disease phenotype and to specific microbes previously characterized in the same samples. Our data reveal novel differentiating metabolites for CD that may provide diagnostic biomarkers and/or monitoring tools as well as insight into potential targets for disease therapy and prevention.

  11. Increased risk of intestinal cancer in Crohn's disease

    DEFF Research Database (Denmark)

    Jess, Tine; Gamborg, Michael; Matzen, Peter

    2005-01-01

    OBJECTIVES: The risk of intestinal malignancy in Crohn's disease (CD) remains uncertain since risk estimates vary worldwide. The global CD population is growing and there is a demand for better knowledge of prognosis of this disease. Hence, the aim of the present study was to conduct a meta......-analysis of population-based data on intestinal cancer risk in CD. METHODS: The MEDLINE search engine and abstracts from international conferences were searched for the relevant literature by use of explicit search criteria. All papers fulfilling the strict inclusion criteria were scrutinized for data on population size......, time of follow-up, and observed to expected cancer rates. STATA meta-analysis software was used to perform overall pooled risk estimates (standardized incidence ratio (SIR), observed/expected) and meta-regression analyses of the influence of specific variables on SIR. RESULTS: Six papers fulfilled...

  12. Crohn’s disease and extra intestinal granulomatous lesions.

    Science.gov (United States)

    Tomasello, G; Scaglione, M; Mazzola, M; Gerges Geaga, A; Jurjus, A; Gagliardo, C; Sinagra, E; Damiani, P; Carini, F; Leone, A

    2018-01-01

    Crohn’s disease (CD) is an inflammatory bowel disease with a multifactorial etiology. Clinical features include mucosal erosion, diarrhea, weight loss and other complications such as formation of granuloma. In CD, granuloma is a non-neoplastic epithelioid lesion, formed by a compact aggregate of histiocytes with the absence of a central necrosis, however, the correlation among CD and the formation of granulomas is unknown. Many cases of granulomas in the extracellular site, related to CD, have been reported in the literature. These granulomas, at times, represented the only visible manifestation of the pathology. Extra intestinal granulomas have been found on ovaries, lungs, male genitalia, female genitalia, orofacial regions and skin. From the data in the literature it could be hypothesized that there is a cross-reaction of the immune system with similar antigenic epitopes belonging to different sites. This hypothesis, if checked, can place CD not only among inflammatory bowel disease but also among inflammatory diseases with systemic involvement.

  13. Surgery and postoperative recurrence in children with Crohn disease

    DEFF Research Database (Denmark)

    Hansen, Lars; Jakobsen, Christian; Paerregaard, Anders

    2015-01-01

    OBJECTIVES: The aim of this study was to describe surgery rates, complications, and risk of disease recurrence after surgery in paediatric Crohn disease (CD). METHODS: Children ... were identified using the Danish National Patient Registry. Patient charts were used to extract data. RESULTS: A total of 115 of 422 children with CD, who had surgery in 2 referral centres, were further studied. Disease extension according to the Montreal classification at the time of operation......, 13 (11%) hemicolectomy, and 10 (9%) a combined colonic and ileal resection. Median time from diagnosis to surgery was 23 months (range 0-147). The median follow-up time after surgery was 121 months (16-226), and median time to disease recurrence was 12 months (3-160). The cumulative clinical...

  14. Active learning based segmentation of Crohns disease from abdominal MRI.

    Science.gov (United States)

    Mahapatra, Dwarikanath; Vos, Franciscus M; Buhmann, Joachim M

    2016-05-01

    This paper proposes a novel active learning (AL) framework, and combines it with semi supervised learning (SSL) for segmenting Crohns disease (CD) tissues from abdominal magnetic resonance (MR) images. Robust fully supervised learning (FSL) based classifiers require lots of labeled data of different disease severities. Obtaining such data is time consuming and requires considerable expertise. SSL methods use a few labeled samples, and leverage the information from many unlabeled samples to train an accurate classifier. AL queries labels of most informative samples and maximizes gain from the labeling effort. Our primary contribution is in designing a query strategy that combines novel context information with classification uncertainty and feature similarity. Combining SSL and AL gives a robust segmentation method that: (1) optimally uses few labeled samples and many unlabeled samples; and (2) requires lower training time. Experimental results show our method achieves higher segmentation accuracy than FSL methods with fewer samples and reduced training effort. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  15. New horizons in the imaging of perianal Crohn's disease: transperineal ultrasonography.

    Science.gov (United States)

    Bezzio, Cristina; Bryant, Robert V; Manes, Gianpiero; Maconi, Giovanni; Saibeni, Simone

    2017-06-01

    perianal disease, most commonly manifest as fistula or abscess formation, affects up to 40% of patients with crohn's disease. perianal crohn's disease is disabling, associated with poor outcomes, and represents a therapeutic challenge for physicians. correct diagnosis and classification of perianal disease is the first crucial step for appropriate multidisciplinary management. Areas covered: A literature search was performed of the PubMed database using the terms 'transperineal ultrasonography', 'transperineal ultrasound', 'perianal disease', 'perianal fistula', 'perianal abscess', 'magnetic resonance', 'endoanal ultrasonography', 'endoscopic ultrasound' in combination with 'Crohn's disease'. A comprehensive review of the relative advantages and disadvantages of the various methods of evaluation of perianal Crohn's disease is provided. A particular focus is placed on transperineal ultrasonography, including historical and technical factors, advantages and limitations, and its current role in practice. An algorithm for integration of transperineal ultrasound into the management of perianal Crohn's disease into clinical practice is proposed, along with future areas research. Expert commentary: Transperineal ultrasound is a simple, safe, cheap and reliable imaging technique for evaluation of perianal Crohn's disease, which should be used more frequently in clinical practice.

  16. Oral contraceptive use and the clinical course of Crohn's disease: a prospective cohort study.

    Science.gov (United States)

    Cosnes, J; Carbonnel, F; Carrat, F; Beaugerie, L; Gendre, J P

    1999-08-01

    Women with Crohn's disease are usually advised not to take oral contraceptives, but, unlike smoking, there is no clear association between current oral contraceptive use and more severe disease. To assess the effect of oral contraceptive use on the clinical course of Crohn's disease. 331 women, aged 16-50 years, with Crohn's disease and Crohn's disease activity index oral contraceptive users or non-users and smokers or non-smokers. A prospective 12-18 month cohort study was used. The main outcome measures were flare up rate and time to flare up. In total, 134 women used oral contraceptives, in most cases low oestrogen formulations. During the study period, 61 oral contraceptive users (46%) developed a flare up, compared with 85 non-users (43%). The hazard ratio for oral contraceptive use was 1.11 (95% confidence interval 0.80 to 1.55). Variables associated with flare up were smoking status, recently active disease, baseline Crohn's disease activity index, and presence of anoperineal lesions. The same results were obtained when the analysis was restricted to patients eligible for a relapse prevention trial. Unlike smoking, oral contraceptives have no effect on Crohn's disease activity.

  17. Immunogenetic markers of Crohn's disease in adults population of the Moscow region

    Directory of Open Access Journals (Sweden)

    Stavtsev D.S.

    2014-12-01

    Full Text Available Aim: to study immunogenetic markers of predisposition to the development and protection for Crohn's disease in adults population of the Moscow region. Material and methods. The study included 53 samples of peripheral blood of patients with Crohn's disease in the Moscow region. The control group was represented by 1,700 samples of umbilical cord blood is healthy newborns. Revealing HLA antigens at low level performed by SSO method on DynalRELI 48 processor. The results received with ambiguous interpretation was using PCR-SSP method (Ivitrogen. Results. Were found the positive and negative associations of groups of HLA alleles with clinical form, the course of Crohn's disease and response to steroid treatment, in particular revealed that, predisposition to the development for Crohn's disease in women and with sensitivity to steroid treatment in this disease associated allele group C*12, to the characteristic restricting markers such as Crohn's disease include the В 38 and A*11 markers nonrestricting, nonpenetrating noninflammatory type groups are alleles B*56 and C*14 and C*14 is also associated with the risk of Crohn's disease in men, characteristic markers of protection to the development of the disease crown with chronic relapsing and severe clinical course are DQB1*02 and DQB1*03, respectively. Conclusion. These results demonstrate the need for studies of gene polymorphism HLA-system, not only in relation to the disease in general, but in selected patients with clinical groups.

  18. Follow up of Crohn's disease under therapy with hydro-MRI

    International Nuclear Information System (INIS)

    Ganten, M.; Flosdorff, P.; Grueber-Hoffmann, B.; Erb, G.; Hansmann, J.; Encke, J.

    2003-01-01

    Evaluation of typical MRI-findings in patients with Crohn's disease receiving therapy.Correlation with the course of disease.Patients and methods 81 follow-up MRI-studies in 25 patients conducted within a period of 3 weeks to 4 years were evaluated retrospectively.Therapy consisted in various combinations of antibiotics and immunosuppressive agents and if necessary operation. The findings of the MRI-studies were correlated with clinical data (e.g.operation of Crohn's complications) and the subjective perception during therapy. The morphological substrate of Crohn's disease in the Hydro-MRI images is reliably detected. Especially in a delineation of extraluminal changes MRI is superior to endoscopy and enteroclysis.Independent from clinical symptoms short- and middleterm follow-up showed inflammatory changes of the intestinal wall in all 25 patients. In 24/81 studies there was persistence or even progression of Crohn's disease in the MRI-studies, although patients were free of symptoms by the time of image acquisition. Hydro-MRI is a modality for the evaluation of inflammatory changes in patients with Crohn's disease.Independent from clinical symptoms persistence of Crohn's disease is detectable. (orig.) [de

  19. Comparison of MR enterography and histopathology in the evaluation of pediatric Crohn disease

    International Nuclear Information System (INIS)

    Dillman, Jonathan R.; Ladino-Torres, Maria F.; Strouse, Peter J.; Adler, Jeremy; DeMatos-Malliard, Vera; McHugh, Jonathan B.; Khalatbari, S.

    2011-01-01

    While MR enterography (MRE) is commonly used to identify segments of bowel affected by Crohn disease in children, there is little data to support this practice. To assess the ability of MRE to identify segments of small bowel and colon affected by pediatric Crohn disease using histopathology as the reference standard. Pediatric MRE examinations performed between April 2009 and December 2010 were identified. Subjects were excluded if they did not have Crohn disease, if they had Crohn disease but no correlative histopathology within 2 months of imaging, or if they had undergone prior bowel resection. Pertinent MRE and histopathology reports were reviewed, and normal and abnormal bowel segments were documented. Thirty-two pediatric MRE examinations were identified with correlative histopathology. MRE had an overall sensitivity of 94% for detecting the presence of Crohn disease, in general. At the bowel segmental level, MRE had a sensitivity of 66%, specificity of 90%, positive predictive value of 85% and negative predictive value of 76%. The terminal ileum was abnormal by MRE in 11 of 15 (73%) subjects lacking a diagnostic biopsy of this bowel segment. MRE successfully identifies small bowel and colon segments affected by pediatric Crohn disease. (orig.)

  20. Crohn's disease: Th1, Th17 or both? The change of a paradigm: new immunological and genetic insights implicate Th17 cells in the pathogenesis of Crohn's disease.

    Science.gov (United States)

    Brand, S

    2009-08-01

    Traditionally, Crohn's disease has been associated with a Th1 cytokine profile, while Th2 cytokines are modulators of ulcerative colitis. This concept has been challenged by the description of tolerising regulatory T cells (Treg) and by proinflammatory Th17 cells, a novel T cell population characterised by the master transcription factor RORgammat, the surface markers IL23R and CCR6, and by production of the proinflammatory cytokines IL17A, IL17F, IL21, IL22 and IL26, and the chemokine CCL20. Th17 cells differentiate under the influence of IL1beta, IL6, IL21 and IL23. Recent studies indicate that TGFbeta is essential not only for the development of murine Th17 cells but also for differentiation of human Th17 cells. TGFbeta reciprocally regulates the differentiation of inflammatory Th17 cells and suppressive Treg subsets, with the concomitant presence of proinflammatory cytokines favouring Th17 cell differentiation. Several studies demonstrated an important role of Th17 cells in intestinal inflammation, particularly in Crohn's disease. Genome-wide association studies indicate that IL23R and five additional genes involved in Th17 differentiation (IL12B, JAK2, STAT3, CCR6 and TNFSF15) are associated with susceptibility to Crohn's disease and partly also to ulcerative colitis. Taken together, both Th1 and Th17 cells are important mediators of inflammation in Crohn's disease, although activities previously ascribed to IL12 may be mediated by IL23. Anti-IL12/IL23p40 antibody therapy, which targets both Th1 and Th17 cells, is effective in Crohn's disease. However, the complex relationship between Th1 and Th17 cells has not been completely analysed. This will be of great importance to delineate the specific contributions of these cells to Crohn's disease and other autoimmune diseases.

  1. Estudo evolutivo de fístulas na doença de Crohn A follow-up study of fistulae in Crohn's disease

    Directory of Open Access Journals (Sweden)

    Flavio STEINWURZ

    1999-12-01

    Full Text Available Foram estudados 16 pacientes portadores de doença de Crohn com fístulas. A evolução de 29 fístulas, nestes casos, 10 tratadas por cirurgia e 19 através de medicamentos, foi acompanhada quanto à cicatrização e melhora do processo.Sixteen Crohn's disease patients with fistulae were studied. They had overall 29 fistulae, 10 treated surgically and 19 with drugs, which were followed regarding to the healing and improvement of the process.

  2. Doença de Crohn: fatores de risco para recidiva no pós-operatório Crohn's disease: risk factors for surgical recurrence

    Directory of Open Access Journals (Sweden)

    Idblan Carvalho de Albuquerque

    2008-03-01

    Full Text Available Apesar dos avanços na compreensão da doença de Crohn, os fatores determinantes da recidiva no pós-operatório permanecem especulativos. O objetivo deste estudo foi analisar retrospectivamente os fatores preditivos da recidiva na doença de Crohn no pós-operatório. Métodos: foram analisados 45 pacientes com diagnóstico de doença de Crohn, submetidos ao tratamento cirúrgico, avaliando recidiva da doença e fatores como idade, sexo, raça, tabagismo, localização, padrão anatomo-clínico, indicação cirúrgica, tipo de anastomose. Resultados: em 67,7% dos pacientes houve recidiva da doença sendo a causa mais freqüente a forma fistulizante; 64,6% foram operados três vezes ou mais (p=0,002. Doentes com quadro de perfuração apresentaram maior número de reoperações, três ou mais operações, em 63,6% (p=0,003. Conclusões: Quadro de perfuração e forma fistulizante da doença determinaram maior número de recidiva nos pacientes estudados.Despite the advances in the understanding of Crohn's disease, the determinants of surgical recurrence remain speculative. The aim of this study was to examine retrospectively the factors affecting post-operative recurrence of Crohn's disease. Methods: The following factors were investigated in 45 patients submitted to surgery for Crohn's disease: age, sex, race, smoking, anatomical site of involvement, type (inflammatory, fibrostenotic, or fistulizing, indication for surgery and anastomotic technique. Results: Recurrence occurred in 67,7% patients. Patients fistulizing Crohn's disease had undergone three or more surgical procedures, 64,6% (p=0, 002. Perforating indication for initial surgeryPatients with perforation presented the greatest number of reoperations, three or more surgical procedures in 63,6% (p=0,003. Conclusions: Perforationg and fistulizing type in Crohn's disease estabilished the major cause of recurrence in the patients studied.

  3. Aktiv ismåne

    DEFF Research Database (Denmark)

    Pedersen, Jens Olaf Pepke

    2011-01-01

    Enceladus. Den er kun den sjettestørste af Saturns måner, men den tiltrækker sig stor opmærksomhed.......Enceladus. Den er kun den sjettestørste af Saturns måner, men den tiltrækker sig stor opmærksomhed....

  4. Aktiv regulering: Optimering af effektregulering

    DEFF Research Database (Denmark)

    Bindner, H.

    1999-01-01

    The current report is part of the reporting of the work executed as part of the project 'Active Control and Wind Turbine Dynamics'. The project has been supported by the Danish Energy Agency under contract EFP91, ENS j.nr. 1364/91-0003. Projectparticipants were Vestas Wind Systems A/S, DTU...... with the LQG-controllers have shown that it is very important to include robustness considerations in the design of these moreadvanced controllers. The model developed in the project can be applied in the design of controllers for variable speed wind turbines if a model of the frequency converted is included....

  5. Bones and Crohn's: Estradiol deficiency in men with Crohn's disease is not associated with reduced bone mineral density

    Directory of Open Access Journals (Sweden)

    Boehm BO

    2008-10-01

    Full Text Available Abstract Background Reduced bone mineral density (BMD and osteoporosis are frequent in Crohn's disease (CD, but the underlying mechanisms are still not fully understood. Deficiency of sex steroids, especially estradiol (E2, is an established risk factor in postmenopausal osteoporosis. Aim To assess if hormonal deficiencies in male CD patients are frequent we investigated both, sex steroids, bone density and bone metabolism markers. Methods 111 male CD patients underwent osteodensitometry (DXA of the spine (L1–L4. Disease related data were recorded. Disease activity was estimated using Crohn's disease activity index (CDAI. Testosterone (T, dihydrotestosterone (DHT, estradiol (E2, sex hormone binding globulin (SHBG, Osteocalcin and carboxyterminal cross-linked telopeptids (ICTP were measured in 111 patients and 99 age-matched controls. Results Patients had lower T, E2 and SHBG serum levels (p 10 g had lower BMD. 32 (28.8% patients showed osteoporosis, 55 (49.5% osteopenia and 24 (21.6% had normal BMD. Patients with normal or decreased BMD showed no significant difference in their hormonal status. No correlation between markers of bone turnover and sex steroids could be found. ICTP was increased in CD patients (p Conclusion We found an altered hormonal status – i.e. E2 and, to a lesser extent T deficiency – in male CD patients but failed to show an association to bone density or markers of bone turnover. The role of E2 in the negative skeletal balance in males with CD, analogous to E2 deficiency in postmenopausal females, deserves further attention.

  6. Computed tomography enterography and magnetic resonance enterography in small intestine of Crohn's disease

    Directory of Open Access Journals (Sweden)

    Aida Cristina Correia Oliveira Azevedo

    2017-07-01

    Full Text Available Crohn disease is defined as a chronic inflammatory and idiopathic process that can affect any portion of the gastrointestinal tract. The small intestine is the most frequently affected place, so small bowel morphology investigation is often mandatory.For decades small bowel was almost inaccessible to endoscopies, and, studies like enteroclysis and bowel transit time test, were considered gold standard tests. Recently, innovative imaging techniques, improved diagnosis and follow-up of Crohn disease patients by allowing the exploration of this gut segment.Authors review literature, concerning the role of computed tomography enterography and magnetic resonance enterography in the evaluation of small bowel Crohn disease.Authors conclude that the choice of examination to be made should be weighted considering several factors such as the age of the patient, their tolerability, the Crohn's disease phenotype and the availability of hospital resources. Resumo: A doença de Crohn é definida como um processo inflamatório e idiopático crônico que pode afetar qualquer parte do trato gastrintestinal. O intestino delgado é o local mais frequentemente afetado e, assim, com frequência torna-se obrigatória uma investigação da morfologia do intestino delgado.Durante décadas, o intestino delgado era praticamente inacessível às endoscopias; nesse contexto, estudos como a enteróclise e a determinação do tempo de trânsito intestinal eram considerados como os critérios diagnósticos principais. Recentemente, técnicas imaginológicas inovadoras aperfeiçoaram o diagnóstico e seguimento de pacientes com doença de Crohn, por permitirem a exploração desse segmento intestinal.Os autores revisam a literatura pertinente ao papel da enterografia por tomografia computadorizada e da enterografia por ressonância magnética na avaliação da doença de Crohn no intestino delgado.Os autores concluem que a escolha do exame a ser realizado deve levar em conta

  7. ABO histo-blood group might modulate predisposition to Crohn's disease and affect disease behavior.

    Science.gov (United States)

    Forni, Diego; Cleynen, Isabelle; Ferrante, Marc; Cassinotti, Andrea; Cagliani, Rachele; Ardizzone, Sandro; Vermeire, Severine; Fichera, Maria; Lombardini, Marta; Maconi, Giovanni; de Franchis, Roberto; Asselta, Rosanna; Biasin, Mara; Clerici, Mario; Sironi, Manuela

    2014-06-01

    ABO encodes a glycosyltranferase which determines the major human histo-blood group. The FUT2 fucosyltransferase allows expression of ABO antigens on the gastrointestinal mucosa and in bodily secretions (secretor phenotype). A nonsense allele in FUT2 represents a susceptibility variant for Crohn's disease, and both the secretor and ABO blood group status affect the composition of the gut microbiota. Thus, we evaluated if variants in ABO might represent good candidates as Crohn's disease susceptibility loci. We recruited two case-control cohorts, from Italy (n=1301) and Belgium (n=2331). Subjects were genotyped for one SNP in FUT2 and two variants in ABO. No effect on Crohn's disease risk was detected for ABO variants, whereas an association was observed between the FUT2 polymorphism and Crohn's disease susceptibility in the Belgian sample, but not in the Italian cohort. The effect of histo-blood groups was evaluated using group O as the reference. Most non-O groups had odds ratios (ORs) higher than 1 in both cohorts, and combined analysis of the two samples indicated a predisposing effect for the A and B groups (OR=1.17, 95% CI: 1.02-1.32 and OR=1.33, 95% CI: 1.09-1.58, respectively). In Crohn's disease patients, the non-O blood group and the non-secretor status were associated with higher risk of developing a stricturing or penetrating disease. ABO histo-blood group might confer susceptibility to Crohn's disease and modulate disease severity. Copyright © 2013 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

  8. Recommendations of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) on the monitoring, prevention and treatment of post-operative recurrence in Crohn's disease.

    Science.gov (United States)

    Domènech, Eugeni; López-Sanromán, Antonio; Nos, Pilar; Vera, Maribel; Chaparro, María; Esteve, María; Gisbert, Javier P; Mañosa, Míriam

    Despite the availability of new, powerful drugs for Crohn's disease, a significant proportion of patients will undergo an intestinal resection to control the disease as it develops. In the absence of an effective preventative treatment, the appearance of new intestinal lesions after surgery for Crohn's disease is the norm; this is known as post-operative recurrence and may appear very early on, even a few weeks after the surgical resection. Furthermore, the drugs that are currently available for the prevention of post-operative recurrence have a limited effect; up to 50% of cases present recurrent Crohn's disease activity despite the preventative treatment, which may require further surgery with the consequent loss of intestinal function, leading some patients to suffer from short bowel syndrome as an irreversible complication. The management of Crohn's disease patients who undergo an intestinal resection should thus be geared towards prevention, early detection and, in the worst case scenario, the treatment of post-operative recurrence. This article reviews the natural history, diagnostic measures, monitoring, prevention and treatment of post-operative recurrence, and proposes recommendations based on existing knowledge. Copyright © 2017 Elsevier España, S.L.U., AEEH y AEG. All rights reserved.

  9. Differentiation of tuberculous enteritis and Crohn's disease with barium study using Bayes theory

    International Nuclear Information System (INIS)

    Lim, Kyoung Ja; Choi, Chul Soon; Yeun, Eun Joo; Seo, Young Lan; Lee, Il Sung; Yang, Ik; Whang, Woo Chul; Bae, Sang Hoon; Kang, Ik Won

    2004-01-01

    To differentiate tuberculous enteritis and Crohn's disease with barium study using Bayes theory. The study group consisted of 34 patients with tuberculous enteritis (age range 16-86 years, mean age 43.3 years, M:F19:15) and 36 patients with Crohn's disease (age range 19-78 years, mean age 35.2 years, M:F= 18:18). These diagnoses were confirmed by therapeutic tests (tuberculous enteritis: 15, Crohn's disease:16) or histopathological examinations (tuberculous enteritis: 19, Crohn's disease: 20) conducted from January 1993 to May 2003. Three radiologists (two abdominal specialists and one trainee) analyzed each radiological finding of tuberculous enteritis and Crohn's disease by means of a barium enema and/or small bowel series. We used Fisher's exact test to verify the statistical significance of each radiological finding and p-values less than 0.05 were considered to be significant. We calculated the likelihood ratio (LR) of tuberculous enteritis versus Crohn's disease for each finding by employing Bayes theory. The radiological findings associated with a high likelihood ratio for tuberculous enteritis were the involvement of the cecum (LR= 2.65) and ascending colon (LR= 1.99), rigid narrowing (LR= 1.94), shortening of the bowel (LR= 1.99), haustral loss (LR= 1.97) and sacculation (LR= 3.88). The radiological findings associated with a high LR for Crohn's disease (low LR for tuberculous enteritis) were age between 20 and 29 years (LR = 0.53), the involvement of the jejunum (LR= 0.12), terminal ileum (LR= 0.19), sigmoid colon (LR= 0.30) or rectum (LR= 0.17), and the presence of skip lesions (LR0.19) or strictures (LR =0.21). With these LRs, the probability of the subject having tuberculous enteritis versus Crohn's disease could be calculated using Bayes theory. The analysis of a barium study using Bayes theory could provide an objective, easy and fast method of differentiating tuberculous enteritis and Crohn's disease

  10. Plasma arachidonic acid-rich phospholipids in Crohn's disease: response to treatment.

    Science.gov (United States)

    Pereira, S P; Cassell, T B; Engelman, J L; Sladen, G E; Murphy, G M; Dowling, R H

    1996-10-01

    1. Increased concentrations of plasma polyunsaturated fatty acids have been implicated in the pathogenesis of Crohn's disease. However, it is not known whether there are corresponding changes in circulating phospholipids--the major source of fatty acids in the plasma. 2. Fasting plasma samples were obtained from 17 control subjects and 13 patients with active Crohn's disease [Simple Index of Crohn's Disease Activity (SICDA) > 6] before, and 2 and 8 weeks after, treatment with either a peptide diet or oral prednisolone. 3. Before treatment, the Crohn's disease patients had mildly active disease (SICDA 9.9 +/- 0.8, erythrocyte sedimentation rate 26.4 +/- 6.5 mm/h, serum C-reactive protein 2.8 +/- 0.4 mg/l). The proportions of the polyunsaturated phosphatidylcholine species, 16:0-20:4 (10.0 +/- 0.7%) and 16:0-22:6 (7.1 +/- 0.8%), were both significantly higher than those in healthy controls (7.6 +/- 0.5%, P theory that, in active Crohn's disease, the mucosal phospholipids containing polyunsaturated fatty acids are increased, contribute to eicosanoid synthesis and 'spill' into the plasma.

  11. [Impact of cigarette smoking on the clinical outcome of Crohn's disease].

    Science.gov (United States)

    Radwan-Kwiatek, Karolina; Wójtowicz-Chomicz, Katarzyna; Radwan, Piotr; Skrzydło-Radomska, Barbara; Borzecki, Andrzej

    2009-01-01

    Cigarette smoking is a well known independent risk factor for a more severe course of Crohn's disease, but individual factors determining this impact are poorly known and it is not evident if smoking cessation is associated with an improvement in the disease activity. The aim of our study was to assess the factors determining the harmful impact of smoking in individuals with Crohn's disease. A total of 148 consecutive patients with Crohn's disease and Crohn's disease activity index oral contraceptive use and blood lipid levels were also recorded. The main outcome measure was the rate of fare-up. We observed the flare-up developement in 38% current smokers, versus 21% non-smokers and 26% former smokers. The relative risk of flare-up adjusted for confounding factors was 1.37 (1.09 +/- 1.96) in current smokers. Obesity, dyslipidaemia, and alcohol consumption had no significant effect. Current smoking, particularly heavy smoking, significantly increases the risk of flare-up in Crohn's disease patients. Former smokers have a risk similar to that of non-smokers.

  12. Vitamin C status in 137 outpatients with Crohn's disease. Effect of diet counseling.

    Science.gov (United States)

    Imes, S; Dinwoodie, A; Walker, K; Pinchbeck, B; Thomson, A B

    1986-08-01

    Vitamin C intake, and serum and leukocyte ascorbate levels were assessed serially over 6 months in 137 outpatients with Crohn's disease. Vitamin C intake was low in 18% of males and 37% of females. Serum ascorbate levels were suboptimal in 11% of males and 18% of females. Leukocyte ascorbate levels were low in 26% of males and 49% of females. Serum ascorbate levels were more frequently below the reference range in patients who smoked, but neither the serum nor the leukocyte ascorbate levels were affected by Crohn's disease activity, the use of an oral contraceptive agent, or by taking prednisone or sulfasalazine. Monthly diet counseling sessions significantly increased vitamin C intake, led to more patients consuming a normal ascorbate intake, and to a normalization of serum ascorbate values. We did not establish the importance of these ascorbate abnormalities on the clinical course of Crohn's disease. We conclude that low serum or leukocyte ascorbate levels are relatively common in patients with active or inactive Crohn's disease; these abnormalities are due in part to the reduced intake of dietary ascorbate; and the ascorbate status in patients with Crohn's disease may be normalized by improving the dietary intake of vitamin C.

  13. Effects of current and former cigarette smoking on the clinical course of Crohn's disease.

    Science.gov (United States)

    Cosnes, J; Carbonnel, F; Carrat, F; Beaugerie, L; Cattan, S; Gendre, J

    1999-11-01

    Cigarette smoking is associated with a more severe course of Crohn's disease, but individual factors determining this effect are poorly known and it is not clear whether smoking cessation is associated with an improvement in the disease activity. To assess the factors determining the harmful effect of smoking in individuals with Crohn's disease. A total of 622 consecutive patients with Crohn's disease and Crohn's disease activity index oral contraceptive use, body mass index, and blood lipid levels were also recorded. The main outcome measure was the rate of flare-up. A total of 139 current smokers (46%) developed a flare-up, vs. 79 non-smokers (30%) and 13 former smokers (23%). The relative risk of flare-up adjusted for confounding factors was 1.35 (1.03-1.76) in current smokers. This risk was increased in patients with previously inactive disease and in those who had no colonic lesions. It became significant above a threshold of 15 cigarettes per day. Former smokers behaved like non-smokers. Obesity, dyslipidaemia, and alcohol consumption had no significant effect. Current smoking, particularly heavy smoking, markedly increases the risk of flare-up in Crohn's disease. Former smokers have a risk similar to that of non-smokers.

  14. Ascorbic acid absorption in Crohn's disease. Studies using L-[carboxyl-14C]ascorbic acid

    International Nuclear Information System (INIS)

    Pettit, S.H.; Shaffer, J.L.; Johns, C.W.; Bennett, R.J.; Irving, M.H.

    1989-01-01

    Total body pool and intestinal absorption of ascorbic acid were studied in 12 patients undergoing operation for Crohn's disease (six with fistulae and six without) and in six control patients undergoing operation for reasons other than Crohn's disease. L-[carboxyl- 14 C]Ascorbic acid, 0.19-0.40 megabecquerels (MBq), was given orally. After a period of equilibration, the labeled ascorbic acid was flushed out of the patient's body tissues using large doses of unlabeled ascorbic acid. Intestinal absorption of ascorbic acid, assessed from the total cumulative urinary 14 C recovery, was found to be similar in patients with fistulizing Crohn's disease (73.9 +/- 8.45%), those without fistulas (72.8 +/- 11.53%), and in controls (80.3 +/- 8.11%). Total body pools of ascorbic acid, calculated using the plasma 14 C decay curves, were similar in patients with Crohn's disease with fistulas (17.1 +/- 5.91 mg/kg), patients without fistulas (9.6 +/- 3.58 mg/kg), and in controls (13.3 +/- 4.28 mg/kg). The results indicate that ascorbic acid absorption is normal in patients with both fistulizing and nonfistulizing Crohn's disease. The results suggest that routine supplements of vitamin C are not necessary unless oral ascorbic acid intake is low

  15. Hydro-MRI with fast sequences in Crohn's disease: Comparison with barium studies

    International Nuclear Information System (INIS)

    Schunk, K.; Kern, A.; Heussel, C.P.; Kalden, P.; Thelen, M.; Orth, T.; Wanitschke, R.

    1999-01-01

    Purpose: To compare the value of hydro-MRI with that of barium studies in patients with Crohn's disease. Materials and methods: After an oral bowel opacification using 1000 ml of a 2.5% mannitol solution, axial and coronal breathhold sequences (T2W HASTE±FS, contrast-enhanced T1W FLASH FS) were acquired in 46 patients with Crohn's disease at 1,0 T. The findings of hydro-MRI were compared with those of barium studies. Results: In the stomach and the small bowel, hydro-MRI and barium studies demonstrated similar numbers of Crohn's involvements (39 vs. 36); in the colon, hydro-MRI showed clearly more affections (23 vs. 10). Hydro-MRI showed 12.7 cm of inflamed bowel per patient, on average (barium studies: 10,4 cm; p=0,004). There was a good agreement between the two methods regarding the assessment of the extent of Crohn's disease and the severity of bowel stenoses (r=0.89 and 0.88, respectively). Conclusions: For the assessment of Crohn's disease, hydro-MRI is preferable to the barium study because of the superior imaging quality and the lack of radiation exposure. (orig.) [de

  16. Accuracy of enteroclysis in Crohn's disease of the small bowel: a retrospective study

    International Nuclear Information System (INIS)

    Cirillo, L.C.; Della Noce, M.; Camera, L.; Salvatore, M.; Castiglione, F.; Mazzacca, G.

    2000-01-01

    The aim of this study was to evaluate the accuracy of enteroclysis in the diagnosis of Crohn's disease of the small bowel in a group of consecutive patients. From January 1992 to December 1995, 165 patients with suspected Crohn's disease of the small bowel presented to our institution for enteroclysis. In 14 patients up to three enteroclysis exams were performed. Most patients (78 %) underwent colonoscopy and retrograde ileoscopy. In the remaining patients clinical follow-up was used as gold standard. In 79 patients no radiographic abnormalities were found. Sixty-one patients (40 men and 21 women; mean age 34.2 years) had a radiological diagnosis of Crohn's disease. This involved the terminal ileum in 39 patients (64 %) either alone (n = 25) or in association with the pelvic ileum (n = 14). In 12 of these patients retrograde ileoscopy was not feasible. Twenty-one patients underwent surgery. In 4 patients pathology revealed diseases other than Crohn's. These patients had all ileocecal diseases (tuberculosis = 2; non-Hodgkin's lymphoma = 1; adenocarcinoma = 1). One false-negative result was observed. Overall, enteroclysis showed a sensitivity of 98.2 % and a positive predictive value of 93.4 %. Enteroclysis is a sensitive technique in evaluating both the extent and the severity of small bowel involvement in Crohn's disease, although the overlap of radiographic findings may hamper its accuracy when the disease is confined to the ileocecal area. (orig.)

  17. Grading luminal Crohn's disease: Which MRI features are considered as important?

    International Nuclear Information System (INIS)

    Ziech, M.L.W.; Bossuyt, P.M.M.; Laghi, A.; Lauenstein, T.C.; Taylor, S.A.; Stoker, J.

    2012-01-01

    Objectives: Magnetic resonance imaging (MRI) is increasingly used for disease activity grading in small bowel Crohn's disease. It is not known which imaging features are essential for grading. For further insight, we solicited the opinion of expert radiologists. Methods: A questionnaire about the grading of Crohn's disease was sent to 36 radiologists who had published on MRI grading of Crohn's disease between January 2006 and January 2010. Radiologists were asked which MRI protocol they used, how they graded luminal Crohn's disease, which features they used, how important they considered those features for grading, and which reference standards they used. Results: Twenty-four radiologists responded (66%). They used different protocols and features; most frequently T2-weighted sequences (79%) and contrast enhanced fat saturated T1-weighted sequences (83%). MR-enterography was more often used than MR-enteroclysis (88% versus 33%). Features most frequently considered important for grading were bowel wall thickness (79% of radiologists), the presence of an abscess (75%), T1 enhancement (75%), and T1 stratification (46%). Reference standards differed; most commonly (ileo-) colonoscopy (88%) or surgery (75%) were used. Conclusions: Bowel wall thickness, abscess, T1 enhancement and T1 stratification are most often used for grading. Because of difference in grading, there is need for an international consensus on MRI grading of Crohn's disease.

  18. Does hydro-MRI allow an assessment of the activity in Crohn's disease?

    International Nuclear Information System (INIS)

    Schunk, K.; Kern, A.; Heussel, C.P.; Kalden, P.; Mayer, I.; Orth, T.; Wanitschke, R.

    2000-01-01

    Purpose: To assess the value of hydro-MRI in the assessment of the activity of Crohn's disease. Materials and methods: After an oral bowel opacification using 1000 ml of a 2,5% mannitol solution, axial and coronal breathhold sequences (T 2 W HASTE±FS, contrast-enhanced T 1 W FLASH FS) were acquired in 63 patients with Crohn's disease at 1.0 T. The enhancement of the bowel wall was correlated with other MRI findings, with the Crohn's disease activity index (CDAI), and the C-reactive protein (CRP). Results: In Crohn's disease, contrast enhancement of the affected bowel wall is markedly increased in comparison with the normal bowel wall (+80±23% vs. +43±11%; p=8x10 -11 ). Positive correlations could be established between the increase of bowel wall enhancement and other MRI findings. Between the increase of bowel wall enhancement and the CDAI a poor correlation was found (r=0.25; p=0.046). There was no statistical correlation between the increase of bowel wall enhancement and the CRP (r=0.09; p=0.24). Conclusion: Hydro-MRI allows an assessment of the activity of Crohn's disease. (orig.) [de

  19. Role of delayed indium-111 labeled leukocyte scan in the management of Crohn's disease

    International Nuclear Information System (INIS)

    Slaton, G.D.; Navab, F.; Boyd, C.M.; Diner, W.C.; Texter, E.C. Jr.

    1985-01-01

    Comparison of nine patients with Crohn's disease who had a positive delayed (24 hr) 111 indium leukocyte scan and 10 patients with negative scan showed no significant difference between the two groups for the Crohn's disease activity index, sedimentation rate, survival, complications, number of days in hospital, outpatient visits, or readmissions. Despite the apparent lack of statistical significance in Crohn's disease activity index, the scan was positive in nine of 16 patients with a Crohn's disease activity index more than 150, and none of three patients with Crohn's disease activity index less than 150. In the patients studied, there were no false-positive leukocyte scans. In nine of 10 patients with ileocolonic disease, scanning results correctly predicted the proper management. Six patients with positive scan and enteroclysis responded to medical treatment. Four patients had positive enteroclysis and negative scan; of these, three had radiographic features of chronic ileal stricture which was confirmed at operation. The results suggest that a negative delayed indium-111 leukocyte scan may be useful in diagnosis of chronic fibrotic ileal stricture

  20. The effect of anti-tumor necrosis factor alpha agents on postoperative anastomotic complications in Crohn's disease

    DEFF Research Database (Denmark)

    El-Hussuna, Alaa Abdul-Hussein H; Krag, Aleksander; Olaison, Gunnar

    2013-01-01

    Patients with Crohn's disease treated with anti-tumor necrosis factor alpha agents may have an increased risk of surgical complications.......Patients with Crohn's disease treated with anti-tumor necrosis factor alpha agents may have an increased risk of surgical complications....

  1. Short- and medium-term outcomes following primary ileocaecal resection for Crohn's disease in two specialist centres

    NARCIS (Netherlands)

    de Buck van Overstraeten, A.; Eshuis, E. J.; Vermeire, S.; van Assche, G.; Ferrante, M.; D'Haens, G. R.; Ponsioen, C. Y.; Belmans, A.; Buskens, C. J.; Wolthuis, A. M.; Bemelman, W. A.; D'Hoore, A.

    2017-01-01

    Background: Despite improvements in medical therapy, the majority of patients with Crohn's disease still require surgery. The aim of this study was to report safety, and clinical and surgical recurrence rates, including predictors of recurrence, after ileocaecal resection for Crohn's disease.

  2. Evaluation of conventional, dynamic contrast enhanced and diffusion weighted MRI for quantitative Crohn's disease assessment with histopathology of surgical specimens

    NARCIS (Netherlands)

    Tielbeek, Jeroen A. W.; Ziech, Manon L. W.; Li, Zhang; Lavini, Cristina; Bipat, Shandra; Bemelman, Willem A.; Roelofs, Joris J. T. H.; Ponsioen, Cyriel Y.; Vos, Frans M.; Stoker, Jaap

    2014-01-01

    To prospectively compare conventional MRI sequences, dynamic contrast enhanced (DCE) MRI and diffusion weighted imaging (DWI) with histopathology of surgical specimens in Crohn's disease. 3-T MR enterography was performed in consecutive Crohn's disease patients scheduled for surgery within 4 weeks.

  3. Induction and Maintenance Infliximab Therapy for the Treatment of Moderat-to Severe Crohns Disease in Children

    DEFF Research Database (Denmark)

    Pærregaard, Anders; NN, NN

    2007-01-01

    BACKGROUND AND AIMS: The REACH study evaluated the safety and efficacy of infliximab in children with moderately to severely active Crohn's disease. METHODS: Patients (n = 112) with a Pediatric Crohn's Disease Activity Index (PCDAI) score >30 received infliximab 5 mg/kg at weeks 0, 2, and 6...

  4. Environmental factors in familial Crohn's disease in Belgium.

    Science.gov (United States)

    Van Kruiningen, Herbert J; Joossens, Marie; Vermeire, Severine; Joossens, Sofie; Debeugny, Stéphane; Gower-Rousseau, Corinne; Cortot, Antoine; Colombel, Jean-Frédéric; Rutgeerts, Paul; Vlietinck, Robert

    2005-04-01

    Environmental factors are believed to trigger the onset of Crohn's disease (CD) in genetically susceptible individuals. The aim of this study was to assess environmental and familial factors that might be etiologically related to CD. Twenty-one families with 3 or more affected first-degree relatives were studied, together with 10 matched control families. There were 74 patients with CD, 84 unaffected family members, and 59 controls. Family members were interviewed together at the parental home. A 176-item questionnaire delved into first symptoms, childhood vaccinations and diseases, food items, potable water supplies, social activities, travel, pets, and home and surrounding environment. Questions were directed specifically for 2 time-frames, childhood until age 20 and a 10-year epoch before the onset of first symptoms within a family. The possible factors linked to disease were evaluated using univariate and multivariate logistic regression. There were significantly more smokers in the patients and their relatives than in controls. Patients had more appendicitis during adolescence, ate less oats, rye, and bran than controls, and consumed more unpasteurized cheese. Patients drank significantly less tap water and more well water than controls. Clustering of cases in time occurred in 13 of the 21 affected families. The less frequent consumption of oats, rye, and bran and the more frequent eating of unpasteurized cheeses imitate potential dietary influences on gastrointestinal flora. More importantly, our data suggest that the drinking of well water represents an important risk factor for CD.

  5. Ustekinumab in the management of Crohn's disease: Expert opinion.

    Science.gov (United States)

    Armuzzi, Alessandro; Ardizzone, Sandro; Biancone, Livia; Castiglione, Fabiana; Danese, Silvio; Gionchetti, Paolo; Orlando, Ambrogio; Rizzello, Fernando; Scribano, Maria Lia; Vecchi, Maurizio; Daperno, Marco

    2018-03-11

    This expert-opinion paper reviews available evidence for the use of ustekinumab, a human interleukin 12/23 monoclonal antibody, in the treatment of Crohn's disease and discusses its potential role in the current treatment scenario for the condition. Ustekinumab appears to be associated with rapid and sustained clinical effect, as reported from the clinical research program, with additional support for potential mucosal healing. These characteristics are paralleled by a favorable safety profile, lack of immunogenicity and the presence of systemic anti-inflammatory activity. Importantly, ustekinumab requires only one single intravenous administration, while subsequent dosing is administered subcutaneously, with potential advantages for home-based therapy. Lastly, the dosage of ustekinumab is flexible. On the basis of the evidence, ustekinumab has a role in patients with primary failure or secondary loss of response to anti-tumor necrosis factor agents, as well as in those who have adverse events on front-line biologics or are reinitiating therapy after a treatment holiday. Current evidence suggests that ustekinumab may be particularly suitable in patients who present extra-intestinal manifestations of the disease or are at risk of infections. Ustekinumab may also be considered in the first-line setting, especially in frail patients, in young subjects or in those who have concomitant immune-mediated diseases. Copyright © 2018 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  6. Use of antibiotics in the treatment of Crohn's disease.

    Science.gov (United States)

    Scribano, Maria Lia; Prantera, Cosimo

    2013-02-07

    Many data coming from animal models and clinical observations support an involvement of intestinal microbiota in the pathogenesis of Crohn's disease (CD). It is hypothesized in fact, that the development of chronic intestinal inflammation is caused by an abnormal immune response to normal flora in genetically susceptible hosts. The involvement of bacteria in CD inflammation has provided the rationale for including antibiotics in the therapeutic armamentarium. However, randomized controlled trials have failed to demonstrate an efficacy of these drugs in patients with active uncomplicated CD, even if a subgroup of patients with colonic location seems to get benefit from antibiotics. Nitroimidazole compounds have been shown to be efficacious in decreasing CD recurrence rates in operated patients, and the use of metronidazole and ciprofloxacin is recommended in perianal disease. However, the appearance of systemic side effects limits antibiotic long-term employment necessary for treating a chronic relapsing disease. Rifaximin, characterized by an excellent safety profile, has provided promising results in inducing remission of CD.

  7. [Analysis of body composition in patients with Crohn's disease].

    Science.gov (United States)

    Yan, Ting; Li, Lingling; Wu, Qinyan; Gao, Xiang; Hu, Pinjin; He, Qing

    2014-10-01

    To investigate the differences in body composition between Crohn's disease(CD) patients and healthy subjects as well as the characteristics of human body composition in various types of CD. A total of 57 CD patients were prospectively selected from the Sixth Affiliated Hospital of Sun Yat-sen University as the study group, while 51 healthy subjects as the control group. Protein content, mineral content, fat content, lean body mass, waist circumference, and hip circumference in the two groups were measured by body composition analyzer. Characteristics of CD at different location and different disease activity index were investigated as well. Intracellular fluid, extracellular fluid, weight, protein content, fat content, lean body mass, muscle weight, body fat ratio, waist hip ratio, body weight ratio, arm muscle circumference, arm circumference, quality of cells, BMI and basal metabolic rate in CD patients were significantly lower than those in control group(all Pbody mass in ileocolic CD patients were lower than those with small bowel and colonic CD(all Pbody mass in patients with high disease activity index were lower than those in patients with low and medium index, but higher basal metablic rate was found in the former group(all Pbody composition in patients with CD are different from healthy people. Disease location and disease activity index have an impact on protein content, fat content, and lean body mass.

  8. Autologous hematopoietic stem cells for refractory Crohn's disease.

    Science.gov (United States)

    DiNicola, C A; Zand, A; Hommes, D W

    2017-05-01

    Autologous hematopoietic stem cells are gaining ground as an effective and safe treatment for treating severe refractory Crohn's disease (CD). Autologous hematopoietic stem cell therapy (AHSCT) induces resetting of the immune system by de novo regeneration of T-cell repertoire and repopulation of epithelial cells by bone-marrow derived cells to help patients achieve clinical and endoscopic remission. Areas covered: Herein, the authors discuss the use of AHSCT in treating patients with CD. Improvements in disease activity have been seen in patients with severe autoimmune disease and patients with severe CD who underwent AHSCT for a concomitant malignant hematological disease. Clinical and endoscopic remission has been achieved in patients treated with AHSCT for CD. The only randomized trial published to date, the ASTIC Trial, did not support further use of AHSCT to treat CD. Yet, critics of this trial have deemed AHSCT as a promising treatment for severe refractory CD. Expert opinion: Even with the promising evidence presented for HSCT for refractory CD, protocols need to be refined through the collaboration of GI and hemato-oncology professionals. The goal is to incorporate safe AHSCT and restore tolerance by delivering an effective immune 'cease fire' as a treatment option for severe refractory CD.

  9. Identification of a novel bacterial sequence associated with Crohn's disease.

    Science.gov (United States)

    Sutton, C L; Kim, J; Yamane, A; Dalwadi, H; Wei, B; Landers, C; Targan, S R; Braun, J

    2000-07-01

    Enteric microorganisms are implicated in the pathogenesis of Crohn's disease (CD), but no clear bacterial or viral species has been identified. In this study, representational difference analysis (RDA) was used to isolate DNA segments preferentially abundant in lamina propria mononuclear cells of lesional mucosa vs. adjacent uninvolved mucosa. Two RDA-derived microbial sequences were isolated (I1 and I2) and identified as novel homologues of the ptxR and tetR bacterial transcription-factor families. Quantitative competitive polymerase chain reaction of paraffin-embedded intestinal specimens from 212 patients showed that I2 DNA was present in many CD colonic lesions (43%), but was infrequent in other colonic specimens (9% of ulcerative colitis lesions and 5% of non-inflammatory bowel disease diseases; Pfusion protein showed frequent immunoglobulin A seroreactivity in CD (54% of patients), but infrequent seroreactivity in patients with ulcerative colitis, other inflammatory enteric diseases, or normals (10%, 19%, and 4%, respectively; Pmicroorganism expressing the I2 gene product may be related to CD pathogenesis.

  10. The Role of Laboratory Tests in Crohn's Disease

    Directory of Open Access Journals (Sweden)

    Maria Cappello

    2016-09-01

    Full Text Available In the past, laboratory tests were considered of limited value in Crohn's disease (CD. In the era of biologics, laboratory tests have become essential to evaluate the inflammatory burden of the disease (C-reactive protein, fecal calprotectin since symptoms-based scores are subjective, to predict the response to pharmacological options and the risk of relapse, to discriminate CD from ulcerative colitis, to select candidates to anti-tumor necrosis factors [screening tests looking for hepatitis B virus and hepatitis C virus status and latent tuberculosis], to assess the risk of adverse events (testing for thiopurine metabolites and thiopurine-methyltransferase activity, and to personalize and optimize therapy (therapeutic drug monitoring. Pharmacogenetics, though presently confined to the assessment of thiopurineme methyltransferase polymorphisms and hematological toxicity associated with thiopurine treatment, is a promising field that will contribute to a better understanding of the molecular mechanisms of the variability in response to the drugs used in CD with the attempt to expand personalized care and precision medicine strategies.

  11. An update on medical management on Crohn's disease.

    Science.gov (United States)

    Affronti, Andrea; Orlando, Ambrogio; Cottone, Mario

    2015-01-01

    The management of Crohn's disease (CD) is continuously evolving. New issues emerging from more recent studies could influence the decision-making process in clinical practice. The aim of this review article is to highlight critical issues on the management of CD, new evidence from clinical trials, long-term prospective studies and real life experience, beyond the current guidelines. The role of mucosal healing in clinical practice is uncertain, clinical remission remains the primary end point. The timing for the definition of steroid-resistant CD should be considered between 2 and 4 weeks. Early treatment strategy with immunomodulators is effective for inducing remission but no controlled data are available regarding long-term outcome. Combination therapy (anti-TNFs agents and immunosuppressors) is more effective than single therapy but there is a lack of long-term data and an increased risk of malignancy. The effect of mesalazine, metronidazole and azathioprine in reducing postoperative recurrence is not clinically relevant; biologics are effective, but the duration of treatment is unknown. New drugs are under investigation in order to find exit strategy for patients who no longer respond to biologics. Combination therapy set on anti-TNF-α is until now the best option both to achieve fistula healing and avoid recurrence.

  12. Crohn's disease in the small bowel (radiological features)

    International Nuclear Information System (INIS)

    Pomakov, P.; Lyutzkanova, E.; Kondova, M.; Natzkov, V.

    2002-01-01

    The radiological characteristic features of Crohn's disease located in the small bowel are made up of three main syndromes. Prestenotic - involving the small bowel loops proximally to the pathological process. Strong peristalsis with retroperistalsis, along with fluid and mucus collection, intestinal lumen widening up to 3 - 6 am diameter and formation of gas fluid levels are observed. Stenotic - presenting irregularly narrowed section with rigid walls, uneven rough polymorphic contours with gradual transition to the other part of the intestine. Ulcero-polypoid syndrome mirroring changes in the small-bowel mucosa - longitudinal, circular and oval contrast material depots are seen - ulcer destructions. When fistulas are formed, long spicular added shadows appear along the contour. Not infrequently such fistulas communicate with other parts of gastrointestinal tract; large polymorphic clear zones are also visualized - pseudo polyps. The images observed upon fractionated contrast material passage are supplemented be computerized tomography and percutaneous abdominal sonography - the so called cockade symptom associated with thickening of the intestinal wall, mesenteric hypervascularization and the like. Enteroclysis which are method of choice is not used owing to technical reasons. (authors)

  13. Metronidazole-induced encephalopathy in a patient with Crohn's disease

    Directory of Open Access Journals (Sweden)

    Jihye Kim

    2017-01-01

    Full Text Available Metronidazole is a widely used antibiotic for the treatment of anaerobic bacterial infections. Metronidazole-induced encephalopathy (MIEP is a rare but potentially reversible disease. The mechanism of MIEP remains unclear, and differences in the neurotoxic effects of oral versus intravenous (IV metronidazole administration have not yet been determined. We report the case of a Crohn's disease (CD patient who experienced encephalopathy immediately after a single IV dose of metronidazole following long-term exposure to the oral form of the drug. The 64-year-old man with intractable CD experienced a sudden change in mental status, aphasia, and muscle weakness after IV administration of metronidazole. He had previously taken metronidazole orally for 13 years and received intermittent IV metronidazole treatments for CD exacerbation. Brain magnetic resonance imaging (MRI showed high-intensity signals in the bilateral medial thalamus and the midbrain and pontine tegmentum on fluid-attenuated inversion recovery images. After discontinuation of metronidazole, the high-intensity brain MRI signals resolved and the patient's mental status dramatically improved; however, the patient exhibited mild cognitive dysfunction 2 months after the onset of encephalopathy.

  14. Crohn's disease and early exposure to domestic refrigeration.

    Science.gov (United States)

    Malekzadeh, Fatemeh; Alberti, Corinne; Nouraei, Mehdi; Vahedi, Homayoon; Zaccaria, Isabelle; Meinzer, Ulrich; Nasseri-Moghaddam, Siavosh; Sotoudehmanesh, Rasoul; Momenzadeh, Sara; Khaleghnejad, Reza; Rashtak, Shahrooz; Olfati, Golrokh; Malekzadeh, Reza; Hugot, Jean-Pierre

    2009-01-01

    Environmental risk factors playing a causative role in Crohn's Disease (CD) remain largely unknown. Recently, it has been suggested that refrigerated food could be involved in disease development. We thus conducted a pilot case control study to explore the association of CD with the exposure to domestic refrigeration in childhood. Using a standard questionnaire we interviewed 199 CD cases and 207 age-matched patients with irritable bowel syndrome (IBS) as controls. Cases and controls were followed by the same gastroenterologists of tertiary referral clinics in Tehran, Iran. The questionnaire focused on the date of the first acquisition of home refrigerator and freezer. Data were analysed by a multivariate logistic model. The current age was in average 34 years in CD cases and the percentage of females in the case and control groups were respectively 48.3% and 63.7%. Patients were exposed earlier than controls to the refrigerator (X2 = 9.9, df = 3, P = 0.04) and refrigerator exposure at birth was found to be a risk factor for CD (OR = 2.08 (95% CI: 1.01-4.29), P = 0.05). Comparable results were obtained looking for the exposure to freezer at home. Finally, among the other recorded items reflecting the hygiene and comfort at home, we also found personal television, car and washing machine associated with CD. This study supports the opinion that CD is associated with exposure to domestic refrigeration, among other household factors, during childhood.

  15. Ulcerative colitis and Crohn's disease tissue cytotoxins

    Energy Technology Data Exchange (ETDEWEB)

    McLaren, L.C.; Gitnick, G.

    1982-06-01

    Bowel-wall tissue filtrates from patients with inflammatory bowel disease produce cytopathic effects in tissue culture. The cytopathic effects inducers have been reported to have the characteristics of a small RNA virus. Clostridium difficile toxin also produces cytopathic effects and has been found in the stools of patients with Crohn's disease and ulcerative colitis. The present study concerns the further characterization of the cytopathic inducers in tissues of inflammatory bowel disease patients. It was found that they are nonsedimentable at 148,000 g for 2 h and resistant to inactivation by UV light. They are proteins that are distinct from C. difficile toxin and are unique cytotoxins which are associated with the early cytopathic effects observed in Riff-free chick embryo and rabbit ileum cell cultures. These results suggest that the early cytopathic effects previously described are not produced by a virus. They do not explain the delayed cytopathic effects seen in rabbit ileum or WI-38 cells.

  16. Difficult-to-treat-pediatric Crohn's disease: focus on adalimumab

    Directory of Open Access Journals (Sweden)

    Zeisler B

    2015-04-01

    Full Text Available Bella Zeisler, Jeffrey S Hyams Division of Digestive Diseases, Hepatology, and Nutrition, Connecticut Children's Medical Center Hartford, University of Connecticut School of Medicine, Department of Pediatrics, Farmington, CT, USA Abstract: Adalimumab is a fully humanized anti-tumor necrosis factor alpha monoclonal antibody that was recently granted regulatory approval in the USA for the treatment of moderate to severe Crohn’s disease (CD in children. Like infliximab, the first biologic agent used to treat pediatric CD, regulatory approval was secured many years following approval for adults. The long delay between adult and pediatric approval has led to many years of off-label use of adalimumab, although it is anticipated that the use of adalimumab may further increase with official regulatory approval. To date, pediatric literature on the use of adalimumab for treatment of CD is limited, and pediatric practitioners have mostly extrapolated from research and experience provided by the adult literature. The aim of this paper is to review the literature regarding adalimumab for the treatment of pediatric CD, and includes a review of landmark adult studies as well as the pivotal pediatric study that facilitated regulatory approval. We also discuss the role of anti-tumor necrosis factor alpha agents including adalimumab in the current treatment paradigm for pediatric CD. Keywords: pediatrics, Crohn's disease, adalimumab, biologic agent

  17. Fatal evolution of systemic lupus erythematosus associated with Crohn's disease

    Directory of Open Access Journals (Sweden)

    CHEBLI Júlio M. Fonseca

    2000-01-01

    Full Text Available The authors describe the case of a young Brazilian woman who was treated of ileocolonic Crohn's disease sparing rectum, as confirmed by colonoscopy and histopathological examination. After a 4-year course of sulfasalazine treatment, she presented with skin facial lesions in vespertilio, fever, arthralgias and high titers of anti-ANA and LE cells. A sulfasalazine-induced lupus syndrome was diagnosed, because after sulfasalazine withdrawal and a short course of prednisone, the clinical symptoms disappeared and the laboratory tests returned to normal. Mesalazine 3 g/day was started and the patient remained well for the next 3 years, when she was again admitted with fever, weakness, arthralgias, diplopy, strabismus and hypoaesthesia in both hands and feet, microhematuria, haematic casts, hypocomplementemia and high titers of autoimmune antibodies. A diagnosis of associated systemic lupus erythematosus was made. Although a pulsotherapy with methylprednisolone was started, no improvement was noticed. A cyclophosphamide trial was tried and again no positive results occurred. The patient evolved to severe clinical manifestations of general vasculitis affecting the central and peripheral nervous system and lungs, having a fatal evolution after 2 weeks. Although uncommon, the association of both disease may occur, and the authors call attention to this possibility, making a brief review of literature.

  18. Endoscopic features of gastrointestinal tuberculosis and crohn's disease

    Directory of Open Access Journals (Sweden)

    Praneeth Moka

    2017-01-01

    Full Text Available Endoscopic examination of the gastrointestinal (GI tract plays a very important role in the diagnosis and follow-up of patients with Crohn's disease (CD and intestinal tuberculosis (TB. The clinical, morphological, and histological features of GI TB and CD are so similar that it becomes difficult to differentiate between these two entities. In geographical regions such as India where both GI TB and CD are prevalent, differential diagnosis between the two is challenging. While there is a lot of similarities between these two disorders, these two can be differentiated from each other with a combination of clinical, endoscopic, histological, radiological, and endoscopic features. The observation of the characteristic lesions at endoscopic examination and the extent of involvement in CD and intestinal TB is an important step in differentiation between these two disorders. While the most important endoscopic characteristics such as involvement of left side of the colon and presence of longitudinal ulcerations and cobblestoning support a diagnosis of CD, predominant involvement of ileocecal region and transverse ulcers support the diagnosis of intestinal TB. In this review, we have described the usefulness and limitations of endoscopic modalities in the diagnosis and differentiation of intestinal TB and CD.

  19. Severe metabolic alkalosis and recurrent acute on chronic kidney injury in a patient with Crohn's disease.

    Science.gov (United States)

    Jacobi, Johannes; Schnellhardt, Susanne; Opgenoorth, Mirian; Amann, Kerstin U; Küttner, Axel; Schmid, Axel; Eckardt, Kai-Uwe; Hilgers, Karl F

    2010-04-18

    Diarrhea is common in patients with Crohn's disease and may be accompanied by acid base disorders, most commonly metabolic acidosis due to intestinal loss of bicarbonate. Here, we present a case of severe metabolic alkalosis in a young patient suffering from M. Crohn. The patient had undergone multiple resections of the intestine and suffered from chronic kidney disease. He was now referred to our clinic for recurrent acute kidney injury, the nature of which was pre-renal due to profound volume depletion. Renal failure was associated with marked hypochloremic metabolic alkalosis which only responded to high volume repletion and high dose blockade of gastric hypersecretion. Intestinal failure with stomal fluid losses of up to 5.7 litres per day required port implantation to commence parenteral nutrition. Fluid and electrolyte replacement rapidly improved renal function and acid base homeostasis. This case highlights the important role of gastrointestinal function to maintain acid base status in patients with Crohn's disease.

  20. Genotyping for NOD2 genetic variants and crohn disease: a metaanalysis

    DEFF Research Database (Denmark)

    Yazdanyar, Shiva; Weischer, Maren; Nordestgaard, Børge

    2009-01-01

    important risk factors for Crohn disease. In addition, we used studies for which combined information from all genotypes was available to compare risks in simple heterozygotes, compound heterozygotes, and homozygotes. PubMed, EMBASE, and Web of Science were searched. Seventy-five articles (18 727 cases......BACKGROUND: Arg702Trp, Gly908Arg, and Leu1007fsinsC variants of the NOD2 gene (nucleotide-binding oligomerization domain containing 2; alias, CARD15) influence the risk of Crohn disease. METHODS: We conducted a systematic review to examine whether Arg702Trp, Gly908Arg, and Leu1007fsinsC are equally......-test results: simple heterozygotes vs compound heterozygotes, P risk of Crohn disease was markedly higher for Leu1007fsinsC than for Arg702Trp and Gly908Arg. Combining all...

  1. [Crohn's disease after administration of oral contraceptives. Report of a case (author's transl)].

    Science.gov (United States)

    Bourdais, J P; Delavierre, P; Vayre, P; Hureau, J; Letailleur, M

    1976-03-01

    The case of a 20-year-old female patient is which ileo-colic Crohn's disease developed after repeated attempts at contraceptive treatment (no rgestrel-ethinyl estradiol) had resulted in periods of diarrhea, which ceased after stopping treatment, is reported. As a consequence of the severity of the disease, after the 3rd attempt at using oral contraceptives (OCs) a partial removal of the ileum and colon had to be performed. The relation between Crohn's disease and other acute ulcerative colitis in patinets receiving OCs and the role of these drugs as a triggering factor in Crohn's disease are discussed. It is conclude d that, while their causative role is unproven, in view of studies on th e relation between pregnancy and this disease, OCs may favor the development of the disease, and intestinal disorders during OC treatment should be carefully monitored.

  2. Predicting, treating and preventing postoperative recurrence of Crohn's disease: the state of the field.

    Science.gov (United States)

    Borowiec, Anna M; Fedorak, Richard N

    2011-03-01

    The majority of patients diagnosed with Crohn's disease eventually require surgical intervention. Unfortunately, postsurgical remission tends to be short lived; a significant number of patients experience clinical relapse and many require additional operations. The pathogenesis of this postoperative recurrence is poorly understood and, currently, there are no reliable tools to predict when and in whom the disease will recur. Furthermore, the postoperative prophylaxis profiles of available Crohn's disease therapeutic agents such as 5-aminosalicylates, immunomodulators, steroids and probiotics have been disappointing. Recently, the combination of antibiotics and azathioprine in selected high-risk patients has demonstrated some potential for benefit. The goal of the present article is to provide a coherent summary of previous and new research to guide clinicians in managing the challenging and complex problem of postoperative Crohn's disease recurrence.

  3. Complement activation in plasma before and after infliximab treatment in Crohn disease

    DEFF Research Database (Denmark)

    Zimmermann-Nielsen, E; Agnholt, J; Thorlacius-Ussing, O

    2003-01-01

    complicated by fistulizing ano-rectal disease was collected before and after three Infliximab infusions (5 mg kg(-1)). RESULTS: Before treatment, the C3-activation capacities (C3-AC) in plasma from patients with Crohn disease were comparable with values obtained from healthy controls. The classical C pathway......-mediated C3-AC, mannan-binding lectin C4-AC, leucocyte count, C-reactive protein concentration and Crohn Disease Activity Index decreased significantly 8 weeks after the first infusion of Infliximab (P ... in plasma from patients with Crohn disease; the decrease observed in the classical pathway-mediated C3-AC after treatment with Infliximab reflects a general down-regulation in immune activation....

  4. Transformation of chenodeoxycholic acid to ursodeoxycholic acid in patients with Crohn's disease

    International Nuclear Information System (INIS)

    Miwa, H.; Yamamoto, M.; Nishida, T.; Yao, T.

    1986-01-01

    In vivo 7 beta-epimerization of chenodeoxycholic acid to ursodeoxycholic acid and the role of 7-ketolithocholic acid as an intermediate in this biotransformation were studied in 11 patients with Crohn's disease and in 5 healthy volunteers. The incorporation of deuterium into biliary ursodeoxycholic acid and 7-ketolithocholic acid was determined by computed gas chromatography-mass fragmentography after ingestion of a dideuterated chenodeoxycholic acid, chenodeoxycholic-11,12-d2 acid. The incorporation of deuterium into ursodeoxycholic acid increased to a peak level at 48 h in the patients with Crohn's disease, but was delayed in healthy volunteers. In 8 patients and 2 healthy controls there were small amounts of 7-ketolithocholic acid in bile. The incorporation of deuterium into 7-ketolithocholic acid was confirmed in only 2 patients and the peak level was noted at 48 h. These observations suggest that 7-ketolithocholic acid is an intermediate of this biotransformation in patients with Crohn's disease

  5. Environmental risk factors and Crohn's disease: a population-based, case-control study in Spain.

    Science.gov (United States)

    Sicilia, B; López Miguel, C; Arribas, F; López Zaborras, J; Sierra, E; Gomollón, F

    2001-12-01

    The pathogenesis of inflammatory bowel disease probably involves an interaction between genetic and environmental factors: cigarette smoking, appendectomy and oral contraceptives have been the factors most frequently linked to its aetiology To analyse the association between known environmental risk factors and development of Crohn's disease in the community of Aragón, Spain. A case-control, population-based study has been carried out. All patients diagnosed with Crohn's disease in the community of Aragón from 1st February 1992 to 31st January 1995 were prospectively included. The Lennard Jones criteria were used to define the cases and selected controls among the healthy population matched with patients for age, sex and rural/urban habitat. Statistical analysis included multivariate analysis using conditional logistic regression, testing 38 different models. A total of 103 patients were diagnosed with Crohn's disease in Aragón from 1st February, 1992 to 31st January, 1995. Of these 62 patients (60.2%) with Crohn's disease were smokers, compared with 42 (40.8%) controls (pCrohn's disease with an odds ratio of 3.09 (95% confidence interval, 1.58-6.05). After multivariate analysis, the positive association is maintained. A dose-dependent relation could not be demonstrated. No statistical differences (p=0.50) were detected in the analysis of previous appendectomy. Use of oral contraceptive acts as a risk factor with a p=0.048; odds ratio 2, 8, 95% confidence interval: 1.009-7.774; but this association disappears in the multivariate analysis. Eight patients had a family history (3 first degree and 5 second degree relatives) versus none of the controls (p=0.002). Of the variables studied for childhood hygiene none appeared significant. Smoking, family history, and oral contraceptive use, appear as risk factors for developing Crohn's disease in univariate analysis, but only smoking remains significant in all models of multivariate analysis.

  6. Infliximab for the Treatment of Crohn'S Disease: Review and Indications for Clinical Use in Canada

    Directory of Open Access Journals (Sweden)

    Remo Panaccione

    2001-01-01

    Full Text Available Crohn's disease is a chronic inflammatory disorder of the gastrointestinal tract. It may affect any portion of the gastrointestinal tract from the mouth to the anus. Symptoms typically include cramping abdominal pain, diarrhea (which may be bloody and nausea. As the severity of the illness worsens, patients may experience constant abdominal pain, vomiting, weight loss and fever. From the perspective of the patient, disease symptoms significantly impair quality of life, and interfere with their work environment and activities of daily living. Unfortunately, there is no cure for Crohn's disease. Patients experience a chronic, relapsing course characterized by recurrent flares of their disease. Conventional medical treatment of Crohn's disease includes the use of non-specific anti-inflammatory drugs (5-aminosalicylic acid agents, prednisone, budesonide, immunosuppressives (6-mercaptopurine, azathioprine, methotrexate and antibiotics. A variable onset of action, incomplete response rates and a significant risk of adverse effects characterize current therapies. Although surgery is frequently used to treat complications or medically refractory disease, postoperative recurrence is a common problem. Infliximab, a murine chimeric monoclonal antibody directed toward tumour necrosis factor-alpha, is a highly effective treatment of active Crohn's disease. In randomized, placebo-controlled clinical trials, 33% of patients treated with infliximab 5 mg/kg achieved remission (Crohn's Disease Activity Index score less than 150, compared with only 4% of those receiving placebo (P<0.001. Additionally, infliximab is the only drug therapy shown to be effective for the treatment of fistulizing Crohn's disease. In studies done to date, infliximab appears to be well tolerated and has a favourable side effect profile.

  7. Misleading pustular plaques of the lower limbs during Crohn's disease: two case reports

    Directory of Open Access Journals (Sweden)

    Farhi David

    2007-10-01

    Full Text Available Abstract Background Extraintestinal manifestations of Crohn's disease may involve the skin, the eyes, the genital mucosa, and the joints. Dermatoses associated with Crohn's disease include neutrophilic dermatoses, erythema nodosum, granulomatous dermatitis, blistering dermatoses, and non-specific skin manifestations. Cutaneous Crohn's disease is characterized by skin non-caseating epithelioid granulomatas with giant cells, remote from the gastrointestinal tract. We report herein two new cases. Observations On both patients, differential diagnosis of neutrophilic dermatoses and infectious disease were evoked, and antimicrobial agents were introduced in one of them. Given the atypical presentation, the final diagnosis of cutaneous Crohn's disease could only be made with histological examination. In patient 1, the plaques decreased in size and infiltration by more than 75% after 3 weeks of treatment with bethametasone dipropionate 0.05% cream. In patient 2, the plaques decreased by more than 50% after 6 weeks of treatment with prednisolone (45 mg/day and azathioprine (100 mg/day. Discussion Cutaneous Crohn's disease may present as dusky, erythematous, infiltrated, and ulcerated plaques and nodules. Female-to-male sex ratio is about 2, and the mean age at onset is 35. Recurrently, the hypothesis of a skin mycobacterial or fungal infection greatly delays proper treatment. Rarity of cutaneous Crohn's disease hampers therapeutic assessment in controlled trials. Thus, available literature is limited to case reports and sparse small series, with contradictory results. These reports are subject to publication bias, and no definite evidence-based recommendations can be made on the most adequate therapeutic strategy.

  8. Enteroelysis and spiral CT examination in diagnosis and evaluation of small bowel Crohn's disease

    International Nuclear Information System (INIS)

    Mako, E.K.; Mester, A.R.; Tarjan, Zs.; Karlinger, K.; Toth, G.

    2000-01-01

    Introduction: During the last few decades introducing many of new radiologic methods, diagnostic conditions and facilities of Crohn's disease has became markedly improved. Appropriate using of these techniques definitely modifies the management of patients with known or suspected Crohn's disease serving reliable information about extent, severity and possible complications of disease. Enteroclysis and Computed tomography are the two major and basic methods to disclose or confirm diagnosis of Crohn's disease, obtain appropriate inforination about disease either with mucosal, transmural or extraintestinal manifestation. Methods and patients: We evaluated 281 patients who were referred in our institution under suspicion of Crohn's disease. Enteroclysis and abdominal spiral CT in all cases were carried out usually within 1 week. The 172 patients underwent abdominal spiral CT as the primary examination to evaluate diagnostic value of spiral CT in this entity, while 109 patients had enteroclysis followed by abdominal CT. In 11 cases we also perforined CT enteroclysis with administration of 0.5% methylcellulose solution thorough nasojejunal tube controlled by electric motor driven contrast pump. Results were compared with final clinical, pathological or surgical data were available. Results: From the 281 patients eventually 74 proved Crohn's disease; sensitivity and specificity of enteroclysis proved to be 96 and 98%, while spiral CT sensitivity and specificity was 94 and 95%, respectively. Enteroclysis was superior to the spiral CT in demonstration of early lesions and functional disorders, while spiral CT proved to be essential in evaluation of transmural and extraintestinal complications. Conclusions: Regarding enteroclysis and spiral CT as complementary methods, they provide excellent results in diagnosis of Crohn's disease

  9. Multidrug resistance 1 gene polymorphisms may determine Crohn's disease behavior in patients from Rio de Janeiro

    Directory of Open Access Journals (Sweden)

    Ana Teresa P. Carvalho

    2014-01-01

    Full Text Available OBJECTIVES: Conflicting data from studies on the potential role of multidrug resistance 1 gene polymorphisms in inflammatory bowel disease may result from the analysis of genetically and geographically distinct populations. Here, we investigated whether multidrug resistance 1 gene polymorphisms are associated with inflammatory bowel diseases in patients from Rio de Janeiro. METHODS: We analyzed 123 Crohn's disease patients and 83 ulcerative colitis patients to determine the presence of the multidrug resistance 1 gene polymorphisms C1236T, G2677T and C3435T. In particular, the genotype frequencies of Crohn's disease and ulcerative colitis patients were analyzed. Genotype-phenotype associations with major clinical characteristics were established, and estimated risks were calculated for the mutations. RESULTS: No significant difference was observed in the genotype frequencies of the multidrug resistance 1 G2677T/A and C3435T polymorphisms between Crohn's disease and ulcerative colitis patients. In contrast, the C1236T polymorphism was significantly more common in Crohn's disease than in ulcerative colitis (p = 0.047. A significant association was also found between the multidrug resistance 1 C3435T polymorphism and the stricturing form of Crohn's disease (OR: 4.13; p = 0.009, whereas no association was found with penetrating behavior (OR: 0.33; p = 0.094. In Crohn's disease, a positive association was also found between the C3435T polymorphism and corticosteroid resistance/refractoriness (OR: 4.14; p = 0.010. However, no significant association was found between multidrug resistance 1 gene polymorphisms and UC subphenotypic categories. CONCLUSION: The multidrug resistance 1 gene polymorphism C3435T is associated with the stricturing phenotype and an inappropriate response to therapy in Crohn's disease. This association with Crohn's disease may support additional pathogenic roles for the multidrug resistance 1 gene in regulating gut

  10. Infliximab Dependency in a National Cohort of Children with Crohn's Disease

    DEFF Research Database (Denmark)

    Wewer, Anne Vibeke; Riis, L; Vind, Ida

    2006-01-01

    AIM: The aim was to evaluate the pattern of responsiveness and to monitor side effects of episodic administration of infliximab in children with active Crohn's disease (CD) treated in Denmark from 1999 to 2003. MATERIAL AND METHODS: The National Danish Crohn Colitis Database of infliximab was used...... of symptoms requiring reinfusions of infliximab to regain CR or PR, and 6 (25%) had NR. Six (25%) patients needed surgery during or after treatment with infliximab. Side effects were seen in four (17%) patients. No serious events were noted. CONCLUSION: Seventy-one percent of the children appeared to benefit...

  11. Infliximab dependency in a national cohort of children with Crohn's disease

    DEFF Research Database (Denmark)

    Wever, Anne Vibeke; Riis, Lene; Vind, Ida

    2006-01-01

    AIM: The aim was to evaluate the pattern of responsiveness and to monitor side effects of episodic administration of infliximab in children with active Crohn's disease (CD) treated in Denmark from 1999 to 2003. MATERIAL AND METHODS: The National Danish Crohn Colitis Database of infliximab was used...... of symptoms requiring reinfusions of infliximab to regain CR or PR, and 6 (25%) had NR. Six (25%) patients needed surgery during or after treatment with infliximab. Side effects were seen in four (17%) patients. No serious events were noted. CONCLUSION: Seventy-one percent of the children appeared to benefit...

  12. Imaging Modalities for the Noninvasive Assessment of Fibrosis in Crohn's Disease

    Science.gov (United States)

    Stasi, Cristina; Falchini, Massimo; Milani, Stefano

    2012-01-01

    The development of strictures in Crohn's disease is a main cause of hospitalization and often represent an indication for surgery. The differentiation between inflammatory and fibrotic strictures is useful to determine the optimal treatment. Today, the availability of noninvasive methods to assess the presence and extension of strictures offers new tools for the diagnosis and follow-up of the disease. Bowel ultrasound, power doppler ultrasound, contrast-enhanced ultrasound, magnetic resonance imaging offer the additional advantage that they do not expose patients to ionizing radiation. In this paper we provide an update on the accuracy of these noninvasive methods for the diagnosis of Crohn's disease. PMID:22654607

  13. Imaging Modalities for the Noninvasive Assessment of Fibrosis in Crohn's Disease

    Directory of Open Access Journals (Sweden)

    Cristina Stasi

    2012-01-01

    Full Text Available The development of strictures in Crohn's disease is a main cause of hospitalization and often represent an indication for surgery. The differentiation between inflammatory and fibrotic strictures is useful to determine the optimal treatment. Today, the availability of noninvasive methods to assess the presence and extension of strictures offers new tools for the diagnosis and follow-up of the disease. Bowel ultrasound, power doppler ultrasound, contrast-enhanced ultrasound, magnetic resonance imaging offer the additional advantage that they do not expose patients to ionizing radiation. In this paper we provide an update on the accuracy of these noninvasive methods for the diagnosis of Crohn's disease.

  14. The value of radiological signs in the follow-up of Crohn's disease

    International Nuclear Information System (INIS)

    Kersjes, W.; Harder, T.; Gugler, R.; Klauck, W.; Bonn Univ.; Staedtisches Klinikum Karlsruhe

    1989-01-01

    The value of various radiological signs in the follow-up of Crohn's disease has been studied in 175 radiological examinations of the gastro-intestinal tract in 39 patients. Changes in the significant radiological signs in Crohn's disease, such as spiculae, cobblestone pattern, stenoses and fistulas, provide information on the development of the disease and on the effect of treatment. The signs have a prognostic significance only insofar as their persistence excludes any improvement. Radiological follow-up is particularly useful for spotting complications and for the early recognition of recurrences. (orig.) [de

  15. X-ray diagnosis of Crohn's disease in the region of the colon

    International Nuclear Information System (INIS)

    Bargon, G.

    1980-01-01

    The article reviews the catalogue of signs visualized on X-ray film in colitis granulomatosa Crohn, underlining the typical changes such as segmental involvement, right-sided colitis, preferential involvement of the part of the wall of the colon which is close to the mesentery, pronounced tendency to fistula formation, as well as the various forms of mucosal lesions. Attention is drawn to the possibility of roentgenologic differentiation between colitis granulomatosa Crohn and colitis ulcerosa. The individual signs of both diseases are compared with each other in tabular form. (orig.) [de

  16. Infliximab dependency is related to decreased surgical rates in adult Crohn's disease patients

    DEFF Research Database (Denmark)

    Pedersen, N.; Duricova, D.; Lenicek, M.

    2010-01-01

    Background Infliximab dependency in children with Crohn's disease (CD) has recently been described and found to be associated with a decreased surgery rate. Aim To assess infliximab dependency of adult CD patients, evaluate the impact on surgery, and search for possible clinical and genetic...... predictors. Methods Two hundred and forty-five CD patients treated with infliximab were included from Danish and Czech Crohn Colitis Database (1999-2006). Infliximab response was assessed as immediate outcome, 1 month after infliximab start: complete, partial, and no response. Three months outcome, after...

  17. Differentiation between active and chronic Crohn's disease using MRI small-bowel motility examinations — Initial experience

    International Nuclear Information System (INIS)

    Bickelhaupt, S.; Froehlich, J.M.; Cattin, R.; Patuto, N.; Tutuian, R.; Wentz, K.U.; Culmann, J.L.; Raible, S.; Bouquet, H.; Bill, U.; Patak, M.A.

    2013-01-01

    Aim: To evaluate the influence of locally active Crohn's disease on systemic small-bowel motility in patients with chronic Crohn's disease compared to healthy individuals. Material and methods: Fifteen healthy individuals (11 men, four women; mean age 37 years) and 20 patients with histopathologically proven active (n = 15; 10 women, 5 men; mean age 45 years) or chronic (n = 5; four women, one man; mean age 48 years) Crohn's disease were included in this institutional review board-approved, retrospective study. Magnetic resonance imaging (MRI; 1.5 T) was performed after standardized preparation. Two-dimensional (2D) cine sequences for motility acquisition were performed in apnoea (27 s). Motility assessment was performed using dedicated software in three randomly chosen areas of the small-bowel outside known Crohn's disease-affected hotspots. The main quantitative characteristics (frequency, amplitude, occlusion rate) were compared using Student's t-test and one-way analysis of variance (ANOVA). Results: Three randomly chosen segments were analysed in each participant. Patients with active Crohn's disease had significantly (p < 0.05) reduced contraction frequencies (active Crohn's disease: 2.86/min; chronic: 4.14/min; healthy: 4.53/min) and luminal occlusion rates (active: 0.43; chronic: 0.70; healthy: 0.73) compared to healthy individuals and patients with chronic Crohn's disease. Contraction amplitudes were significantly reduced during active Crohn's disease (6.71 mm) compared to healthy participants (10.14 mm), but this only reached borderline significance in comparison to chronic Crohn's disease (8.87 mm). Mean bowel lumen diameter was significantly (p = 0.04) higher in patients with active Crohn's disease (16.91 mm) compared to healthy participants (14.79 mm) but not in comparison to patients with chronic Crohn's disease (13.68). Conclusion: The findings of the present study suggest that local inflammatory activity of small-bowel segments in patients with

  18. Coexistent pulmonary granulomatosis with polyangiitis (Wegener granulomatosis) and Crohn disease.

    Science.gov (United States)

    Vaszar, Laszlo T; Orzechowski, Nicole M; Specks, Ulrich; Ytterberg, Steven R; Loftus, Edward V; Mark, Eugene J; Tazelaar, Henry D

    2014-03-01

    Crohn disease (CD) may be associated with various extraintestinal manifestations, including, rarely, respiratory tract involvement. When necrobiotic pulmonary nodules are present, the differential diagnosis includes granulomatosis with polyangiitis (Wegener granulomatosis) (GPA). The respiratory tract manifestations of CD and GPA may mimic each other, complicating the diagnosis and suggesting the possible coexistence of these 2 conditions. The aim of this study was to describe the clinical, radiographic, and pathologic features of patients in whom CD and GPA coexist. We reviewed the teaching files of the authors and searched the Mayo Clinic medical records for coexistent inflammatory bowel diseases and antineutrophilic cytoplasmic antibodies (ANCA)-associated vasculitides. We reviewed in detail 97 patient charts and excluded cases of ulcerative colitis and those in whom only one of the diagnoses was present. Pulmonary and gastrointestinal biopsies were reviewed when available. We also searched the medical literature for previously published cases. We found 6 cases of coexistent CD and pulmonary GPA and 4 cases with extrapulmonary GPA; 3 cases (all with extrapulmonary GPA) have been published previously. The diagnosis of CD preceded that of GPA in 11 cases. Proteinase 3-ANCA was positive in 6 cases, negative in 2, and not reported in 5 cases. Myeloperoxidase-ANCA was negative in 6 cases and unavailable in the remainder of patients. Pathology revealed features diagnostic of GPA in all cases with necrotizing granulomatous inflammation and segmental vasculitis. Pulmonary findings in patients with CD or the presence of granulomatous colitis in patients with GPA should prompt the inclusion in the differential diagnosis of a possible coexistence of CD and GPA.

  19. [Isolated ileocecal tuberculosis simulating malignant neoplasia and Crohn's disease].

    Science.gov (United States)

    Bromberg, S H; Faroud, S; de Castro, F F; Morrone, N; de Godoy, A C; França, L C

    2001-01-01

    Isolated ileocecal involvement by tuberculosis in the absence of pulmonar disease is rare in Brasil, therefore causes a diagnostic dilemma as it mimics colonic malignancy and Crohn's disease. Between 1969 and 1989, eight patients with isolated hypertrophic ileocecal tuberculosis were treated by surgery in the Gastroenterology Surgery Department of the HSPE-FMO. The most common complaint among them was abdominal pain (100%) with associated symptoms of weight loss (62.5%); nausea, vomiting, fever and general weekness appeared in half of the patients. A right iliac fossa mass was present in seven (87.5% ) of them. The mean duration of symptoms was 14.7 month (range 5-36 months). In all eight patients chest x-rays were negative for tuberculosis. Barium contrast studies showed abnormalities in all cases, but these could not be distinguished from carcinoma. Colonoscopy was helpful in establishing the diagnosis of suboclusive lesions of the ileocecal regions in three patients. Tuberculosis diagnosis was suspected in two of them because ofr the presence of granulomas in colonic biopsy material. Six patients were submitted to elective right hemicolectomy. The two remaining with suspect of tuberculosis were operated with signals of intestinal occlusion, and underwent a limited ileocaecal resection. The positive diagnosis of intestinal tuberculosis was made in all the patients by identification of acid-fast bacilli and by the presence of caseating granulomas in intestinal or lymph node tissue on histological examination. The outcome in all of them was favorable. They received treatment with three antituberculosis drugs over a twelve month period. Hypertrophic ileocecal tuberculosis must still be considered in the differential diagnosis of abdominal pathology localized in the right lower quadrant.

  20. Role of colonoscopy in differentiating intestinal tuberculosis from Crohn's disease

    Directory of Open Access Journals (Sweden)

    P Rajesh Prabhu

    2017-01-01

    Full Text Available Background: The interface between tuberculosis (TB and Crohn's disease (CD is relevant as TB complicates both the diagnosis and management of CD. Aim: This study aimed to identify the distinctive characteristics of ileocaecal and colonic TB (C-TB and colonic CD (C-CD at colonoscopy and to correlate the colonoscopy findings with histology. Materials and Methods: This prospective study included consecutive patients presenting with classical symptoms of TB or CD. The colonoscopic findings were compared with histology, which was taken as gold standard. Appropriate statistical tests were applied. Results: Fifty-eight individuals fulfilled the inclusion criteria. Nine and 16 patients with C-TB and C-CD, respectively, had histological confirmation of respective diagnosis. In 33 specimens, the histological diagnosis was inconclusive. The sensitivity of colonoscopy for diagnosing C-TB was high at 88.9% (95% confidence interval [CI]: 51.8–99.7. It was 50% (95% CI: 24.7–75.4 for CD. The reverse was true for CD whose specificity was high at 71.4% (95% CI: 55.3–84.3 and low for TB at 46.9% (95% CI: 32.5–61.7. All the patients diagnosed as confirmed CD or TB responded well to respective treatment. Six of the thirty patients with failed response to anti-TB treatment required surgery or change in treatment after 2 months. Conclusion: Colonoscopic findings of isolated ileal involvement, aphthous ulcer, cobble stoning, long-segment strictures, skip lesions and perianal involvement favored a diagnosis of CD. Correlation of colonoscopy with histology is poor for both CD and TB. The accuracy, sensitivity and specificity of colonoscopy were better and superior for the diagnosis of CD, than in the diagnosis of TB.

  1. Phase I trial of sargramostim in pediatric Crohn's disease.

    Science.gov (United States)

    Kelsen, Judith R; Rosh, Joel; Heyman, Mel; Winter, Harland S; Ferry, George; Cohen, Stanley; Mamula, Petar; Baldassano, Robert N

    2010-07-01

    Improving granulocyte function may represent an effective therapy for Crohn's disease (CD). We performed a Phase I-2 trial of sargramostim (SRG) in children with CD. This was multicenter, open-label study in 6-16-year-old patients with moderate to severely active CD. Patients received either 4 or 6 microg/kg SRG subcutaneously daily for 8 weeks, with and without concomitant corticosteroids (CS). The primary endpoint was identification of a safe and tolerable dose in children. The secondary endpoint was establishment of the pharmacokinetics (PK). Efficacy, a tertiary endpoint, was measured by the Pediatric CD Activity Index (PCDAI). Response was defined as a decrease from baseline of > or =12.5 points and remission as absolute PCDAI of < or =10. In all, 22 patients were enrolled: 12 and 10 received 4 and 6 mg/kg, respectively; 19 completed the course. Both doses were found to be safe and well tolerated. Mild injection-site reactions occurred in 90% of patients. Three patients required dose reductions due to elevated absolute neutrophil counts. Following 4 microg/kg the mean area under the curve (AUC) was 2.64 and 2.80 ngh/mL for the 6-11- and 12-16-year-old groups, respectively. The mean half-life (t(1/2)) was 1.22 and 1.59 hours, respectively. Following 6 microg/kg, the mean AUC was 5.01 ngh/mL for the 12-16-year-old group, a 1.8-fold increase. A total of 16/18 patients (88%) achieved remission or response. Sargramostim at both 4 and 6 mg/kg was well tolerated. PK analysis suggested dose proportionality unaffected by CS exposure. Remission and response data are encouraging, but further trials are needed to assess efficacy.

  2. Platelets Toll-like receptor-4 in Crohns disease.

    Science.gov (United States)

    Schmid, Werner; Novacek, Gottfried; Vogelsang, Harald; Papay, Pavol; Primas, Christian; Eser, Alexander; Panzer, Simon

    2017-02-01

    Platelets are activated in Crohn's disease (CD) and interplay with leukocytes. Engagement of Toll-like receptor-4 (TLR-4), which is expressed in human platelets, may be involved in crosstalks between platelets and leukocytes leading to their mutual activation for host defense. Human neutrophil peptides (HNPs), lipoprotein binding peptides, and sCD14 were determined by enzyme-linked immunosorbent assays in 42 patients with active CD, in 43 patients with CD in remission, and in 30 healthy individuals. Neutrophil-platelet aggregates and binding of the TLR-4 monoclonal antibody to platelets were determined by flow cytometry. Levels of HNPs were higher in patients with CD than in controls (P = 0.0003 vs. active CD and P = 0.01 vs. CD in remission). Likewise, neutrophils with adhering platelets were higher in patients with active CD than in controls (P = 0.004). Binding of the TLR-4 antibody in patients with active CD was similar to that in controls, while patients in remission had significantly higher binding capacities (P = 0.59 and P = 0.003). Incubation of plasma from patients with active disease or patients in remission with platelets from healthy controls confirmed lower binding of the TLR-4 antibody in the presence of plasma from active diseased patients compared to controls (P = 0.039), possibly due to high levels of lipopolysaccharides, as suggested by high levels of sCD14 and lipoprotein binding protein. Our study indicates involvement of platelet TLR-4 in enhancing the secretion of antimicrobial peptides from neutrophils. While platelet aggregation can be due to a variety of mechanisms in inflammatory disease, the mutual activation of platelets and neutrophils may augment host defense. © 2016 Stichting European Society for Clinical Investigation Journal Foundation.

  3. Pilotní studie ročního režimu pohybové aktivity gymnaziálních studentek [Variability of year-round physical activity in high school girls – pilot study

    OpenAIRE

    Marek Pelcl; František Chmelík; Jana Vašíčková; Jana Pelclová; Karel Frömel

    2008-01-01

    Tato studie analyzuje výsledky výzkumu u devíti gymnaziálních dívek, které dobrovolně celý školní rok 2005-06 nosily krokoměry k monitorování pohybové aktivity a její variability v průběhu jejich školní docházky a volného času. Korigovaná data byla zpracována opakovanou analýzou rozptylu a zjištěny byly významné rozdíly mezi dny v týdnu, měsíci, dny s vyučovacími jednotkami tělesné výchovy a bez tělesné výchovy a ročními obdobími. [The adolescent period seems to be critical in age-related dec...

  4. Development of active barriers for removing heavy metals from mine water: Freiberg colliery, Sachsen; Entwicklung aktiver Barrieren fuer die Entfernung von Schwermetallen aus Grubenwaessern am Beispiel der Freiberger Grube, Sachsen

    Energy Technology Data Exchange (ETDEWEB)

    Zoumis, T.

    2003-07-01

    Mine water treatment is costly, difficult, and requires extensive surface installations. The author explains the development of geochemical ('active') barriers of low-cost materials. The materials investigated were industrial residues (red sludge, fly ash, tinder residues, porous concrete residues), natural materials (bark, zeolite, bentonite, hydroxyl apatite), and commercial products (GEH, Ratio Pur MF-S). Investigations focused on density, specific surface, grain size, and acid neutralization capacity. In the final stage, experiments were made on heavy metal removal from a model water. [German] Einen grossen Anteil an der Schwermetallbelastung in Fluessen haben toxische Abwaesser aus Bergbaugebieten (Grubenwaesser). Die Moeglichkeit der Behandlung sind sehr aufwendig, kostenintensiv und nur 'ueber Tage' durchfuehrbar. Die vorliegende Arbeit erlaeutert die Behandlung von Grubenwaessern mit geochemischen ('aktiven') Barrieren. Es werden aktive Barrieren entwickelt, die in einen Schacht eingebracht werden koennen, um eine Schwermetallausbreitung zu unterbinden. In diesem Zusammenhang werden kostenguenstige Materialien untersucht, die Schadstoffe durch chemische und/oder physikalische Mechanismen aus Wasser entfernen koennen. Untersucht wurden industrielle Reststoffe (Rotschlamm, Flugasche, Zunderrueckstaende, Porenbetonabfall), natuerliche Materialien (Baumrinde, Zeolith, Bentonit, Hydroxylapatit) und kommerzielle Produkte (GEH, Ratio Pur MF-S). Die Materialien werden hinsichtlich der Dichte, der spezifischen Oberflaeche, der Korngroesse und der Saeureneutralisationskapazitaet charakterisiert. Anschliessend wurden Versuche zur Schwermetallentfernung aus einem Modellwasser durchgefuehrt. (orig.)

  5. Integrated multiplex ligation dependent probe amplification (MLPA) assays for the detection of alterations in the HEXB, GM2A and SMARCAL1 genes to support the diagnosis of Morbus Sandhoff, M. Tay-Sachs variant AB and Schimke immuno-osseous dysplasia in humans.

    Science.gov (United States)

    Sobek, Anna K U; Evers, Christina; Dekomien, Gabriele

    2013-02-01

    Multiplex ligation dependent probe amplification (MLPA) assays were designed for the genes HEXB (OMIM: 606873), GM2A (OMIM: 613109) and SMARCAL1 (OMIM: 606622) of humans. Two sets of synthetic MLPA probes for these coding exons were tested. Changes in copy numbers were detected as well as single nucleotide polymorphisms (SNPs) by complementary DNA sequence analyses. The MLPA method was shown to be reliable for mutation detection and identified five published and 12 new mutations. In all cases from a Morbus Sandhoff cohort of patients, exclusively one variation in copy number was observed and linked to a nucleotide alteration called c.1614-14C>A. This deletion comprised exons 1-5. One of these cases is described in detail. Deletions were neither detected in the GM2A nor the SMARCAL1 genes. The MLPA assays complement routine diagnostics for M. Sandhoff (OMIM: 268800), M. Tay-Sachs variant AB (OMIM: 272750) and Schimke immuno-osseous dysplasia (OMIM: 242900). Copyright © 2012 Elsevier Ltd. All rights reserved.

  6. Identifying decreased peristalsis of abnormal small bowel segments in Crohn's disease using cine MR enterography: the frozen bowel sign.

    Science.gov (United States)

    Guglielmo, Flavius F; Mitchell, Donald G; O'Kane, Patrick L; Deshmukh, Sandeep P; Roth, Christopher G; Burach, Ilene; Burns, Aaron; Dulka, Susan; Parker, Laurence

    2015-06-01

    The purpose of this study was to evaluate whether affected bowel in Crohn's disease patients can be identified by observing decreased peristalsis (frozen bowel sign) using cine balanced steady-state free precession (cine BSSFP) images. 5 radiologists independently reviewed cine BSSFP sequences from randomized MR Enterography (MRE) exams for 30 normal and 30 Crohn's disease patients, graded overall small bowel peristalsis from slowest to fastest, and graded peristalsis for the most abnormal small bowel segment. Sensitivity and specificity of the frozen bowel sign for diagnosing Crohn's disease were calculated. T tests of the peristalsis difference between abnormal segments and overall small bowel were conducted. For 5 readers, the sensitivity and specificity of cine BSSFP of the frozen bowel sign for diagnosing Crohn's disease ranged from 70% to 100% and 87% to 100%, respectively. There were significant differences in peristalsis between abnormal small bowel segments and the overall small bowel for Crohn's patients, but not in the overall small bowel between normal-MRE patients and Crohn's disease patients. Abnormal Crohn's small bowel segments have significantly decreased peristalsis compared to normal small bowel, which can be identified using cine BSSFP sequences as the frozen bowel sign.

  7. Twin studies reveal specific imbalances in the mucosa-associated microbiota of patients with ileal Crohn's disease

    Energy Technology Data Exchange (ETDEWEB)

    Willing, B.; Halfvarson, J.; Dicksved, J.; Rosenquist, M.; Jarnerot, G.; Engstrand, L.; Tysk, C.; Jansson, J. K

    2008-08-15

    Large inter-individual variation in the composition of the intestinal microbiota between unrelated individuals has made it challenging to identify specific aspects of dysbiosis that lead to Crohn's disease. To reduce variations in exposure during establishment of the gut flora and influence of genotype, we studied the mucosaassociated microbiota of monozygotic twin pairs that were discordant (n=6) or concordant (n=4) for Crohn's disease. DNA was extracted from biopsies collected from 5 locations between the ileum and rectum. Bacterial 16S ribosomal RNA genes were amplified and community composition assessed by terminal-restriction fragment length polymorphism, cloning and sequencing and quantitative real-time PCR. The microbial compositions at all biopsy locations for each individual were similar, regardless of disease state, but there were differences between individuals. In particular, individuals with predominantly ileal Crohn's had a dramatically lower abundance (P<0.001) of Faecalibacterium prausnitzii and increased abundance (P<0.03) of Escherichia coli compared to healthy co-twins and those with Crohn's localized in the colon. This dysbiosis was significantly correlated to the disease phenotype rather than genotype. The reduced abundance of F. prausnitzii and increased abundance of E. coli are indicative of an ileal Crohn's disease phenotype, distinct from colonic Crohn's disease and the relative abundances of these specific bacterial populations are promising biomarker candidates for differential diagnosis of Crohn's and eventually customized treatment.

  8. Comparative Study between Axial and Coronal Planes of CT Enterography in Evaluation of Disease Activity and Complications of Crohn Disease

    International Nuclear Information System (INIS)

    Ahn, Sung Eun; Park, Seong Jin; Moon, Soung Kyung; Lim, Joo Won; Lee, Dong Ho; Ko, Young Tae; Kim, Hyo Jong

    2013-01-01

    To retrospectively compare the accuracy of axial and coronal planes of CT enterography for detection of pathologic findings of Crohn disease. 168 patients who were suspected of having Crohn disease underwent CT enterography. 66 patients who were diagnosed Crohn disease were retrospectively evaluated (endoscopic biopsy of terminal ileum: 12 patients, segmental resection of small bowel: 6 patients, diagnosed based on a combination of clinical, histopathological and imaging findings: 48 patients). 2 radiologists reviewed axial planes of CT enterography and one month later reviewed coronal planes. CT enterography findings of active phase, chronic phase and complications of Crohn disease were evaluated and then compared with axial and coronal planes by using chi-square test. Mucosal hyperenhancement, wall thickening, and mesenteric fat stranding were more detected on axial planes, which were CT findings of active Crohn disease. Pseudosacculation, fibrotic strictures, fistulas, abscesses were more detected on coronal planes, which were CT findings of chronic Crohn disease or complications. In particular, pseudosacculation and fibrotic strictures were significantly more detected on coronal planes. When evaluating CT enterography in Crohn disease, coronal planes provide more useful diagnostic information of pseudosacculation and fibrotic strictures.

  9. Quantitative Contrast-Enhaced Ultrasound Comparsion Between Inflammatory and Fibrotic Lesions in Patients with Crohn's Disease

    Czech Academy of Sciences Publication Activity Database

    Nylund, K.; Jiřík, Radovan; Mézl, M.; Leh, S.; Hausken, T.; Pfeffer, F.; Odegaard, S.; Taxt, T.; Gilja, O.H.

    2013-01-01

    Roč. 39, č. 7 (2013), s. 1197-1206 ISSN 0301-5629 R&D Projects: GA ČR GAP102/12/2380 Institutional support: RVO:68081731 Keywords : Crohn's disease * Inflammatory bowel disease * Intestinal blood flow * Ultrasonography Subject RIV: FS - Medical Facilities ; Equipment Impact factor: 2.099, year: 2013

  10. Medium-term follow-up of Crohn's disease in Cape Town

    African Journals Online (AJOL)

    1989-08-09

    Aug 9, 1989 ... related to the disease. This patient had Crohn's colitis and died 8 years after diagnosis from cardiac arrest presumed to have been caused by electrolyte imbalance during an attack of diarrhoea away from Groote Schuur HospitaL This gave an overall mortality rate of 0,95%, which is similar to the 1,79%.

  11. Histologic scoring indices for evaluation of disease activity in Crohn's disease

    NARCIS (Netherlands)

    Novak, Gregor; Parker, Claire E.; Pai, Rish K.; Macdonald, John K.; Feagan, Brian G.; Sandborn, William J.; D'Haens, Geert; Jairath, Vipul; Khanna, Reena

    2017-01-01

    Histologic assessment of mucosal disease activity has been increasingly used in clinical trials of treatment for Crohn's disease. However, the operating properties of the currently existing histologic scoring indices remain unclear. A systematic review was undertaken to evaluate the development and

  12. Serial magnetic resonance imaging for monitoring medical therapy effects in Crohn's disease

    NARCIS (Netherlands)

    Tielbeek, Jeroen A. W.; Löwenberg, Mark; Bipat, Shandra; Horsthuis, Karin; Ponsioen, Cyriel Y.; D'Haens, Geert R.; Stoker, Jaap

    2013-01-01

    Tumor necrosis factor (TNF) antagonists can induce mucosal healing in patients with Crohn's disease (CD), but the effects on transmural inflammation and stenotic lesions are largely unknown. We performed a retrospective study in 50 patients (54% female, median age 37 yr) with CD who had undergone

  13. Problems in the Surgical Management of Crohn's Disease of the Colon

    African Journals Online (AJOL)

    classical ulcerative colitis and Crohn's disease when the latter affects the whole length of the colon and it is only during the last decade and in particular since the papers of. Lockhart-Mummery and Morson",l2 that the histological features of the two diseases have been described in detail. Since then many cases of primary ...

  14. Contribution of rs11465788 in IL23R gene to Crohn's disease ...

    Indian Academy of Sciences (India)

    Home; Journals; Journal of Genetics; Volume 88; Issue 2. Contribution of rs11465788 in IL23R gene to Crohn's disease susceptibility and phenotype in Chinese population. Chen Bin Zeng Zhirong Wu Xiaoqin Chen Minhu Li Mei Gao Xiang Chen Baili Hu Pinjin. Research Article Volume 88 Issue 2 August 2009 pp 191-196 ...

  15. Clinical outcomes and advantages of laparoscopic surgery for primary Crohn's disease: are they significant?

    Science.gov (United States)

    Tanaka, Shinnosuke; Matsuo, Katsuichi; Sasaki, Takamitsu; Nakano, Masahiho; Shimura, Hideo; Yamashita, Yuichi

    2009-01-01

    The clinical outcomes and advantages of laparoscopic surgery for Crohn's disease have not yet been recognized in general. The aim of this study was to critically assess the clinical outcomes, safety, cosmesis, quality of life (QOL) and feasibility of laparoscopic surgery for primary Crohn's disease. The study subjects consisted of 48 patients who had primary surgical treatment for Crohn's disease, 28 through conventional laparotomy and 20 in whom surgery was laparoscopically assisted. The short-term and long-term outcomes, cosmesis, and postoperative QOL were evaluated in both groups. There were no statistically significant differences in the patient characteristics between the two groups. In the laparoscopic group, non-resected procedures were significantly more frequent (p cosmetic results were very satisfactory in 11 patients (64.7%). There were no severe complications and no increase of the recurrence rate for laparoscopic surgery. Moreover, there was no definite clinical disadvantage and no prolonged operating time in the laparoscopic procedures. Laparoscopic surgery for primary Crohn's disease is safe and feasible in selected patients without severe adhesion, fistula or abscess, and was associated with better cosmesis than conventional open surgery. Therefore, laparoscopic procedures should be considered as the preferred operative approach for a primary bowel resection.

  16. The effect of perioperative blood transfusion on recurrence after primary operation for Crohn's disease

    NARCIS (Netherlands)

    Steup, W. H.; Brand, A.; Weterman, I. T.; Zwinderman, K. H.; Lamers, C. B. H. W.; Gooszen, H. G.

    1991-01-01

    The effect of perioperative blood transfusion on recurrence after primary operation was retrospectively studied in a group of 104 patients with Crohn's disease. Patients who had minor procedures like strictureplasty, segmental small-bowel resection, and operation for perianal fistula were excluded.

  17. Vitamin D-mediated calcium absorption in patients with clinically stable Crohn's disease: a pilot study

    Science.gov (United States)

    Vitamin D is the critical hormone for intestinal absorption of calcium. Optimal calcium absorption is important for proper mineralization of bone in the prevention of osteoporosis and osteoporotic fractures, among other important functions. Diseases associated with gut inflammation, such as Crohn's ...

  18. Training readers to improve their accuracy in grading Crohn's disease activity on MRI

    NARCIS (Netherlands)

    Tielbeek, Jeroen A. W.; Bipat, Shandra; Boellaard, Thierry N.; Nio, C. Yung; Stoker, Jaap

    2014-01-01

    To prospectively evaluate if training with direct feedback improves grading accuracy of inexperienced readers for Crohn's disease activity on magnetic resonance imaging (MRI). Thirty-one inexperienced readers assessed 25 cases as a baseline set. Subsequently, all readers received training and

  19. A global consensus on the classification, diagnosis and multidisciplinary treatment of perianal fistulising Crohn's disease

    NARCIS (Netherlands)

    Gecse, Krisztina B.; Bemelman, Willem; Kamm, Michael A.; Stoker, Jaap; Khanna, Reena; Ng, Siew C.; Panés, Julián; van Assche, Gert; Liu, Zhanju; Hart, Ailsa; Levesque, Barrett G.; D'Haens, Geert; Bouguen, Guillaume; Sturm, Andreas; Laharie, David; Feagan, Brian; Sandborn, William; Sands, Bruce; Colombel, Jean-Frederic

    2014-01-01

    To develop a consensus on the classification, diagnosis and multidisciplinary treatment of perianal fistulising Crohn's disease (pCD), based on best available evidence. Based on a systematic literature review, statements were formed, discussed and approved in multiple rounds by the 20 working group

  20. Crohn's disease but not chronic ulcerative colitis induces the expression of PAI-1 in enteric neurons

    DEFF Research Database (Denmark)

    Laerum, O.D.; Illemann, M.; Skarstein, A.

    2008-01-01

    OBJECTIVES: Chronic inflammation of the intestinal wall is the common characteristic of Crohn's disease and ulcerative colitis; disorders, which in some cases can be difficult to distinguish. The inflammation also affects the local neuronal plexuses of the enteric nervous system. It is known...

  1. [Analysis of risk factors for anastomotic infectious complications following bowel resection for Crohn disease].

    Science.gov (United States)

    Wang, Wang-yue; Chen, Cheng-long; Chen, Guang-lan; Wu, Cheng-jun; Li, Hong-guang; Luan, Shuang-mei; Zhu, Ya-bi

    2013-04-01

    To investigate the risk factors for anastomotic infectious complications after bowel resection in patients with Crohn disease. Clinical data of 124 patients with Crohn disease undergoing bowel resection between January 1990 and October 2012 were analyzed retrospectively. The risk factors were identified by χ(2) test and Logistic regression. Fourteen patients (12.3%, 14/114) developed anastomotic infectious complications in the postoperative period, including anastomotic leak (n=7), intra-abdominal abscess (n=6), and enterocutaneous fistula (n=1). Crohn disease activity index (CDAI)>150 (OR=2.185, 95%CI:1.098-6.256, P=0.040), steroid usage (OR=2.674, 95%CI:1.118-8.786, P=0.027), and the presence of preoperative abscess/fistula (OR=3.447, 95%CI:1.254-10.462, P=0.014) were identified as independent risk factors of anastomotic infectious complications. In the absence of these 3 risk factors, the rate of anastomotic infectious complication was 5.7% (3/53), which increased to 11.4% (4/35) when one risk factor was present, 21.1% (4/19) when two risk factors were present, and 42.9% (3/7) when all the 3 risk factors were present. CDAI>150, steroid usage and preoperative abscess/fistula are associated with higher rates of anastomotic infectious complications following bowel resection for Crohn disease. A prudent management should be carried out if risk factors can not be eliminated preoperatively.

  2. Complications and Disease Recurrence After Primary Ileocecal Resection in Pediatric Crohn's Disease: A Multicenter Cohort Analysis

    NARCIS (Netherlands)

    Diederen, Kay; de Ridder, Lissy; van Rheenen, Patrick; Wolters, Victorien M.; Mearin, Maria L.; Damen, Gerard M.; de Meij, Tim G.; van Wering, Herbert; Tseng, Laura A.; Oomen, Matthijs W.; de Jong, Justin R.; Sloots, Cornelius E.; Benninga, Marc A.; Kindermann, Angelika

    2017-01-01

    Studies on the outcome of ileocecal resection in pediatric Crohn's disease (CD) have a limited follow-up and fail to assign predictors of adverse outcomes. Therefore, we aimed to investigate (I) the complication and disease recurrence rates and (II) identify risk factors for these adverse outcomes

  3. Risk factors for surgical site infection and association with infliximab administration during surgery for Crohn's disease.

    Science.gov (United States)

    Uchino, Motoi; Ikeuchi, Hiroki; Matsuoka, Hiroki; Bando, Toshihiro; Ichiki, Kaoru; Nakajima, Kazuhiko; Tomita, Naohiro; Takesue, Yoshio

    2013-10-01

    Preoperative infliximab treatment may influence postoperative infectious complications in patients with Crohn's disease. The aim of this study was to identify predictors of surgical site infection after surgery for Crohn's disease and evaluate the effects of preoperative infliximab administration. We performed a prospective surveillance and review of surgical site infections. This study was conducted in the Surgical Department of Hyogo College of Medicine. A total of 405 consecutive patients with Crohn's disease who underwent abdominal surgery between January 2008 and December 2011 were included. Infection was diagnosed by the infection control team. The possible risk factors were analyzed by using logistic regression analyses to determine their predictive significance. Within the patient population, 20% of patients received infliximab, and 60% had penetrating disease. The median duration from the last infliximab infusion to surgery was 43 days (range, 4-80). The overall incidence of surgical site infection was 27%. The incidence of incisional surgical site infection was 18%, and the organ/space surgical site infection rate was 8%. In the multivariate analysis, proctectomy was the highest risk factor for all surgical site infection (OR, 3.4-11.8; p risk factor for surgical site infection. By contrast, there was a significantly reduced risk of incisional surgical site infection in patients with penetrating disease who received infliximab (OR, 0.1; p risk factor for surgical site infection in patients with Crohn's disease. The administration of preoperative infliximab was not a risk factor for surgical site infection.

  4. Genetic polymorphisms associated with smoking behaviour predict the risk of surgery in patients with Crohn's disease

    NARCIS (Netherlands)

    Lang, B. M.; Biedermann, L.; van Haaften, W. T.; de Valliere, C.; Schuurmans, M.; Begre, S.; Zeitz, J.; Scharl, M.; Turina, M.; Greuter, T.; Schreiner, P.; Heinrich, H.; Kuntzen, T.; Vavricka, S. R.; Rogler, G.; Beerenwinkel, N.; Misselwitz, B.

    Background: Smoking is a strong environmental factor leading to adverse outcomes in Crohn's disease, but a more benign course in ulcerative colitis. Several single nucleotide polymorphisms (SNPs) are associated with smoking quantity and behaviour. Aim: To assess whether smoking-associated SNPs

  5. Recommendations for the treatment of Crohn's disease with tumor necrosis factor antagonists: An expert consensus report

    NARCIS (Netherlands)

    Feagan, Brian G.; Lémann, Marc; Befrits, Ragnar; Connell, William; D'Haens, Geert; Ghosh, Subrata; Michetti, Pierre; Ochsenkühn, Thomas; Panaccione, Remo; Schreiber, Stefan; Silverberg, Mark; Sorrentino, Dario; van der Woude, C. Janneke; Vermeire, Severine; Rutgeerts, Paul

    2012-01-01

    Background: Symptom relief is the traditional treatment goal in Crohn's disease (CD). New goals including mucosal healing and bowel preservation are now achievable with tumor necrosis factor (TNF) antagonists. Infliximab and adalimumab are approved as second-line treatments for severe, active CD.

  6. Complications and Disease Recurrence After Primary Ileocecal Resection in Pediatric Crohn's Disease : A Multicenter Cohort Analysis

    NARCIS (Netherlands)

    Diederen, Kay; de Ridder, Lissy; van Rheenen, Patrick; Wolters, Victorien M.; Mearin, Maria L.; Damen, Gerard M.; de Meij, Tim G.; van Wering, Herbert; Tseng, Laura A.; Oomen, Matthijs W N; de Jong, Justin R.; Sloots, Cornelius E. J.; Benninga, Marc A.; Kindermann, Angelika

    Background: Studies on the outcome of ileocecal resection in pediatric Crohn's disease (CD) have a limited follow-up and fail to assign predictors of adverse outcomes. Therefore, we aimed to investigate (I) the complication and disease recurrence rates and (II) identify risk factors for these

  7. ATG16L1: A multifunctional susceptibility factor in Crohn disease.

    Science.gov (United States)

    Salem, Mohammad; Ammitzboell, Mette; Nys, Kris; Seidelin, Jakob Benedict; Nielsen, Ole Haagen

    2015-04-03

    Genetic variations in the autophagic pathway influence genetic predispositions to Crohn disease. Autophagy, the major lysosomal pathway for degrading and recycling cytoplasmic material, constitutes an important homeostatic cellular process. Of interest, single-nucleotide polymorphisms in ATG16L1 (autophagy-related 16-like 1 [S. cerevisiae]), a key component in the autophagic response to invading pathogens, have been associated with an increased risk of developing Crohn disease. The most common and well-studied genetic variant of ATG16L1 (rs2241880; leading to a T300A conversion) exhibits a strong association with risk for developing Crohn disease. The rs2241880 variant plays a crucial role in pathogen clearance, resulting in imbalanced cytokine production, and is linked to other biological processes, such as the endoplasmic reticulum stress/unfolded protein response. In this review, we focus on the importance of ATG16L1 and its genetic variant (T300A) within the elementary biological processes linked to Crohn disease.

  8. Visceral adiposity, genetic susceptibility, and risk of complications among individuals with crohn's disease

    NARCIS (Netherlands)

    Van Der Sloot, Kimberley W.; Bellavance, Danielle; Gilpin, Katherine; Stewart, Kathleen; Joshi, Amit D.; Garber, John; Giallourakis, Comas; Yajnik, Vijay; Ananthakrishnan, Ashwin N.; Alizadeh, Behrooz; Xavier, Ramnik; Khalili, Hamed

    2016-01-01

    Introduction: Adipose tissue in mesenteric fat plays a key role in systemic and luminal inflammation through production of Tumor Necrosis Factor-α (TNF-α) and inhibition of adiponectin, an anti-inflammatory cytokine, in patients with Crohn's disease (CD). However, little is known about the role of

  9. Active and passive smoking behaviour and cessation plans of patients with Crohn's disease and ulcerative colitis

    NARCIS (Netherlands)

    van der Heide, Frans; Dijkstra, Arie; Albersnagel, Frans A.; Kleibeuker, Jan H.; Dijkstra, Gerard

    Background: Smoking is a remarkable risk factor in inflammatory bowel disease (IBD), with negative effects on Crohn's disease (CD) and positive effects on ulcerative colitis (UC). This makes different changes in smoking behaviour after diagnosis between CD and UC likely. Changes in active smoking,

  10. Complications and Disease Recurrence After Primary Ileocecal Resection in Pediatric Crohn's Disease : A Multicenter Cohort Analysis

    NARCIS (Netherlands)

    Diederen, Kay; de Ridder, Lissy; van Rheenen, Patrick; Wolters, Victorien M; Mearin, Maria L; Damen, Gerard M; de Meij, Tim G; van Wering, Herbert; Tseng, Laura A; Oomen, Matthijs W; de Jong, Justin R; Sloots, Cornelius E; Benninga, Marc A; Kindermann, Angelika

    BACKGROUND: Studies on the outcome of ileocecal resection in pediatric Crohn's disease (CD) have a limited follow-up and fail to assign predictors of adverse outcomes. Therefore, we aimed to investigate (I) the complication and disease recurrence rates and (II) identify risk factors for these

  11. Ileum resection is the most predictive factor for osteoporosis in patients with Crohn's disease

    NARCIS (Netherlands)

    van Hogezand, R. A.; Bänffer, D.; Zwinderman, A. H.; McCloskey, E. V.; Griffioen, G.; Hamdy, N. A. T.

    2006-01-01

    INTRODUCTION: Crohn's disease is associated with a host of factors potentially increasing the risk for osteoporosis and fractures. The aim of our study was to identify the most predictive factors for skeletal pathology in this patients. METHODS: Using a cross-sectional study design, 146 randomly

  12. A study of the menopause, smoking, and contraception in women with Crohn's disease.

    Science.gov (United States)

    Lichtarowicz, A; Norman, C; Calcraft, B; Morris, J S; Rhodes, J; Mayberry, J

    1989-07-01

    One hundred and ninety-six women with Crohn's disease from south-east Wales were asked to provide details of their menstrual cycles, age at menopause, history of surgery, smoking habits and use of oral contraceptives. One hundred and forty-six provided the information (response rate 77 per cent). Eighty-four were still menstruating, three were pregnant, 10 had undergone hysterectomy, one had a pharmacologically-induced menopause and 48 had had a physiological menopause. Of these 48 women, 33 were diagnosed as having Crohn's disease before the menopause. Twenty-five of these were smokers. The mean age at menopause was similar in smokers and non-smokers and in those diagnosed before and after the menopause. The mean age at menopause was between 46 and 47. A logistic analysis using the 'status quo' method showed that 50 per cent of women with Crohn's disease had the menopause at 47.6 years compared with 49.6 years in a group of healthy women from the same area. The two groups had similar smoking habits and it would seem that a premature menopause is associated with Crohn's disease.

  13. CARD15 in inflammatory bowel disease and Crohn's disease phenotypes : An association study and pooled analysis

    NARCIS (Netherlands)

    Oostenbrug, L. E.; Nolte, I. M.; Oosterom, E.; van der Steege, G.; Meerman, G. J. te; van Dullemen, H. M.; Drenth, J. P. H.; de Jong, D. J.; van der Linde, K.; Jansen, P. L. M.; Kleibeuker, J. H.

    2006-01-01

    Background. Three major polymorphisms of the Caspase-Activation Recruitment Domain containing protein 15 gene have been described to be associated with Crohn's disease. Genotype-phenotype studies reported in literature provide conflicting data on disease localisation and behaviour. We investigated

  14. Magnetic resonance imaging for evaluation of disease activity in Crohn's disease: a systematic review

    NARCIS (Netherlands)

    Horsthuis, K.; Bipat, S.; Stokkers, P.C.F.; Stoker, J.

    2009-01-01

    To systematically review the evidence on the accuracy of MRI for grading disease activity in Crohn's disease (CD). The MEDLINE, EMBASE, CINAHL and Cochrane databases were searched for studies on the accuracy of MRI in grading CD compared to a predefined reference standard. Two independent observers

  15. Molecular prediction of disease risk and severity in a large Dutch Crohn's disease cohort

    NARCIS (Netherlands)

    Weersma, R.K.; Stokkers, P.C.F.; van Bodegraven, A.A.; van Hogezand, R.A.; Verspaget, H.W.; de Jong, D.J.; van der Woude, C.J.; Oldenburg, B.; Linskens, R.K.; Festen, E.A.M.; van der Steege, G.; Hommes, D.W.; Crusius, J.B.A.; Wijmenga, C.; Nolte, I.M.; Dijkstra, G.

    2009-01-01

    Background: Crohn's disease and ulcerative colitis have a complex genetic background. We assessed the risk for both the development and severity of the disease by combining information from genetic variants associated with inflammatory bowel disease (IBD). Methods: We studied 2804 patients (1684

  16. Long-Term Performance of Readers Trained in Grading Crohn Disease Activity Using MRI

    NARCIS (Netherlands)

    Puylaert, Carl A. J.; Tielbeek, Jeroen A. W.; Bipat, Shandra; Boellaard, Thierry N.; Nio, C. Yung; Stoker, Jaap

    2016-01-01

    We aim to evaluate the long-term performance of readers who had participated in previous magnetic resonance imaging (MRI) reader training in grading Crohn disease activity. Fourteen readers (8 women; 12 radiologists, 2 residents; mean age 40; range 31-59), who had participated in a previous MRI

  17. Effects of active and passive smoking on disease course of Crohn's disease and ulcerative colitis

    NARCIS (Netherlands)

    van der Heide, Frans; Dijkstra, Arie; Weersma, Rinse K.; Albersnagel, Frans A.; van der Logt, Elise M. J.; Faber, Kloos Nico; Sluiter, Wim J.; Kleibeuker, Jan H.; Dijkstra, Gerard

    Background: Smoking is a remarkable risk factor for inflammatory bowel disease (IBD). aggravating Crohn's disease (CD) while having beneficial effects On Ulcerative colitis (UC). We Studied the effects of active and passive smoking in Dutch IBD patients. Methods: A questionnaire focusing Oil

  18. Current trends and challenges in the postoperative medical management of Crohn's disease: A systematic review.

    Science.gov (United States)

    Schlussel, Andrew T; Cherng, Nicole B; Alavi, Karim

    2017-11-01

    Crohn's disease is an aggressive chronic inflammatory disorder, and despite medical advances no cure exists. There is a great risk of requiring an operative intervention, with evidence of recurrence developing in up to 80-90% of cases. Therefore, we sought to systematically review the current status in the postoperative medical management of Crohn's disease. A systematic literature review of medications administered following respective therapy for Crohn's disease was performed from 1979 through 2016. Twenty-six prospective articles provided directed guidelines for recommendations and these were graded based on the level of evidence. The postoperative management of Crohn's disease faces multiple challenges. Current indicated medications in this setting include: antibiotics, aminosalicylates, immunomodulators, and biologics. Each drug has inherent risks and benefits, and the optimal regimen is still unknown. Initiating therapy in a prophylactic fashion compared to endoscopic findings, or escalating therapy versus treating with the most potent drug first is debated. Although a definitive consensus on postoperative treatment is necessary, aggressive and early endoluminal surveillance is paramount in the treatment of these complicated patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Are NOD2 polymorphisms linked to a specific disease endophenotype of Crohn's disease?

    DEFF Research Database (Denmark)

    Jensen, Stina Rikke; Nielsen, Ole Haagen; Pedersen, Susanne Brix

    2011-01-01

    The complex and yet unknown etiology of Crohn's disease (CD) might consist of various disease endophenotypes, each of which represent their own pathogenesis. This review focuses on the disease endophenotype linked to polymorphisms in the nucleotide‐binding oligomerization domain containing 2 (NOD...

  20. European Crohn's and Colitis Organisation Topical Review on Treatment Withdrawal ('Exit Strategies') in Inflammatory Bowel Disease

    DEFF Research Database (Denmark)

    Doherty, Glen; Katsanos, Konstantinos H; Burisch, Johan

    2018-01-01

    Clinically effective therapies now exist for remission maintenance in both ulcerative colitis (UC) and Crohn's Disease (CD). For each major class of IBD medications (5-aminosalicyclates, immunomodulators and biologic agents), used alone or in combination, there is a risk of relapse following redu...

  1. Ex vivo intestinal adhesion of Escherichia coli LF82 in Crohn's disease

    DEFF Research Database (Denmark)

    Jensen, Stina Rikke; Fink, Lisbeth Nielsen; Nielsen, Ole Haagen

    2011-01-01

    Adherent-invasive Escherichia coli (AIEC) are reported to inhabit the gut mucosa in Crohn's disease (CD), however, little is known about the importance of host factors for the interplay between AIEC and the human gut. To examine if differences in bacterial adhesion patterns are disease associated...

  2. Single port laparoscopic ileocaecal resection for Crohn's disease: a multicentre comparison with multi-port laparoscopy

    NARCIS (Netherlands)

    Carvello, M.; de Groof, E. J.; de Buck van Overstraeten, A.; Sacchi, M.; Wolthuis, A. M.; Buskens, C. J.; D'Hoore, A.; Bemelman, W. A.; Spinelli, A.

    2018-01-01

    AimSingle port (SP) ileocaecal resection (ICR) is an established technique but there are no large studies comparing SP and multi-port (MP) laparoscopic surgery in Crohn's disease (CD). The aim of this study was to compare postoperative pain scores and analgesia requirements after SP and MP

  3. Long-Term Outcome of Early Combined Immunosuppression Versus Conventional Management in Newly Diagnosed Crohn's Disease

    NARCIS (Netherlands)

    Hoekman, Daniël R.; Stibbe, Judith A.; Baert, Filip J.; Caenepeel, Philip; Vergauwe, Philippe; de Vos, Martine; Hommes, Daniel W.; Benninga, Marc A.; Vermeire, Severine A.; D'Haens, Geert R.

    2018-01-01

    Long term outcomes of early combined immunosuppression (top-down) compared to conventional management (step-up) in recently diagnosed Crohn's disease (CD) are unknown. We aimed to investigate long-term outcomes of participants of the Step-up/Top-down-trial. Trial participants' medical records were

  4. Accuracy of abdominal ultrasound and MRI for detection of Crohn disease and ulcerative colitis in children

    NARCIS (Netherlands)

    Ziech, Manon L. W.; Hummel, Thalia Z.; Smets, Anne M. J. B.; Nievelstein, Rutger A. J.; Lavini, Cristina; Caan, Matthan W. A.; Nederveen, Aart J.; Roelofs, Joris J. T. H.; Bipat, Shandra; Benninga, Marc A.; Kindermann, Angelika; Stoker, Jaap

    2014-01-01

    Endoscopy is currently the primary diagnostic technique for inflammatory bowel disease (IBD) in children. To assess the accuracy of US and dynamic contrast-enhanced MRI for diagnosing inflammatory bowel disease and for distinguishing Crohn disease and ulcerative colitis in comparison to a reference

  5. Laparoscopic-assisted vs. open ileocolic resection for Crohn's disease. A comparative study

    NARCIS (Netherlands)

    Bemelman, W. A.; Slors, J. F.; Dunker, M. S.; van Hogezand, R. A.; van Deventer, S. J.; Ringers, J.; Griffioen, G.; Gouma, D. J.

    2000-01-01

    BACKGROUND: The objective of this study was to compare laparoscopic-assisted ileocolic resection for Crohn's disease of the distal ileum with open surgery in two consecutive groups of patients. METHODS: From 1995 until 1998, 48 patients underwent open ileocolic resection at the Academic Medical

  6. Laparoscopic-assisted versus open ileocolic resection for Crohn's disease: a randomized trial

    NARCIS (Netherlands)

    Maartense, Stefan; Dunker, Mich S.; Slors, J. Frederik M.; Cuesta, Miguel A.; Pierik, Erik G. J. M.; Gouma, Dirk J.; Hommes, Daan W.; Sprangers, Miriam A.; Bemelman, Willem A.

    2006-01-01

    OBJECTIVE: The aim of the study was to compare laparoscopic-assisted and open ileocolic resection for primary Crohn's disease in a randomized controlled trial. METHODS: Sixty patients were randomized for laparoscopic-assisted or open surgery. Primary outcome parameter was postoperative quality of

  7. Effect of tight control management on Crohn's disease (CALM): a multicentre, randomised, controlled phase 3 trial

    NARCIS (Netherlands)

    Colombel, Jean-Frederic; Panaccione, Remo; Bossuyt, Peter; Lukas, Milan; Baert, Filip; Vaňásek, Tomas; Danalioglu, Ahmet; Novacek, Gottfried; Armuzzi, Alessandro; Hébuterne, Xavier; Travis, Simon; Danese, Silvio; Reinisch, Walter; Sandborn, William J.; Rutgeerts, Paul; Hommes, Daniel; Schreiber, Stefan; Neimark, Ezequiel; Huang, Bidan; Zhou, Qian; Mendez, Paloma; Petersson, Joel; Wallace, Kori; Robinson, Anne M.; Thakkar, Roopal B.; D'Haens, Geert

    2018-01-01

    Biomarkers of intestinal inflammation, such as faecal calprotectin and C-reactive protein, have been recommended for monitoring patients with Crohn's disease, but whether their use in treatment decisions improves outcomes is unknown. We aimed to compare endoscopic and clinical outcomes in patients

  8. Fasting plasma carotenoids concentrations in Crohn's and pancreatic cancer patients compared to control subjects.

    Science.gov (United States)

    Drai, J; Borel, P; Faure, H; Galabert, C; Le Moël, G; Laromiguière, M; Fayol, V

    2009-03-01

    Carotenoids are colored molecules that are widespread in the plant kingdom, but animals cannot synthesize them. Carotenes are long, apolar molecules which require fully functioning digestive processes to be absorbed properly. Hence they could be interesting markers of intestinal absorption and digestion. Indeed, only few tests are available to assess these processes and only the D-xylose tolerance test is routinely used. However D-xylose is a sugar that tests only the absorption of water-soluble compounds and it only tests duodenal absorption. In this study, we have evaluated carotenoids as markers of digestion and absorption. We compared fasting plasma carotenoids concentrations in 21 control subjects, 20 patients with Crohn's disease, and 18 patients with pancreatic cancer. Crohn's disease alters intestinal absorption while pancreatic cancer decreases pancreatic enzyme secretion thus impairing digestion. Results show that all carotenoids are significantly lower in Crohn's and cancer patients as compared to control subjects and the multifactorial analysis shows that this decrease is mostly independent of dietary intake. Interestingly, maldigestion as seen in pancreatic cancer more strongly influences plasma lutein and lycopene concentrations while malabsorption in Crohn's disease acts on other carotenoids. Thus carotenoids could be interesting alternatives for testing and following patients that are suspected of having malabsorption or maldigestion syndromes.

  9. Inadvertent yellow fever vaccination of a patient with Crohn's disease treated with infliximab and methotrexate

    DEFF Research Database (Denmark)

    Ekenberg, C.; Friis-Møller, N.; Ulstrup, Thomas

    2016-01-01

    We present a case of a 56-year-old woman with Crohn's disease, treated with methotrexate and infliximab, who inadvertently received yellow fever vaccination (YFV) prior to a journey to Tanzania. She was not previously vaccinated against YF. YFV contains live-attenuated virus, and is contraindicated...

  10. European Crohn's and Colitis Organisation Topical Review on environmental factors in IBD

    DEFF Research Database (Denmark)

    Maaser, Christian; Langholz, Ebbe; Gordon, Hannah

    2017-01-01

    This ECCO topical review of the European Crohn's and Colitis Organisation (ECCO) focuses on the role of environmental factors in respect to the development of IBD as well as the influence on the course of established IBD.The objective was to reach expert consensus to provide evidence-based guidan...

  11. Early combined immunosuppression for the management of Crohn's disease (REACT): a cluster randomised controlled trial

    NARCIS (Netherlands)

    Khanna, Reena; Bressler, Brian; Levesque, Barrett G.; Zou, Guangyong; Stitt, Larry W.; Greenberg, Gordon R.; Panaccione, Remo; Bitton, Alain; Paré, Pierre; Vermeire, Séverine; D'Haens, Geert; MacIntosh, Donald; Sandborn, William J.; Donner, Allan; Vandervoort, Margaret K.; Morris, Joan C.; Feagan, Brian G.; Anderson, Frank; Atkinson, Kenneth; Bacchus, Rahman; Berezny, Gary; Borthistle, Bruce; Buckley, Alan; Chiba, Naoki; Cockeram, Alan; Elkashab, Magdy; Fashir, Baroudi; Gray, James; Hemphill, Douglas; Hoare, Connie; Holland, Stephen; Hurowitz, Eric; Kaal, Nuri; Laflamme, Pierre; Borromee, Saint-Charles; Lau, Helena; McMullen, William; Memiche, Reshat; Menon, Krishna; Miller, D. Alexander; O'Hara, William; Oravec, Michael; Penner, Robert; Petrunia, Denis; Pluta, Henryk; Prabhu, Umesh; Prest, Marcia; Shaaban, Hani; Sheppard, Duane; Shulman, Scott

    2015-01-01

    Conventional management of Crohn's disease features incremental use of therapies. However, early combined immunosuppression (ECI), with a TNF antagonist and antimetabolite might be a more effective strategy. We compared the efficacy of ECI with that of conventional management for treatment of

  12. Infliximab Reduces Endoscopic, but Not Clinical, Recurrence of Crohn's Disease After Ileocolonic Resection

    NARCIS (Netherlands)

    Regueiro, Miguel; Feagan, Brian G.; Zou, Bin; Johanns, Jewel; Blank, Marion A.; Chevrier, Marc; Plevy, Scott; Popp, John; Cornillie, Freddy J.; Lukas, Milan; Danese, Silvio; Gionchetti, Paolo; Hanauer, Stephen B.; Reinisch, Walter; Sandborn, William J.; Sorrentino, Dario; Rutgeerts, Paul; Debinski, H.; Florin, T.; Hetzel, D.; Lawrance, I.; Radford-Smith, G.; Sloss, A.; Sorrentino, D.; Gassner, S.; Haas, T.; Reicht, G.; Reinisch, W.; Strasser, M.; Vogelsang, H.; Bossuyt, P.; Dewit, O.; D'Haens, G.; Franchimont, D.; Louis, E.; Vermeire, S.; Bernstein, C. N.; Bourdages, R.; Chiba, N.; Dhalla, S. S.; Feagan, B. G.; Fedorak, R. N.; Lachance, J. R.; Panaccione, R.; Ropeleski, M.; Singh Salh, B.; Lukas, M.; Colombel, J.-F.; Allez, M.; Desreumaux, P.; Dupas, J. L.; Grimaud, J.-C.; Hebuterne, X.; Laharie, D.; Lerebours, E.; Peyrin-Biroulet, L.; Reimund, J.-M.; Viennot, S.; Zerbib, F.; Antoni, C.; Atreya, R.; Baumgart, D. C.; Berg, C.; Boecker, U.; Bramkamp, G.; Bünning, C.; Ehehalt, R.; Howaldt, S.; Kucharzik, T.; Lamprecht, H. G.; Mudter, J.; Preiss, J. C.; Schreiber, S.; Seidler, U.; Altorjay, I.; Banai, J.; Lakatos, P. L.; Varga, M.; Vincze, A.; Avni-Biron, I.; Fishman, S.; Fraser, G. M.; Goldin, E.; Rachmilewitz, D.; Annese, V.; Ardizzone, S.; Biancone, L.; Bossa, F.; Danese, S.; Fries, W.; Gionchetti, P.; Maconi, G.; Terrosu, G.; Usai, P.; Gearry, R. B.; Hill, J.; Rowbotham, D. S.; Schultz, M.; Stubbs, R. S.; Wallace, D.; Walmsley, R. S.; Wyeth, J.; Malecka-Panas, E.; Paradowski, L.; Regula, J.; Beales, I. P.; Campbell, S.; Hawthorne, A. B.; Parkes, M.; Travis, S. P.; Achkar, J. P.; Behm, B. W.; Bickston, S. J.; Brown, K. J.; Chiorean, M. V.; DeVilliers, W. J. S.; Elliott, D. E.; Grunkmeier, D.; Hamilton, J. W.; Hanauer, S. B.; Hanson, J. S.; Hardi, R.; Helper, D. J.; Herfarth, H.; Higgins, P. D. R.; Holderman, W. H.; Kottoor, R.; Kreines, M. D.; Leman, B. I.; Li, X.; Loftus, E. V.; Noar, M.; Oikonomou, I.; Onken, J.; Peterson, K. A.; Phillips, R. P.; Randall, C. W.; Ricci, M.; Ritter, T.; Rubin, D. T.; Safdi, M.; Sandborn, W. J.; Sauberman, L.; Scherl, E.; Schwarz, R. P.; Sedghi, S.; Shafran, I.; Sninsky, C. A.; Stein, I.; Swoger, J.; Vecchio, J.; Weinberg, D. I.; Wruble, L. D.; Yajnik, V.; Younes, Z.

    2016-01-01

    BACKGROUND & AIMS: Most patients with Crohn's disease (CD) eventually require an intestinal resection. However, CD frequently recurs after resection. We performed a randomized trial to compare the ability of infliximab vs placebo to prevent CD recurrence. METHODS: We evaluated the efficacy of

  13. Limitations of fecal calprotectin at diagnosis in untreated pediatric Crohn's disease

    DEFF Research Database (Denmark)

    Shaoul, Ron; Sladek, Marlgozata; Turner, Dan

    2012-01-01

    Fecal Calprotectin (FC) is a validated screening test for intestinal inflammation in Crohn's disease (CD). The objective of the study was to prospectively evaluate the limitations of FC for identifying CD in newly diagnosed untreated pediatric patients and to assess the association of FC levels w...

  14. DMBT1 confers mucosal protection in vivo and a deletion variant is associated with Crohn's disease

    DEFF Research Database (Denmark)

    Renner, Marcus; Bergmann, Gaby; Krebs, Inge

    2007-01-01

    BACKGROUND & AIMS: Impaired mucosal defense plays an important role in the pathogenesis of Crohn's disease (CD), one of the main subtypes of inflammatory bowel disease (IBD). Deleted in malignant brain tumors 1 (DMBT1) is a secreted scavenger receptor cysteine-rich protein with predominant expres...

  15. Detection of longitudinal ulcer using roughness value for computer aided diagnosis of Crohn's disease

    Science.gov (United States)

    Oda, Masahiro; Kitasaka, Takayuki; Furukawa, Kazuhiro; Watanabe, Osamu; Ando, Takafumi; Goto, Hidemi; Mori, Kensaku

    2011-03-01

    The purpose of this paper is to present a new method to detect ulcers, which is one of the symptoms of Crohn's disease, from CT images. Crohn's disease is an inflammatory disease of the digestive tract. Crohn's disease commonly affects the small intestine. An optical or a capsule endoscope is used for small intestine examinations. However, these endoscopes cannot pass through intestinal stenosis parts in some cases. A CT image based diagnosis allows a physician to observe whole intestine even if intestinal stenosis exists. However, because of the complicated shape of the small and large intestines, understanding of shapes of the intestines and lesion positions are difficult in the CT image based diagnosis. Computer-aided diagnosis system for Crohn's disease having automated lesion detection is required for efficient diagnosis. We propose an automated method to detect ulcers from CT images. Longitudinal ulcers make rough surface of the small and large intestinal wall. The rough surface consists of combination of convex and concave parts on the intestinal wall. We detect convex and concave parts on the intestinal wall by a blob and an inverse-blob structure enhancement filters. A lot of convex and concave parts concentrate on roughed parts. We introduce a roughness value to differentiate convex and concave parts concentrated on the roughed parts from the other on the intestinal wall. The roughness value effectively reduces false positives of ulcer detection. Experimental results showed that the proposed method can detect convex and concave parts on the ulcers.

  16. Contribution of rs11465788 in IL23R gene to Crohn's disease ...

    Indian Academy of Sciences (India)

    Given that the susceptibility loci in IL23R for Crohn's disease (CD) is present in. Western population and not in Asian population; we screened the IL23R gene by DNA sequencing to identify susceptibility loci in a selected CD cohort and confirmed it in all our subjects (134 CD and 131 controls). A novel nonsynonymous SNP.

  17. Surgical management in enterovesical fistula in Crohn disease at a single medical center.

    Science.gov (United States)

    Su, Yann-Rong; Shih, I-Lun; Tai, Huai-Ching; Wei, Shu-Chen; Lin, Been-Ren; Yu, Hong-Jeng; Huang, Chao-Yuan

    2014-01-01

    Crohn disease is a chronic, transmural, inflammatory disease of the gastrointestinal tract with unknown etiology. It can affect any part of the gastrointestinal tract and may cause fistula, stricture, or abscess formation with disease progression. The preoperative diagnosis and definite management of this rare complication are challenges for physicians, urologists, and surgeons.

  18. Intestinal fibrosis is associated with lack of response to Infliximab therapy in Crohn's disease.

    Science.gov (United States)

    de Bruyn, Jessica R; Becker, Marte A; Steenkamer, Jessica; Wildenberg, Manon E; Meijer, Sybren L; Buskens, Christianne J; Bemelman, Willem A; Löwenberg, Mark; Ponsioen, Cyriel Y; van den Brink, Gijs R; D'Haens, Geert R

    2018-01-01

    Overt fibrostenotic disease is a relative contraindication for anti-TNF therapy in Crohn's disease. We hypothesized that subclinical fibrosis may also contribute to an incomplete response to anti-TNF therapy before the onset of symptomatic stenosis. In a previous trial, patients with ileocecal Crohn's disease were randomized to either immediate ileocecal resection or medical treatment with Infliximab. In case of insufficient response to Infliximab, the latter underwent secondary ileocecal resection. We compared specimens from those patients undergoing immediate resection (Infliximab naïve, n = 20) to those who failed Infliximab therapy (n = 20). Infliximab naïve and Infliximab failure patients had similar severity of inflammation when assessed by CRP levels (median 14 vs 9 mg/L) and histology (Geboes-D'Haens-score, median 10 vs 11 points). On immunohistochemistry, collagen-III and fibronectin depositions were increased in patients previously exposed to Infliximab compared to patients naïve to Infliximab. On mRNA level, procollagen peptidase showed significantly more mucosal mRNA expression in Crohn's disease patients who failed Infliximab. Infliximab responders showed no increase of this marker after 4 weeks of successful Infliximab treatment. Failure to Infliximab therapy is associated with subclinical fibrosis in Crohn's disease.

  19. The duration of effect of infliximab maintenance treatment in paediatric Crohn's disease is limited

    NARCIS (Netherlands)

    de Bie, C. I.; Kindermann, A.; Kokke, F. T. M.; Damen, G. M.; Kneepkens, C. M. F.; van Rheenen, P. F.; Schweizer, J. J.; Hoekstra, J. H.; Norbruis, O. F.; Ten, W. E. Tjon A.; Vreugdenhil, A. C.; Deckers-Kocken, J. M.; Gijsbers, C. F. M.; Escher, J. C.; de Ridder, L.; Hummel, T.

    2011-01-01

    P>Background Infliximab is effective for induction and maintenance of remission in children with moderately to severely active Crohn's disease (CD). Aim To evaluate the long-term efficacy of infliximab treatment in paediatric CD. Methods In this observational, multicentre study, all paediatric CD

  20. Infliximab dependency in pediatric Crohn's disease : Long-term follow-up of an unselected cohort

    NARCIS (Netherlands)

    de Ridder, Lissy; Rings, Edmond H. H. M.; Damen, Gerard M.; Kneepkens, C. M. Frank; Schweizer, Joachim J.; Kokke, Freddy T. M.; Benninga, Marc A.; Norbruis, Obbe F.; Hoekstra, J. Hans; Gijsbers, Carolien F. M.; Escher, Johanna C.

    Background: Infliximab is effective for induction and maintenance of remission in Crohn's disease. It is unknown how long patients should be kept on infliximab therapy. The primary aim of this study was to assess duration of effective maintenance therapy and infliximab dependency in pediatric CD

  1. Intestinal fibrosis is associated with lack of response to Infliximab therapy in Crohn's disease

    NARCIS (Netherlands)

    de Bruyn, Jessica R.; Becker, Marte A.; Steenkamer, Jessica; Wildenberg, Manon E.; Meijer, Sybren L.; Buskens, Christianne J.; Bemelman, Willem A.; Löwenberg, Mark; Ponsioen, Cyriel Y.; van den Brink, Gijs R.; D'Haens, Geert R.

    2018-01-01

    Overt fibrostenotic disease is a relative contraindication for anti-TNF therapy in Crohn's disease. We hypothesized that subclinical fibrosis may also contribute to an incomplete response to anti-TNF therapy before the onset of symptomatic stenosis. In a previous trial, patients with ileocecal

  2. Infliximab dependency in pediatric Crohn's disease: Long-term follow-up of an unselected cohort

    NARCIS (Netherlands)

    L. de Ridder (Lissy); E.H.H.M. Rings (Edmond); G.M. Damen (Gerard); C.M.F. Kneepkens (Frank); J. Schweizer; F.T.M. Kokke (Freddy); M.A. Benninga (Marc); O.F. Norbruis (Obbe); J.H. Hoekstra (Hans); C.F.M. Gijsbers (Carolien); J.C. Escher (Johanna)

    2008-01-01

    textabstractBackground: Infliximab is effective for induction and maintenance of remission in Crohn's disease. It is unknown how long patients should be kept on infliximab therapy. The primary aim of this study was to assess duration of effective maintenance therapy and infliximab dependency in

  3. Infliximab dependency in pediatric Crohn's disease: long-term follow-up of an unselected cohort

    NARCIS (Netherlands)

    de Ridder, Lissy; Rings, Edmond H. H. M.; Damen, Gerard M.; Kneepkens, C. M. Frank; Schweizer, Joachim J.; Kokke, Freddy T. M.; Benninga, Marc A.; Norbruis, Obbe F.; Hoekstra, J. Hans; Gijsbers, Carolien F. M.; Escher, Johanna C.

    2008-01-01

    BACKGROUND: Infliximab is effective for induction and maintenance of remission in Crohn's disease. It is unknown how long patients should be kept on infliximab therapy. The primary aim of this study was to assess duration of effective maintenance therapy and infliximab dependency in pediatric CD

  4. Infliximab and adalimumab drug levels in Crohn's disease: contrasting associations with disease activity and influencing factors.

    Science.gov (United States)

    Ward, M G; Warner, B; Unsworth, N; Chuah, S-W; Brownclarke, C; Shieh, S; Parkes, M; Sanderson, J D; Arkir, Z; Reynolds, J; Gibson, P R; Irving, P M

    2017-07-01

    Discriminative drug level thresholds for disease activity endpoints in patients with Crohn's disease. have been consistently demonstrated with infliximab, but not adalimumab. To identify threshold concentrations for infliximab and adalimumab in Crohn's disease according to different disease endpoints, and factors that influence drug levels. We performed a cross-sectional service evaluation of patients receiving maintenance infliximab or adalimumab for Crohn's disease. Serum drug levels were at trough for infliximab and at any time point for adalimumab. Endpoints included Harvey-Bradshaw index, C-reactive protein and faecal calprotectin. 6-tioguanine nucleotide (TGN) concentrations were measured in patients treated with thiopurines. A total of 191 patients (96 infliximab, 95 adalimumab) were included. Differences in infliximab levels were observed for clinical (P=.081) and biochemical remission (P=.003) and faecal calprotectin normalisation (Pinfliximab dose, body mass index and colonic disease independently accounted for 31% of the variation in infliximab levels, and weekly dosing, albumin and weight accounted for 23% of variation in adalimumab levels. TGN levels did not correlate with drug levels. Infliximab drug levels are associated with the depth of response/remission in patients with Crohn's disease, but no such relationship was observed for adalimumab. More data are needed to explain the variation in drug levels. © 2017 John Wiley & Sons Ltd.

  5. Effects of infliximab retreatment after consecutive discontinuation of infliximab and adalimumab in refractory Crohn's disease

    NARCIS (Netherlands)

    Brandse, Johannan F.; Peters, Charlotte P.; Gecse, Krisztina B.; Eshuis, Emma J.; Jansen, Jeroen M.; Tuynman, Hans A.; Löwenberg, Mark; Ponsioen, Cyriel Y.; van den Brink, Gijs R.; Dʼhaens, Geert R.

    2014-01-01

    Switches between anti-tumor necrosis factor agents in the treatment of Crohn's disease (CD) occur in case of treatment failure, intolerance, or patient preference. No data are currently available on the usefulness of a second infliximab treatment after earlier discontinuation and previous switch to

  6. Infliximab dependency in pediatric Crohn's disease: long-term follow-up of an unselected cohort.

    NARCIS (Netherlands)

    Ridder, L.; Rings, E.H.; Damen, G.M.; Kneepkens, C.M.; Schweizer, J.J.; Kokke, F.T.; Benninga, M.A.; Norbruis, O.F.; Hoekstra, J.H.; Gijsbers, C.F.M.; Escher, J.C.

    2008-01-01

    BACKGROUND: Infliximab is effective for induction and maintenance of remission in Crohn's disease. It is unknown how long patients should be kept on infliximab therapy. The primary aim of this study was to assess duration of effective maintenance therapy and infliximab dependency in pediatric CD

  7. Treatment preferences of patients with Crohn's disease: development of the IMPLICA questionnaire

    Directory of Open Access Journals (Sweden)

    Natalia Borruel

    2014-06-01

    Full Text Available Introduction and objective: Patient preferences with respect to available therapies must be taken into account if the quality of care of patients with Crohn's disease is to be improved. The objective was to develop the IMPLICA preferences questionnaire for Crohn's disease patients treated with biological therapies. Methods: As per standard methodology, the questionnaire was developed in Spanish language, in five stages: 1. Literature review to identify attributes related to biological therapies in Crohn's disease; 2. Expert meeting to identify attributes most relevant for patients; 3. Scoring of the most relevant attributes and generation of scenarios; 4. Patient comprehension test for selection and validation of scenarios; and 5. Final list of scenarios and qualitative evaluation of those most accepted by patients. Results: Three attributes related to various characteristics of biological treatments were selected: route of administration, place/duration of administration and person administering the treatment; a combination of them produced seven possible scenarios. The comprehension test gave rise to significant modifications in the instructions, text of the scenarios and response categories. Conclusion: IMPLICA is the first questionnaire to evaluate treatment preferences of Crohn's disease patients receiving biological therapies. This questionnaire facilitates patient's selection of the most appropriate real world treatment option and, therefore, it can be considered a useful tool when deciding the most appropriate and feasible treatment in normal clinical practice.

  8. Influence of smoking on colonic gene expression profile in Crohn's disease

    DEFF Research Database (Denmark)

    Nielsen, Ole Haagen; Bjerrum, Jacob Tveiten; Csillag, Claudio

    2009-01-01

    BACKGROUND: The development and course of Crohn's disease (CD) is related to both genetic and environmental factors. Smoking has been found to exacerbate the course of CD by increasing the risk of developing fistulas and strictures as well as the need for surgery, possibly because of an interaction...

  9. The incidence of Crohn's disease and ulcerative colitis since 1995 in Danish children and adolescents

    DEFF Research Database (Denmark)

    Larsen, Michael Due; Eggebrecht Baldal, Mira; Nielsen, Rasmus Gaardskær

    2016-01-01

    OBJECTIVE: Worldwide the incidence of pediatric Crohn's disease (CD) and ulcerative colitis (UC) is suspected to be increasing. Based on unselected nationwide register data the aim of this study is to examine the change in incidence of CD and UC in children and adolescents in Denmark. MATERIALS...

  10. Fecal calprotectin is equally sensitive in Crohn's disease affecting the small bowel and colon

    DEFF Research Database (Denmark)

    Jensen, Michael Dam; Kjeldsen, Jens; Nathan, Torben

    2011-01-01

    The utility of fecal calprotectin (fCal) in small bowel Crohn's disease (CD) remains to be clarified. The primary aim of this study was to determine levels of fCal in CD restricted to the small bowel compared with CD affecting the colon, in patients undergoing their first diagnostic work...

  11. Model for Postgraduate Medical Education: Study of Crohn's Disease in New Mexico

    Science.gov (United States)

    Gregory, Daniel H.; And Others

    1974-01-01

    The purpose of this study is to introduce a model system for the continuous retrieval, storage, and dissemination of relevant clinical information that has proven to be an effective resource of real-life data. Patients with Crohn's disease from a geographic area served as the population base for 2 groups of physicians, one group practicing in the…

  12. Inter-observer agreement for detection of small bowel Crohn's disease with capsule endoscopy

    DEFF Research Database (Denmark)

    Jensen, Michael Dam; Nathan, Torben; Kjeldsen, Jens

    2010-01-01

    OBJECTIVE: Compared to other modalities, capsule endoscopy (CE) has a high diagnostic yield for diagnosing small bowel Crohn's disease (CD). The aim of this study was to determine the inter-observer agreement for detection of small bowel CD with predefined diagnostic criteria. MATERIAL AND METHODS...

  13. X-ray determination of the reoccurrence of Crohn's disease in patients with anastomosis

    International Nuclear Information System (INIS)

    Kulke, H.; Hoerl, M.; Wilhelm, T.; Wuerzburg Univ.

    1987-01-01

    Of 322 patients receiving operations for Crohn's disease, 52 were determined by the use of GI series with small bowel follow through, barium enema, and fistulography to have reoccurence. The patients had received different operation procedures, including atypical ones. Reoccurences were primarily found in the previous anastomosis region. (orig.) [de

  14. Use of the star sign to diagnose internal fistulas in pediatric patients with penetrating Crohn disease by MR enterography

    Energy Technology Data Exchange (ETDEWEB)

    Braithwaite, Kiery A.; Alazraki, Adina L. [Emory University, Department of Radiology and Imaging Sciences, Children' s Healthcare of Atlanta, Atlanta, GA (United States)

    2014-08-15

    Development of internal fistula due to extramural spread of inflammatory bowel disease is a characteristic feature of penetrating disease in patients with Crohn disease. The ''star sign'' is a radiological finding of internal fistula that has previously been described in the gastroenterology literature in adult Crohn disease patients undergoing MR enteroclysis. The goal of this paper is to review the clinical and imaging features of penetrating disease in pediatric Crohn disease patients, highlighting the star sign as a useful diagnostic tool for diagnosing internal fistula in children by MR enterography. The recognition of penetrating complications by MR imaging can have important therapeutic and prognostic implications. (orig.)

  15. Quality of life study in a regional group of patients with Crohn disease. A structured interview study

    DEFF Research Database (Denmark)

    Guassora, A D; Kruuse, Christina; Thomsen, O O

    2000-01-01

    of 100 consecutive out-patients with Crohn disease, 94 patients accepted to participate together with 94 age- and sex-matched healthy controls. A modified McMaster Inflammatory Bowel Disease Questionnaire (IBDQ23) was used, excluding bowel-related questions. Medical students conducted interviews without...... knowing who were Crohn disease patients and who were controls. The bowel-related questions and Crohn's Disease Activity Index (CDAI) were assessed by gastroenterologists at inclusion in the study. Responses were indicated on a seven-point scale (7 best/1 worst). Mean numeric score was calculated as well...

  16. Use of the star sign to diagnose internal fistulas in pediatric patients with penetrating Crohn disease by MR enterography

    International Nuclear Information System (INIS)

    Braithwaite, Kiery A.; Alazraki, Adina L.

    2014-01-01

    Development of internal fistula due to extramural spread of inflammatory bowel disease is a characteristic feature of penetrating disease in patients with Crohn disease. The ''star sign'' is a radiological finding of internal fistula that has previously been described in the gastroenterology literature in adult Crohn disease patients undergoing MR enteroclysis. The goal of this paper is to review the clinical and imaging features of penetrating disease in pediatric Crohn disease patients, highlighting the star sign as a useful diagnostic tool for diagnosing internal fistula in children by MR enterography. The recognition of penetrating complications by MR imaging can have important therapeutic and prognostic implications. (orig.)

  17. 14C-oxalic acid resorption in patients with small bowel resection, jejunoileal bypass, Crohn's disease, and chronic pancreatitis

    International Nuclear Information System (INIS)

    Moeller, T.; Mueller, G.; Schuette, W.; Rogos, R.; Schneider, W.

    1987-01-01

    The enteric absorption of oxalic acid was determined with 14 C-oxalic acid in patients with small bowel resection, jejunoileal bypass, Crohn's disease and chronic pancreatitis in comparison to the control group. Extreme hyperoxaluria was found in small bowel resections above 100 cm, after bypass operations and in ileocolitis Crohn with signs of clinical activity. Small bowel resections and relapses of Crohn's disease increase the absorption of oxalic acid. The significance of 14 C-oxalic acid absorption test is the recognition of enteric hyperoxaluria. (author)

  18. Anti-TNF therapy induced immune neutropenia in Crohns disease- report of 2 cases and review of literature.

    Science.gov (United States)

    Sebastian, Shaji; Ashton, Katherine; Houston, Yasmine; Diggory, Tina Mary; Dore, Philip

    2012-07-01

    Transient neutropenia is reported in some patients on biologic therapy. We report two cases of severe neutropenia in patients with Crohn`s disease following treatment with anti-TNF therapy. In both cases neutrophil specific granulocyte autoantibodies were detected during period of neutropenia and disappeared on cessation of anti-TNF therapy. These may indicate that anti-TNF agents may produce autoimmune agranulocytosis by triggering production granulocyte autoantibodies. The long term management strategy for patients with anti-TNF therapy induced autoimmune neutropenia is uncertain. Copyright © 2012 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

  19. 5-aminosalicylsyre til induktion af remission eller respons ved Crohns sygdom--en gennemgang af et Cochranereview

    DEFF Research Database (Denmark)

    Bjerrum, Jacob Tveiten; Munck, Lars Kristian; Nielsen, Ole Haagen

    2011-01-01

    A systematic review to evaluate the efficacy of 5-aminosalicylates for induction of remission or clinical response in patients with mild to moderately active Crohn's disease is described. The effect of either high (3 to 4.5 g/day) or low dose (1 to 2 g/day) 5-aminosalicylic acid was similar...... to that of placebo. Overall, sulfasalazine was not superior to placebo and was inferior to glucocorticoids for the treatment of mild to moderately active Crohn's disease. Neither published nor unpublished data support any use of 5-aminosalicylates for the treatment of Crohn's disease....

  20. Dynamic contrast-enhanced MRI in patients with luminal Crohn's disease

    International Nuclear Information System (INIS)

    Ziech, M.L.W.; Lavini, C.; Caan, M.W.A.; Nio, C.Y.; Stokkers, P.C.F.; Bipat, S.; Ponsioen, C.Y.; Nederveen, A.J.; Stoker, J.

    2012-01-01

    Objectives: To prospectively assess dynamic contrast-enhanced (DCE-)MRI as compared to conventional sequences in patients with luminal Crohn's disease. Methods: Patients with Crohn's disease undergoing MRI and ileocolonoscopy within 1 month had DCE-MRI (3T) during intravenous contrast injection of gadobutrol, single shot fast spin echo sequence and 3D T1-weighted spoiled gradient echo sequence, a dynamic coronal 3D T1-weighted fast spoiled gradient were performed before and after gadobutrol. Maximum enhancement (ME) and initial slope of increase (ISI) were calculated for four colon segments (ascending colon + coecum, transverse colon, descending colon + sigmoid, rectum) and (neo)terminal ileum. C-reactive protein (CRP), Crohn's disease activity index (CDAI), per patient and per segment Crohn's disease endoscopic index of severity (CDEIS) and disease duration were determined. Mean values of the (DCE-)MRI parameters in each segment from each patient were compared between four disease activity groups (normal mucosa, non-ulcerative lesions, mild ulcerative and severe ulcerative disease) with Mann–Whitney test with Bonferroni adjustment. Spearman correlation coefficients were calculated for continuous variables. Results: Thirty-three patients were included (mean age 37 years; 23 females, median CDEIS 4.4). ME and ISI correlated weakly with segmental CDEIS (r = 0.485 and r = 0.206) and ME per patient correlated moderately with CDEIS (r = 0.551). ME was significantly higher in segments with mild (0.378) or severe (0.388) ulcerative disease compared to normal mucosa (0.304) (p < 0.001). No ulcerations were identified at conventional sequences. ME correlated with disease duration in diseased segments (r = 0.492), not with CDAI and CRP. Conclusions: DCE-MRI can be used as a method for detecting Crohn's disease ulcerative lesions.

  1. Intestinal lesions in pediatric Crohn disease: comparative detectability among pulse sequences at MR enterography

    Energy Technology Data Exchange (ETDEWEB)

    Sohn, Beomseok; Kim, Myung-Joon; Lee, Mi-Jung [Severance Children' s Hospital, Yonsei University, College of Medicine, Department of Radiology and Research Institute of Radiological Science, Seoul (Korea, Republic of); Koh, Hong [Severance Children' s Hospital, Department of Pediatrics, Seoul (Korea, Republic of); Han, Kyung Hwa [Yonsei University, College of Medicine, Biostatistics Collaboration Unit, Seoul (Korea, Republic of)

    2014-07-15

    Variable sequences can be used in MR enterography, and no consensus exists for the best protocol in children with Crohn disease. To compare the lesion detectability of various MR enterography sequences and to correlate the findings of these sequences with the Pediatric Crohn's Disease Activity Index (PCDAI) in children with Crohn disease. Children with clinically or pathologically confirmed Crohn disease underwent MR enterography, including a single-shot fast spin-echo (SSFSE) sequence, motility imaging (coronal 2-D balanced fast field echo), diffusion-weighted imaging (DWI), and dynamic contrast enhancement imaging (including arterial, portal and delayed phases). The lesion detectability of each sequence was graded 0-2 for each involved bowel segment. The lesion detectability and PCDAI result on different sequences were compared using the weighted least squares method and Student's t-test, respectively. Fifteen children (11 boys, 4 girls, mean age 13.7 ± 1.4 years) with a total of 41 lesions were included in this study. All lesions detected in more than two sequences were visible on the single-shot fast spin-echo (SSFSE) sequence. The relative lesion detection rate was 78.1% on motility imaging, 90.2% on DWI, and 92.7% on arterial, 95.1% on portal and 95.1% on delayed phase imaging. Compared to the SSFSE sequence, motility imaging (P < 0.001) and DWI (P = 0.039) demonstrated lower detectability. The mean PCDAI result in the detected lesions was statistically higher only on dynamic enhancement imaging (P < 0.001). All MR enterography sequences were found to have relatively high lesion detectability in children with Crohn disease, while motility imaging showed the lowest lesion detectability. Lesions detected on dynamic enhancement imaging showed a higher PCDAI result, which suggests that this sequence is specific for active inflammation. (orig.)

  2. Risedronate improves bone mineral density in Crohn's disease: a two year randomized controlled clinical trial.

    Science.gov (United States)

    Soo, Isaac; Siffledeen, Jesse; Siminoski, Kerry; McQueen, Bob; Fedorak, Richard N

    2012-08-01

    Patients with Crohn's disease have an increased frequency of osteopenia and osteoporosis. This randomized, controlled, double-blind study assessed the efficacy of risedronate versus placebo in treating low bone mineral density (BMD) in patients with Crohn's disease. 88 Crohn's disease outpatients with BMD T-score<-1.0 by dual-energy X-ray absorptiometry were randomly assigned to one of two treatment groups for the two year study duration: one group received risedronate 35 mg weekly while another received placebo. Both groups received daily calcium (Ca; 500 mg) and vitamin D (D; 400 IU) supplementation. Percent change in BMD relative to baseline was compared between the two therapies at 12 and 24 months. Using intent-to-treat analysis, at 12 months, risedronate+Ca+D increased BMD, relative to baseline, more than placebo+Ca+D in the femoral trochanter (1.4±3.4% vs -0.1±3.1%; p=0.03) and total hip (1.1±2.7% vs -0.1±2.5%;p=0.04). This trend in greater BMD continued for the 24 month duration of the study. There was no difference between the two treatment groups for changes in spine BMD. Subgroup analysis revealed that risedronate+Ca+D resulted in significantly better improvement in femoral trochanter BMD in non-smokers (p=0.01), males (p=0.01), those with a history of corticosteroid use in the preceding year (p=0.01), and current users of immunosuppressants (p=0.04). Risedronate, in addition to daily calcium and vitamin D supplementation, is superior to calcium and vitamin D alone in improving femoral trochanter and total hip BMD in patients with Crohn's disease. Copyright © 2012 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

  3. Chronic illness and family: impact of schizophrenia and Crohn's disease on the family quality of life.

    Science.gov (United States)

    Loga, Slobodan; Sošić, Bojan; Kulenović, Alma Džubur; Svraka, Emira; Bosankić, Nina; Kučukalić, Abdulah; Cemalović, Omer; Hadžić, Alma

    2012-12-01

    Quality of life assessments are increasingly present in health research. Chronic and progressive illness of a family member unavoidably affects quality of life of a family as a whole. The goals of this study were to gain insight into the family burden of chronic disorders, especially possible differences in family quality of life (FQOL) in families that have members suffering from either schizophrenia or Crohn's disease, and families in which none of the members have chronic somatic or mental illness, as well as to pilot an instrument for this purpose. The sample consisted of 53 families with a member suffering from schizophrenia, 50 families with a member suffering from Crohn's disease, and 45 families with no identifiable chronic illnesses. An informant from each family underwent a structured face to face interview, using a questionnaire specially adapted from Family Quality of Life Survey, an instrument widely used to assess FQOL in families with members with disabilities, and which addresses nine areas of family life. In the domain of health, both groups of families with chronic illnesses believe they have significantly different conditions when compared to members of the Control group. In the Crohn's disease group, families had a great deal more of challenges in accessing healthcare services; and see themselves at a disadvantage when compared to both other groups in the domain of finances. Control group offered lowest rating in the domain of support from others. Overall measures of FQOL show significant variation among the three groups, Crohn's disease group offering lowest ratings, followed by families of mental health service users. Overall, FQOL seems to be lower in families that have members diagnosed with Crohn's disease than in families with members suffering from schizophrenia. Illness-specific studies are required, as well as instruments with stronger psychometric properties and studies of determinants of FQOL. Qualitative approach should be emphasised

  4. Intestinal lesions in pediatric Crohn disease: comparative detectability among pulse sequences at MR enterography

    International Nuclear Information System (INIS)

    Sohn, Beomseok; Kim, Myung-Joon; Lee, Mi-Jung; Koh, Hong; Han, Kyung Hwa

    2014-01-01

    Variable sequences can be used in MR enterography, and no consensus exists for the best protocol in children with Crohn disease. To compare the lesion detectability of various MR enterography sequences and to correlate the findings of these sequences with the Pediatric Crohn's Disease Activity Index (PCDAI) in children with Crohn disease. Children with clinically or pathologically confirmed Crohn disease underwent MR enterography, including a single-shot fast spin-echo (SSFSE) sequence, motility imaging (coronal 2-D balanced fast field echo), diffusion-weighted imaging (DWI), and dynamic contrast enhancement imaging (including arterial, portal and delayed phases). The lesion detectability of each sequence was graded 0-2 for each involved bowel segment. The lesion detectability and PCDAI result on different sequences were compared using the weighted least squares method and Student's t-test, respectively. Fifteen children (11 boys, 4 girls, mean age 13.7 ± 1.4 years) with a total of 41 lesions were included in this study. All lesions detected in more than two sequences were visible on the single-shot fast spin-echo (SSFSE) sequence. The relative lesion detection rate was 78.1% on motility imaging, 90.2% on DWI, and 92.7% on arterial, 95.1% on portal and 95.1% on delayed phase imaging. Compared to the SSFSE sequence, motility imaging (P < 0.001) and DWI (P = 0.039) demonstrated lower detectability. The mean PCDAI result in the detected lesions was statistically higher only on dynamic enhancement imaging (P < 0.001). All MR enterography sequences were found to have relatively high lesion detectability in children with Crohn disease, while motility imaging showed the lowest lesion detectability. Lesions detected on dynamic enhancement imaging showed a higher PCDAI result, which suggests that this sequence is specific for active inflammation. (orig.)

  5. Microbial Population Differentials between Mucosal and Submucosal Intestinal Tissues in Advanced Crohn's Disease of the Ileum.

    Directory of Open Access Journals (Sweden)

    Rodrick J Chiodini

    Full Text Available Since Crohn's disease is a transmural disease, we hypothesized that examination of deep submucosal tissues directly involved in the inflammatory disease process may provide unique insights into bacterial populations transgressing intestinal barriers and bacterial populations more representative of the causes and agents of the disease. We performed deep 16s microbiota sequencing on isolated ilea mucosal and submucosal tissues on 20 patients with Crohn's disease and 15 non-inflammatory bowel disease controls with a depth of coverage averaging 81,500 sequences in each of the 70 DNA samples yielding an overall resolution down to 0.0001% of the bacterial population. Of the 4,802,328 total sequences generated, 98.9% or 4,749,183 sequences aligned with the Kingdom Bacteria that clustered into 8545 unique sequences with <3% divergence or operational taxonomic units enabling the identification of 401 genera and 698 tentative bacterial species. There were significant differences in all taxonomic levels between the submucosal microbiota in Crohn's disease compared to controls, including organisms of the Order Desulfovibrionales that were present within the submucosal tissues of most Crohn's disease patients but absent in the control group. A variety of organisms of the Phylum Firmicutes were increased in the subjacent submucosa as compared to the parallel mucosal tissue including Ruminococcus spp., Oscillospira spp., Pseudobutyrivibrio spp., and Tumebacillus spp. In addition, Propionibacterium spp. and Cloacibacterium spp. were increased as well as large increases in Proteobacteria including Parasutterella spp. and Methylobacterium spp. This is the first study to examine the microbial populations within submucosal tissues of patients with Crohn's disease and to compare microbial communities found deep within the submucosal tissues with those present on mucosal surfaces. Our data demonstrate the existence of a distinct submucosal microbiome and ecosystem

  6. Compreendendo a vivência do paciente portador de doença de Crohn Comprendiendo la vivencia del paciente portador de enfermedad de Crohn Understanding the experience of patients who have Crohn's disease

    Directory of Open Access Journals (Sweden)

    Roberta Soares Sarlo

    2008-01-01

    Full Text Available OBJETIVO: Compreender o significado de ser portador da doença de Crohn. MÉTODOS: Estudo qualitativo, com abordagem Hermenêutica. Foram realizadas oito entrevistas com pacientes com diagnóstico confirmado da doença, tendo como questão norteadora "como é ser portador de doença de Crohn?" RESULTADOS: Foi identificada a seguinte categoria: Alteração no projeto de vida, a qual teve como principais fatores modificadores: ser doença crônica, alimentação, medo, falta de liberdade, prevenção de complicações e esperança. Os pacientes utilizam para isso algumas estratégias para superar as dificuldades e desenvolver habilidades próprias para seguir em frente. CONCLUSÃO: Tentar compreender a natureza humana e conhecer o ser e sentir da pessoa é uma construção que precisa ser melhorada nos cursos da área de saúde para que os profissionais possam dar o suporte necessário aos pacientes e oferecer uma assistência de enfermagem adequada.OBJETIVO: Comprender el significado de ser portador de la enfermedad de Crohn. MÉTODOS: Estudio cualitativo, con abordaje Hermenéutico. Fueron realizadas ocho entrevistas a pacientes con diagnóstico confirmado de la enfermedad, teniendo como pregunta norteadora "¿cómo es ser portador de la enfermedad de Crohn?" RESULTADOS: Fue identificada la siguiente categoría: Alteración en el proyecto de vida, la cual tuvo como principales factores modificadores: ser enfermedad crónica, alimentación, miedo, falta de libertad, prevención de complicaciones y esperanza. Los pacientes utilizan para eso algunas estrategias para superar las dificultades y desarrollar habilidades propias para seguir adelante. CONCLUSIÓN: Intentar comprender la naturaleza humana y conocer el ser y sentir de la persona es una construcción que precisa ser mejorada en los cursos del área de la salud para que los profesionales puedan dar el soporte necesario a los pacientes y ofrecer una asistencia de enfermería adecuada

  7. Diagnostic accuracy of capsule endoscopy for small bowel Crohn's disease is superior to that of MR enterography or CT enterography

    DEFF Research Database (Denmark)

    Jensen, Michael Dam; Nathan, Torben; Rafaelsen, Søren Rafael

    2011-01-01

    Capsule endoscopy (CE) detects small bowel Crohn's disease with greater diagnostic yield than radiologic procedures, although there are concerns that CE has low specificity. We compared the sensitivity and specificity of CE, magnetic resonance imaging enterography (MRE) and computed tomography...

  8. Crohn´s disease: a role of gut microbiota and Nod2 gene polymorphisms in disease pathogenesis

    Czech Academy of Sciences Publication Activity Database

    Hrnčířová, Lucia; Krejsek, J.; Šplíchal, Igor; Hrnčíř, Tomáš

    2014-01-01

    Roč. 57, č. 3 (2014), s. 89-96 ISSN 1211-4286 Grant - others:Universita Karlova(CZ) 37/10/906613 Institutional support: RVO:61388971 Keywords : gut * microbiota * Crohn disease Subject RIV: EC - Immunology

  9. Biologic treatment or immunomodulation is not associated with postoperative anastomotic complications in abdominal surgery for Crohn's disease

    DEFF Research Database (Denmark)

    El-Hussuna, A.; Andersen, J.; Bisgaard, T.

    2012-01-01

    Objectives: There are concerns that biologic treatments or immunomodulation may negatively influence anastomotic healing. This study investigates the relationship between these treatments and anastomotic complications after surgery for Crohn's disease. Patients and methods. Retrospective study...

  10. Paraparesis in a patient with Crohn disease resulting from septic arthritis of the hip and psoas abscess.

    Science.gov (United States)

    Femminineo, A F; LaBan, M M

    1988-03-01

    A psoas abscess is a recognized complication of Crohn disease. Less commonly, septic arthritis has been described with this entity. The occurrence of both these complications together in Crohn disease is quite rare. A 56-year-old patient with Crohn disease presented with weakness and pain in both lower extremities. Computerized body tomograms demonstrated a large psoas abscess with fistulous connections to the bowel as well as extending into the capsule of the left hip joint. X-ray examination revealed evidence of acute septic arthritis. Electromyographic studies demonstrated lumbosacral plexus involvement bilaterally. The patient subsequently underwent ileocolectomy with drainage of the left psoas abscess, followed by extensive inpatient rehabilitation. Some immediate strength improvement was noted bilaterally. At discharge, the patient remained paraparetic. In patients with known history of Crohn disease, a psoas abscess should be considered when there are symptoms of lower extremity pain, hip flexion contractures, and progressive weakness.

  11. Quality of life study in a regional group of patients with Crohn disease. A structured interview study

    DEFF Research Database (Denmark)

    Guassora, A D; Kruuse, Christina; Thomsen, O O

    2000-01-01

    BACKGROUND: The course and prognosis of Crohn disease has previously been described in a regional group of patients in Copenhagen County. The aim of the present study was to reveal the quality of life. as judged by the patients, and compared to age- and sex-matched healthy controls. METHODS: Out...... of 100 consecutive out-patients with Crohn disease, 94 patients accepted to participate together with 94 age- and sex-matched healthy controls. A modified McMaster Inflammatory Bowel Disease Questionnaire (IBDQ23) was used, excluding bowel-related questions. Medical students conducted interviews without...... knowing who were Crohn disease patients and who were controls. The bowel-related questions and Crohn's Disease Activity Index (CDAI) were assessed by gastroenterologists at inclusion in the study. Responses were indicated on a seven-point scale (7 best/1 worst). Mean numeric score was calculated as well...

  12. Transabdominal ultrasound for standardized measurement of bowel wall thickness in normal children and those with Crohn's disease.

    Science.gov (United States)

    Chiorean, Liliana; Schreiber-Dietrich, Dagmar; Braden, Barbara; Cui, XinWu; Dietrich, Christoph F

    2014-12-01

    The intestinal wall can be visualized using high resolution transabdominal ultrasound (TUS). TTUS measurement of the bowel wall thickness has been described in adults but data are lacking in children. The purpose of this prospective study was to sonographically investigate bowel wall thickness in healthy children and children with Crohn's disease. TUS (5-15 MHz) of the intestine was performed in 58 healthy children (age range 3 to 16 years) and in 30 children with Crohn's disease (age range 8 to 17 years). The following regions were assessed and bowel wall thickness measured: terminal ileum, cecum, right flexure, and sigmoid colon. In patients with Crohn's disease, the involved region was additionally assessed regarding length of involved segment and sonographic signs of transmural inflammation and fistula. TUS allowed adequate measurement of bowel wall thickness in all 58 healthy children (100%) and in all 30 Crohn's disease patients (100%). The bowel wall thickness significantly differed between groups. Bowel wall thickness (mean +/- SD) in all segments was less then 2 mm in all healthy children (1.0+/-0.1 mm terminal ileum, 1.1+/-0.1 mm cecum, 1.1+/-0.1 mm right flexure, and 1.3+/-0.1 mm sigmoid colon). In Crohn's disease patients, bowel wall thickness was ≥ 3 mm in the ileocecal region and was significantly increased (5.1+/-1.9 mm) compared to the healthy children. The mean length of involved segment was 15+/-6.5 cm [5 - 30 cm]. Additional findings in Crohn's disease patients were: transmural inflamation (3/30), interenteric fistula (3/30), gastrocolic fistula (1/30) and vesicoenteric fistula (1/30). Similar to adults, normal bowel wall thickness in children is always less than 2 mm. In all patients with Crohn's disease, increased bowel wall thickness could be detected. TUS is a helpful tool in the diagnosis and assessment of activity and complications in Crohn's disease.

  13. Induction and maintenance infliximab therapy for the treatment of moderate-to-severe Crohn's disease in children

    DEFF Research Database (Denmark)

    Hyams, Jeffrey; Crandall, Wallace; Kugathasan, Subra

    2006-01-01

    BACKGROUND AND AIMS: The REACH study evaluated the safety and efficacy of infliximab in children with moderately to severely active Crohn's disease. METHODS: Patients (n = 112) with a Pediatric Crohn's Disease Activity Index (PCDAI) score >30 received infliximab 5 mg/kg at weeks 0, 2, and 6. Pati......, remission rates, but not response rates, at week 54 were superior with every 8-week dosing compared with every 12-week dosing. Udgivelsesdato: 2007-Mar...

  14. Prevalence and family risk of ulcerative colitis and Crohn's disease: an epidemiological study among Europeans and south Asians in Leicestershire.

    OpenAIRE

    Probert, C S; Jayanthi, V; Hughes, A O; Thompson, J R; Wicks, A C; Mayberry, J F

    1993-01-01

    The family history of patients identified during incidence studies in Leicestershire were investigated and the prevalence and comparative risks calculated; 1254 patients aged 15 to 80 years were sent a questionnaire about their family history. All cases with a positive family history were reviewed and confirmed cases included in the study. In Europeans the standardised prevalence of Crohn's disease was 75.8/10(5) and that of ulcerative colitis 90.8/10(5). The prevalence of Crohn's disease amo...

  15. Lack of association between oral contraceptive use and Crohn's disease: a community-based matched case-control study.

    Science.gov (United States)

    Lashner, B A; Kane, S V; Hanauer, S B

    1989-12-01

    Previous epidemiologic studies have suggested a weak association between oral contraceptive use and Crohn's disease, specifically Crohn's colitis. To measure a possible etiologic association, 51 women with Crohn's disease who were 18-50 yr old were studied and compared with peer-nominated age- and sex-matched controls. There were no differences between cases and controls with respect to race, religion, marital status, and number of pregnancies. There was no association between oral contraceptive use and Crohn's disease incidence [current use: odds ratio (OR) 0.73, 95% confidence interval (CI) 0.34-1.59; former use: OR 1.80, CI 0.61-5.29; current or former use: OR 1.00, CI 0.46-2.16]. Stratifying by disease location also failed to identify an association. Cigarette smoking was significantly associated with Crohn's disease incidence. Controlling for possible confounding effects of cigarette smoking did not alter the lack of association between oral contraceptive use and Crohn's disease. Similarly, testing for interaction failed to demonstrate any effect modification. Analyzing for duration of current oral contraceptive use or time interval since last use failed to demonstrate a "dose-response" effect. The study was of sufficient size to detect statistical significance for oral contraceptive use for odds ratios of greater than or equal to 2.76. From this community-based matched case-control study, there was no association between oral contraceptive use and Crohn's disease, and women need not be advised to discontinue oral contraceptive use when a diagnosis of Crohn's disease is made.

  16. High prevalence of overweight and obesity in adults with Crohn's disease: associations with disease and lifestyle factors.

    LENUS (Irish Health Repository)

    Nic Suibhne, Treasa

    2013-08-01

    Obesity and overweight are major public health issues. Although traditionally associated with weight loss, there is now evidence that increasing Body Mass Index (BMI) and overweight are emerging features of Crohn\\'s disease (CD) and may be associated with more severe disease course. The aim of the study was to determine the prevalence of overweight and obesity in patients with CD compared with matched healthy controls and to identify disease-specific and generic factors associated with current BMI in this group.

  17. Selection of symptomatic patients with Crohn's disease for abdominopelvic computed tomography: role of serum C-reactive protein.

    LENUS (Irish Health Repository)

    Desmond, Alan N

    2012-11-01

    Results of previous studies have shown that repeated abdominopelvic computed tomography (CT) examinations can lead to substantial cumulative diagnostic radiation exposure in patients with Crohn\\'s disease (CD). Improved selection of patients referred for CT will reduce unnecessary radiation exposure. This study examines if serum C-reactive protein (CRP) concentration predicts which symptomatic patients with CD are likely to have significant disease activity or disease complications (such as abscess) detected on abdominopelvic CT.

  18. Dietary Fiber Intake is Associated with Increased Colonic Mucosal GPR43+ Polymorphonuclear Infiltration in Active Crohn's Disease.

    Science.gov (United States)

    Zhao, Mingli; Zhu, Weiming; Gong, Jianfeng; Zuo, Lugen; Zhao, Jie; Sun, Jing; Li, Ning; Li, Jieshou

    2015-07-01

    G protein-coupled receptor 43/free fatty acid receptor 2 (GPR43/FFAR2) is essential for polymorphonuclear (PMN) recruitment. We investigated the expression of GPR43/FFAR2 in the colon from Crohn's disease patients and whether dietary fiber in enteral nutrition increases GPR43+ polymorphonuclear infiltration in mucosa. Segments of ascending colon and white blood cells from peripheral blood were obtained from 46 Crohn's disease patients and 10 colon cancer patients. The Crohn's disease patients were grouped by the activity of disease (active or remission) and enteral nutrition with or without dietary fiber. Histological feature, expression and location of GPR43/FFAR2 and level of tumor necrosis factor-α (TNF-α), interleukine-6 (IL-6) and myeloperoxidase were assessed. The results of hematoxylin-eosin and immunohistochemistry staining revealed that the infiltration of immune cells, including GPR43+ PMN, was more severe in active Crohn's disease patients who consumed normal food or enteral nutrition with dietary fiber than in remission patients and colon cancer patients. This finding was supported by the results of GPR43 and myeloperoxidase expression. Active Crohn's disease (CD) patients who consumed enteral nutrition without dietary fiber exhibited severe immune cell infiltration similar to the other active CD patients, but GPR43+ PMNs were rarely observed. The level of TNF-α mRNA in active Crohn's disease patients was higher than those of the other patients. In conclusion, the use of dietary fiber in enteral nutrition by active Crohn's disease patients might increase GPR43+ PMNs infiltration in colon mucosa. This effect was not observed in Crohn's disease patients in remission.

  19. Genetic Variations of PTPN2 and PTPN22: Role in the Pathogenesis of Type 1 Diabetes and Crohn's Disease.

    Science.gov (United States)

    Sharp, Robert C; Abdulrahim, Muna; Naser, Ebraheem S; Naser, Saleh A

    2015-01-01

    Genome wide association studies have identified several genes that might be associated with increase susceptibility to Type 1 Diabetes (T1D) and Crohn's disease. Both Crohn's disease and T1D have a profound impact on the lives of patients and it is pivotal to investigate the genetic role in patients acquiring these diseases. Understanding the effect of single nucleotide polymorphisms (SNP's) in key genes in patients suffering from T1D and Crohn's disease is crucial to finding an effective treatment and generating novel therapeutic drugs. This review article is focused on the impact of SNP's in PTPN2 (protein tyrosine phosphatase, non-receptor type 2) and PTPN22 (protein tyrosine phosphatase non-receptor type 22) on the development of Crohn's disease and T1D. The PTPN2 gene mutation in T1D patients play a direct role in the destruction of beta cells while in Crohn's disease patients, it modulates the innate immune responses. The PTPN22 gene mutations also play a role in both diseases by modulating intracellular signaling. Examining the mechanism through which these genes increase the susceptibility to both diseases and gaining a better understanding of their structure and function is of vital importance to understand the etiology and pathogenesis of Type 1 Diabetes and Crohn's disease.

  20. A BACH2 Gene Variant Is Associated with Postoperative Recurrence of Crohn's Disease.

    Science.gov (United States)

    Laffin, Michael R; Fedorak, Richard N; Wine, Eytan; Dicken, Bryan; Madsen, Karen L

    2018-02-13

    Crohn's disease often requires intestinal resection, which is not considered curative. Repeat surgical intervention is necessary in more than half of patients after their initial operation. Although many genetic loci are implicated in Crohn's disease, few have been associated with post-resection recurrence. A cohort of patients with Crohn's disease who underwent intestinal resection was analyzed to determine genetic and clinical factors associated with post-resection recurrence. Genotype was assessed at 8 loci associated with adaptive immunity (SMAD3, IL10RB, IL15RA, BACH2, IL12B, IL18RAP, IFNGR2, and JAK2). Univariate and multivariable survival analyses were performed using a log-rank test and Cox-proportional hazard model, respectively. One hundred and ninety-one patients with Crohn's disease and 11.2 years mean postoperative follow-up were included. Forty-six percent experienced a surgical recurrence. Factors associated with increased incidence of recurrence included male sex (p = 0.05) and shortened time to first intestinal operation (5.0 vs 7.3 years; p = 0.03); inflammatory disease behavior was associated with a lower chance of repeat operation (p < 0.01). Of the loci assessed on multivariable analysis, homozygosity for a risk allele at BACH2 (rs1847472) was significantly associated with disease recurrence (hazard ratio 1.54; 95% CI 1.00 to 2.36; p < 0.05). We identify BACH2 as a susceptibility locus for postoperative recurrence of Crohn's disease in our cohort. BACH2 is critical in the differentiation and function of T cells, as a regulator of B-cell activity, and is associated with several dysregulated immunologic phenomena. Its identification as a risk locus in postoperative Crohn's disease recurrence suggests a potential role for regulatory T cells, effector T cells, humoral immunity, and immunologic memory in the development of this disease process. Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  1. Impact of anti-TNF agents in postoperative complications in Crohn's disease: a review

    Directory of Open Access Journals (Sweden)

    Mansur Saab

    2015-04-01

    Full Text Available The real impact of biological therapy (anti-TNF agents in abdominal operations secondary to Crohn's disease is a matter of debate in the international literature. Several studies demonstrated that there can be an increase in postoperative complications in patients previously treated with these agents. On the other hand, the majority of studies published over the last years question this effect, and did not demonstrate any relationship between biologics and outcomes related to surgical postoperative complications. Some meta-analyses were published, with different outcomes and different conclusions. Experimental studies in animals were also recently published, with opposite results, despite similar methodology. In this review, the authors resume all the relevant papers in the international literature with respect to the theme, and demonstrate the heterogeneity of the studies, as well as the disparity of their results and outcomes. The real impact of anti-TNF agents on postoperative complications in Crohn's disease is still controversial, and needs to be better elucidated. Controlled trials must be performed to better address this issue. Resumo: O real e verdadeiro impacto da terapia biológica, constituída por inibidores do fator de necrose tumoral (TNF alfa, em operações abdominais na doença de Crohn, ainda é extensamente debatido na literatura. Há muitos estudos que referem aumento da possibilidade de complicações em pacientes tratados previamente com esses agentes. Por outro lado, há uma série maior de trabalhos que questionam esse aumento, não demonstrando qualquer impacto dessas drogas nos desfechos pós-operatórios. Algumas metanálises foram publicadas, com resultados ligeiramente diversos. Trabalhos experimentais em animais foram recentemente realizados, igualmente com resultados opostos, apesar de metodologia semelhante. Nessa revisão, os autores discorrem sobre todos os trabalhos relevantes na literatura nacional e

  2. Predictors of response to infliximab in patients with fistulizing Crohn's disease Factores predictivos de respuesta a infliximab en pacientes con enfermedad de Crohn fistulizante

    Directory of Open Access Journals (Sweden)

    M. Luna-Chadid

    2004-06-01

    Full Text Available Objective: to evaluate the efficacy and toxicity of infliximab for the treatment of fistulizing Crohn's disease. Methods: consecutive patients with fistulizing Crohn's disease receiving infliximab were prospectively enrolled. Partial response was defined as a reduction of 50% or more from base-line in the number of draining fistulae. Complete response was defined as the closure of all fistulae. The influence of different variables on the efficacy of infliximab was evaluated. Results: 108 patients were included. The disease was inflammatory plus fistulizing in 18% and only fistulizing in 82%. After the third infusion of infliximab the response was partial in 26% and complete in 57%. Response (% rates (partial/complete depending on fistula location were: enterocutaneous (25/68%, perianal (35/60%, rectovaginal (36/64%, and enterovesical (20/40%. None of the studied variables (including concomitant immunosuppressive therapy correlated with efficacy of infliximab in the multivariate analysis. Incidence of adverse effects (21% depending on the dose of infliximab was: first dose (5.6%, second (7.4%, and third (11.1%. Conclusions: infliximab is an efficacious treatment for fistulizing Crohn's disease. Partial response was achieved in approximately one third of the patients, and complete response in more than half. No studied variable was predictive of response. Adverse effects were relatively infrequent and mild.Objetivo: evaluar la eficacia e identificar los factores predictivos de respuesta al tratamiento con infliximab en la enfermedad de Crohn fistulizante. Métodos: se realizó un estudio prospectivo en pacientes con enfermedad de Crohn fistulizante que recibían tratamiento con infliximab. La respuesta parcial se definió como una reducción del 50% o más de la línea base en el número de fístulas que drenan. La respuesta completa se definió como el cierre de todas las fístulas. Se evaluó la influencia de diferentes variables sobre la

  3. Assessment of Crohn's disease activity by Doppler sonography of the superior mesenteric artery, clinical evaluation and the Crohn's Disease activity index: A prospective study

    Energy Technology Data Exchange (ETDEWEB)

    Byrne, Michael F.; Farrell, Michael A.; Abass, Suzanne; Fitzgerald, Anthony; Varghese, Jose C.; Thornton, Frank; Murray, Frank E.; Lee, Michael J

    2001-12-01

    AIM: Recent data have shown that superior mesenteric artery (SMA) flow rates are significantly increased in active Crohn's disease, suggesting that SMA flow may be a useful, non-invasive index of disease activity. The aim of this prospective study was to evaluate the use of SMA Doppler sonography as an indicator of Crohn's disease activity and to compare with clinical evaluation and the Crohn's disease activity index (CDAI). MATERIALS AND METHODS: Patients with active Crohn's (n = 19), inactive Crohn's (n = 17) and control subjects (n = 17) were evaluated. Categorization of disease activity was based on a reference standard. CDAI scores were also calculated independently. The SMA flow parameters evaluated were resistive index, pulsatility index, end diastolic velocity, peak systolic velocity, time averaged maximum velocity, cross-sectional area and maximum flow volume. RESULTS: Using a three-group ANOVA for each of peak systolic velocity (PSV) (P = 0.01), end-diastolic velocity (EDV) (P = 0.04), pulsatility index (PI) (P = 0.003), time-averaged maximum velocity (TAMV) (P = 0.05), and maximum flow volume (TAMV.CSA) (P = 0.01), there was a significant effect of group. Using post-hoc tests, only EDV (P = 0.01), TAMV (P = 0.02) and TAMV.CSA (P 0.003) were significantly different between active and inactive Crohn's disease, though with considerable overlap of values for EDV and TAMV. The mean CDAI scores were significantly different between patients with active Crohn's (287) and inactive Crohn's (71) (P = 0.0001) and correlated well with the reference standard. CONCLUSION: Only three of several parameters previously described as allowing Crohn's disease activity assessment actually did so in our study. However, for two of these parameters (EDV, TAMV), there was overlap between the measurements in the active and inactive groups, thus limiting the ability to discriminate disease activity in practice. The degree of overlap for

  4. Crohn's disease and Sweet's syndrome: an uncommon association Enfermedad de Crohn y síndrome de Sweet: una asociación infrecuente

    Directory of Open Access Journals (Sweden)

    I. Catalán-Serra

    2010-05-01

    Full Text Available Sweet's syndrome or acute febrile neutrophilic dermatosis (SS is characterized by the sudden onset of painful erythematous lesions (papules, nodules, and plaques together with fever and neutrophilia. The lesions are typically located on hands, arms, upper trunk, neck and face, showing an asymmetric distribution. Acute phase reactants are usually elevated and dermal infiltration of neutrophils without vasculitis is seen on skin biopsies. It is considered as a marker of systemic disease in over half of the cases, and is associated with infections, inflammatory bowel disease, autoimmune connective tissue disorders and various neoplasias. Its association with Crohn's disease (CD is unusual and it appears mainly in association with colonic involvement. Fewer than 50 cases have been published in the medical literature since its first description in 1964, some concurrent with the first episode of CD. We present two patients with Crohn's disease and Sweet's syndrome diagnosed in our department at the time of CD diagnosis, as well as their response to treatment, subsequent course of the disease, and a review of the scientific literature.El síndrome de Sweet o dermatosis neutrofílica febril aguda (SS se caracteriza por la aparición brusca de lesiones eritematosas, (pápulas, nódulos y placas dolorosas, junto con fiebre y neutrofilia, siendo de presentación poco frecuente. Las lesiones se localizan preferentemente en manos, brazos, parte superior del tronco, cuello y cara, con distribución asimétrica. Suele haber elevación de reactantes de fase aguda y en las biopsias cutáneas se identifica una infiltración dérmica de neutrófilos sin vasculitis. Se considera un marcador de enfermedad sistémica en más de la mitad de los casos, asociándose a infecciones, enfermedad inflamatoria intestinal, conectivopatías autoinmunes y diversas neoplasias. Su asociación con la enfermedad de Crohn (EC es poco habitual, asociado sobre todo a afectación col

  5. Ulcerative colitis, Crohn's disease, and irritable bowel syndrome have different profiles of extracellular matrix turnover, which also reflects disease activity in Crohn's disease

    DEFF Research Database (Denmark)

    Mortensen, Joachim Høg; Manon-Jensen, Tina; Jensen, Michael Dam

    2017-01-01

    Increased protease activity is a key pathological feature of inflammatory bowel disease (IBD). However, the differences in extracellular matrix remodelling (ECM) in Crohn's disease (CD) and ulcerative colitis (UC) are not well described. An increased understanding of the inflammatory processes may...... remodelling was significantly different in UC compared to CD. The best biomarker combination to differentiate UC from CD and colonic CD was BGM and VICM (AUC = 0.98, P5mg/mL), correlation of Pro-C5 (r = 0.36) with CDAI was slightly improved compared to CRP (r = 0.27) corrected for the use of immunosuppressant...

  6. Encefalopatia de Wernicke em criança com doença de Crohn Wernicke encephalopathy in a child with Crohn disease

    Directory of Open Access Journals (Sweden)

    Felippe Borlot

    2009-12-01

    Full Text Available OBJETIVO: Descrever um caso de encefalopatia de Wernicke associada à doença de Crohn na infância. DESCRIÇÃO DO CASO: Menino de cinco anos, com diagnóstico de doença de Crohn por colonoscopia com biópsia há um ano; desde então, fez uso de diversos medicamentos sem resultados terapêuticos. Evoluiu com pancreatite há três meses, quando foi iniciada nutrição parenteral. Apresentou subitamente sonolência, episódios de frases desconexas e alteração da movimentação ocular. O exame neurológico evidenciou nistagmo vertical para cima em todas as posições e nistagmo horizontal no desvio conjugado do olhar. A ressonância magnética do encéfalo mostrou alterações compatíveis com a encefalopatia de Wernicke, sendo instituído o tratamento com tiamina parenteral imediatamente, com reversão completa dos sintomas por volta do 30º dia de tratamento. COMENTÁRIOS: Embora seja uma entidade rara, deve-se suspeitar de encefalopatia de Wernicke frente à presença de fatores de risco, uma vez que o tratamento imediato evita as sequelas neurológicas.OBJECTIVE: To report a case of Wernicke encephalopathy associated with Crohn disease in childhood. CASE DESCRIPTION: A five year-old boy with Crohn disease, diagnosed by colonoscopy and biopsy one year ago; he has been treated with many different medications without results. During the past year, the patient was diagnosed with pancreatites and has received parenteral nutrition since then. After three months, the child suddenly presented drowsiness, meaningless speech and ocular movement disturbance. Neurologic examination disclosed upbeat nystagmus in all positions and horizontal nystagmus during conjugate deviation of the eyes. Magnetic resonance showed abnormalities consistent with Wernicke encephalopathy. Parenteral thiamine has been administered soon after diagnosis and by the 30th day of treatment, recovery of symptoms was complete. COMMENTS: Despite being a rare entity, neurological

  7. Ulcerative colitis, Crohn's disease, and irritable bowel syndrome have different profiles of extracellular matrix turnover, which also reflects disease activity in Crohn's disease

    DEFF Research Database (Denmark)

    Mortensen, Joachim Høg; Manon-Jensen, Tina; Jensen, Michael Dam

    2017-01-01

    Increased protease activity is a key pathological feature of inflammatory bowel disease (IBD). However, the differences in extracellular matrix remodelling (ECM) in Crohn's disease (CD) and ulcerative colitis (UC) are not well described. An increased understanding of the inflammatory processes may...... provide optimized disease monitoring and diagnostics. We investigated the tissue remodelling in IBD and IBS patients by using novel blood-based biomarkers reflecting ECM remodelling. Five ECM biomarkers (VICM, BGM, EL-NE, C5M, Pro-C5) were measured by competitive ELISAs in serum from 72 CD patients, 60 UC...... is related to the level of inflammation in CD and may reflect disease activity in CD....

  8. Uveíte como primeira manifestação de provável doença de Crohn

    OpenAIRE

    Barreira, Ieda Maria Alexandre; Aragão, Ricardo Evangelista Marrocos de; Vale, Ariosto Bezerra; Vieira, Virgínia Apolônio; Bezerra, Luanna Biana Costa

    2012-01-01

    Extraintestinal manifestations of Crohn's disease are common. Although ocular complications of Crohn's disease are infrequent, most ocular manifestations include iritis, uveitis, episcleritis, scleritis and conjuntivitis. We report a patient who developed uveitis two years before diagnose of Crohn's disease.Manifestações extraintestinais da doença de Crohn são comuns. As manifestações oculares são infrequentes e caracterizam-se em sua maioria por irite, uveíte, episclerite, esclerite e conjun...

  9. Histologic scoring indices for evaluation of disease activity in Crohn's disease.

    Science.gov (United States)

    Novak, Gregor; Parker, Claire E; Pai, Rish K; MacDonald, John K; Feagan, Brian G; Sandborn, William J; D'Haens, Geert; Jairath, Vipul; Khanna, Reena

    2017-07-21

    Histologic assessment of mucosal disease activity has been increasingly used in clinical trials of treatment for Crohn's disease. However, the operating properties of the currently existing histologic scoring indices remain unclear. A systematic review was undertaken to evaluate the development and operating characteristics of available histologic disease activity indices in Crohn's disease. Electronic searches of MEDLINE, EMBASE, PubMed, and the Cochrane Library (CENTRAL) databases from inception to 20 July 2016 were supplemented by manual reviews of bibliographies and abstracts submitted to major gastroenterology meetings (Digestive Disease Week, United European Gastroenterology Week, European Crohn's and Colitis Organisation). Any study design (e.g. randomised controlled trial, cohort study, case series) that evaluated a histologic disease activity index in patients with Crohn's disease was considered for inclusion. Study participants included adult patients (> 16 years), diagnosed with Crohn's disease using conventional clinical, radiographic or endoscopic criteria. Two authors independently reviewed the titles and abstracts of the studies identified from the literature search. The full text of potentially relevant citations were reviewed for inclusion and the study investigators were contacted as needed for clarification. Any disagreements regarding study eligibility were resolved by discussion and consensus with a third author.Two authors independently extracted and recorded data using a standard form. The following data were recorded from each eligible study: number of patients enrolled; number of patients per treatment arm; patient characteristics: age and gender distribution; description of histologic disease activity index utilized; and outcomes such as content validity, construct validity, criterion validity, responsiveness, intra-rater reliability, inter-rater reliability, and feasibility. Sixteen reports of 14 studies describing 14 different numerical

  10. Immunodeficiencies and autoimmune diseases: common variable immunodeficiency and Crohn-like

    Directory of Open Access Journals (Sweden)

    Cristina Saldaña-Dueñas

    Full Text Available Background: Common variable immunodeficiency (CVI gives a major risk of principally respiratory and digestive infections. It is associated with autoimmune diseases, granulomatous process and neoplasias. The digestive clinic is common, in 10% of patients it is the only symptom, and 60% present chronic diarrhea. Clinically it can be confused and related with other pathologies such as inflammatory bowel disease which is infrequent (2-13%. Case report: We present the case of a patient with CVI with digestive symptoms being diagnosed of Crohn-like disease with extent ileal affectation. The main treatment of these patients is the same as classical Crohn disease although in the most severe cases, as this one, the use of immunosupresors is necessary. At this time the patient remains on clinical remmision with infliximab. She presented a previous adverse reaction with adalimumab. Discussion: The few case series in this pathology makes the treatment with immunomodulators in this immunodeficiency a real diagnostic and therapeutic challenge.

  11. Difference in Recurrence Patterns Between Anastomosis and Strictureplasty After Surgical Treatment for Crohn Disease

    Science.gov (United States)

    Hayakawa, Shoichiro; Hotokezaka, Masayuki; Ikeda, Takuto; Uchiyama, Shuichiro; Chijiiwa, Kazuo

    2012-01-01

    This study aimed to investigate whether the initial indication for surgery or type of surgery (strictureplasty or resection) performed determines recurrence patterns in patients with Crohn disease. Recurrence patterns of 41 patients (31 patients: only resection and anastomosis of the intestine, and 10 patients: strictureplasty with/without resection and anastomosis) who underwent operation for recurrent Crohn disease (June 2002–December 2010) were evaluated. Strictureplasty for nonperforating disease was performed at 17 sites, and reoperation was required at 11 sites (10 sites for nonperforating disease and 1 site for perforating disease). There was a significant difference in the recurrence pattern in patients who underwent resection and anastomosis (P resection and anastomosis (P resection and anastomosis was performed for nonperforating and for perforating disease. Initial indication for surgery, but not the type of surgery, appeared to determine recurrence patterns. PMID:23102077

  12. [Disseminated tuberculosis following infliximab therapy for Crohn disease: a case report].

    Science.gov (United States)

    Bouchentouf, R; Yasser, Z; Aitbenasser, M A

    2014-12-01

    Anti-tumor necrosis factor (TNF) therapy has been the major advance in the treatment of inflammatory bowel disease, especially Crohn's disease. But there is a higher risk of infections, especially tuberculosis (TB), in patients treated with anti-TNFα. The authors report a case of disseminated tuberculosis with the following features: pulmonary tuberculosis, left supra clavicular cervical and meditational lymphadenopathy, bilateral pleural effusion, peritoneal and splenic involvement. This disseminated tuberculosis was observed in a 39-year-old woman who was treated by infliximab for refractory Crohn's disease. The evolution with antituberculosis drugs was fatal, the death of the patient was due to hepatic encephalitis. The physicians should always be aware in the use of TNF-alpha blockers according to guidelines. Its recommended to realize a complete pretherapeutic assessment and it is necessary to follow-up the patients to detect possible reactivation of latent tuberculosis. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  13. Signet Ring Cell Carcinoma, Ileal Crohn Disease or Both - A Case of Diagnostic Challenge

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    Joana R. Carvalho

    2017-09-01

    Full Text Available Signet ring cell carcinoma is a rare form of adenocarcinoma that predominantly affects the stomach. Signet ring cell carcinoma originated from the ileum is extremely rare and the prognosis is poor. We present a case of small bowel obstruction with features suggesting Crohn disease of the ileum. The symptoms were chronic diarrhea and abdominal pain with a family history of inflammatory bowel disease. The patient underwent surgery and histopathology revealed both aspects of signet ring cell carcinoma and Crohn disease of the ileum. An association between long-standing inflammation and the development of this subtype of tumor has been proposed but there are no established surveillance guidelines for small bowel neoplasm in inflammatory bowel disease.

  14. Leukocyte scintigraphy compared to intraoperative small bowel enteroscopy and laparotomy findings in Crohn's disease

    DEFF Research Database (Denmark)

    Almen, Sven; Granerus, Göran; Ström, Magnus

    2007-01-01

    Background: Leukocyte scintigraphy is a noninvasive investigation to assess inflammation. We evaluated the utility of labeled leukocytes to detect small bowel inflammation and disease complications in Crohn's disease and compared it to whole small bowel enteroscopy and laparotomy findings. Methods......: Scintigraphy with technetium-99m exametazime-labeled leukocytes was prospectively performed in 48 patients with Crohn's disease a few days before laparotomy; 41 also had an intraoperative small bowel enteroscopy. The same procedures were performed in 8 control patients. Independent grading of scans....../or laparotomy (n = 39) the scan was positive in 33. In 8 patients without macroscopic small bowel inflammation, the scan was positive for the small bowel in 3 patients; at histology, 2 of 3 had inflammation. When combining results for patients and controls, the sensitivity of leukocyte scan for macroscopically...

  15. Integrated Metagenomics/Metaproteomics Reveals Human Host-Microbiota Signatures of Crohn's Disease

    Energy Technology Data Exchange (ETDEWEB)

    Erickson, Alison L [ORNL; Cantarel, Brandi [University of Maryland School of Medicine, The, Baltimore, MD; Lamendella, Regina [Lawrence Berkeley National Laboratory (LBNL); Darzi, Youssef [Vrije Universiteit Brussel, Brussels, Belgium; Mongodin, Emmanuel [University of Maryland School of Medicine, The, Baltimore, MD; Pan, Chongle [ORNL; Shah, Manesh B [ORNL; Halfvarsson, J [Orebro University Hospital, Orebro, Sweden; Tysk, C [Orebro University Hospital, Orebro, Sweden; Henrissat, Bernard [Universite d' Aix-Marseille I & II; Raes, Jeroen [Vrije Universiteit Brussel, Brussels, Belgium; Verberkmoes, Nathan C [ORNL; Fraser-Liggett, C [University of Maryland; Hettich, Robert {Bob} L [ORNL; Jansson, Janet [Lawrence Berkeley National Laboratory (LBNL)

    2012-01-01

    Crohn's disease (CD) is an inflammatory bowel disease of complex etiology, although dysbiosis of the gut microbiota has been implicated in chronic immune-mediated inflammation associated with CD. Here we combined shotgun metagenomic and metaproteomic approaches to identify potential functional signatures of CD in stool samples from six twin pairs that were either healthy, or that had CD in the ileum (ICD) or colon (CCD). Integration of these omics approaches revealed several genes, proteins, and pathways that primarily differentiated ICD from healthy subjects, including depletion of many proteins in ICD. In addition, the ICD phenotype was associated with alterations in bacterial carbohydrate metabolism, bacterial-host interactions, as well as human host-secreted enzymes. This eco-systems biology approach underscores the link between the gut microbiota and functional alterations in the pathophysiology of Crohn's disease and aids in identification of novel diagnostic targets and disease specific biomarkers.

  16. Integrated metagenomics/metaproteomics reveals human host-microbiota signatures of Crohn's disease.

    Directory of Open Access Journals (Sweden)

    Alison R Erickson

    Full Text Available Crohn's disease (CD is an inflammatory bowel disease of complex etiology, although dysbiosis of the gut microbiota has been implicated in chronic immune-mediated inflammation associated with CD. Here we combined shotgun metagenomic and metaproteomic approaches to identify potential functional signatures of CD in stool samples from six twin pairs that were either healthy, or that had CD in the ileum (ICD or colon (CCD. Integration of these omics approaches revealed several genes, proteins, and pathways that primarily differentiated ICD from healthy subjects, including depletion of many proteins in ICD. In addition, the ICD phenotype was associated with alterations in bacterial carbohydrate metabolism, bacterial-host interactions, as well as human host-secreted enzymes. This eco-systems biology approach underscores the link between the gut microbiota and functional alterations in the pathophysiology of Crohn's disease and aids in identification of novel diagnostic targets and disease specific biomarkers.

  17. Infliximab dependency in a national cohort of children with Crohn's disease

    DEFF Research Database (Denmark)

    Wever, Anne Vibeke; Riis, Lene; Vind, Ida

    2006-01-01

    AIM: The aim was to evaluate the pattern of responsiveness and to monitor side effects of episodic administration of infliximab in children with active Crohn's disease (CD) treated in Denmark from 1999 to 2003. MATERIAL AND METHODS: The National Danish Crohn Colitis Database of infliximab was used...... to identify all Danish CD patients treated at pediatric departments with infliximab. The clinical outcome was assessed by pattern recognition of the disease course 30 days after the first infliximab infusion and 90 days after intended end of treatment. RESULTS: During a 3 year period, infliximab was given...... to 24 CD patients (9 male/15 female) aged median 15.4 (range 9.8-18.6) years with a median disease duration of 26 (range 0.7-93) months and a median number of infusions of 6 (range 2-11). Five milligrams of infliximab per kilogram infusions were given intravenously. Immediate response was as follows: 8...

  18. Breathhold MRI of the small bowel in Crohn's disease after enteroklysis with oral magnetic particles

    International Nuclear Information System (INIS)

    Holzknecht, N.; Helmberger, T.; Gauger, J.; Faber, S.; Reiser, M.; Ritter, C. von

    1998-01-01

    Purpose: To evaluate the efficacy of breathhold MRI following enteroclysis with addition of oral magnetic particles to study the extension, detection of stenoses and extraluminal manifestations in Crohn's disease. Results: Typical findings were marked bowel wall thickening with strong contrast enhancement. 95.8% of affected small bowel segments and 94.7% of stenoses were correctly detected by MRI. All four fistulas were detected and important extraluminal findings were seen in 6/18 patients. Additionally, one ileoileal and two ileosigmoidal adhesions, two extraluminal abscesses and affection of the right ureter were delineated. Conclusion: MRI in Crohn's disease offers the potential to avoid radiation exposure in this relatively young patient group. Important additional findings relevant to indication of surgery are seen in approximately one third of cases. The replacement of transduodenal intubation by oral contrast application remains to be further studied. (orig./AJ) [de

  19. Role of percutaneous abscess drainage in the management of young patients with Crohn disease

    Energy Technology Data Exchange (ETDEWEB)

    Pugmire, Brian S. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Gee, Michael S. [Massachusetts General Hospital for Children, Department of Radiology, Boston, MA (United States); Massachusetts General Hospital, Division of Abdominal Imaging, Boston, MA (United States); Kaplan, Jess L.; Winter, Harland S. [Massachusetts General Hospital for Children, Department of Pediatrics, Boston, MA (United States); Hahn, Peter F.; Gervais, Debra A. [Massachusetts General Hospital, Division of Abdominal Imaging, Boston, MA (United States); Doody, Daniel P. [Massachusetts General Hospital for Children, Department of Surgery, Boston, MA (United States)

    2016-05-15

    Intra-abdominal abscess is a common complication of Crohn disease in children. Prior studies, primarily in adults, have shown that percutaneous abscess drainage is a safe and effective treatment for this condition; however, the data regarding this procedure and indications in pediatric patients is limited. Our aim was to determine the success rate of percutaneous abscess drainage for abscesses related to Crohn disease in pediatric patients with a focus on treatment endpoints that are relevant in the era of biological medical therapy. We retrospectively reviewed 25 cases of patients ages ≤20 years with Crohn disease who underwent percutaneous abscess drainage. Technical success was defined as catheter placement within the abscess with reduction in abscess size on post-treatment imaging. Clinical success was defined as (1) no surgery within 1 year of drainage or (2) surgical resection following drainage with no residual abscess at surgery or on preoperative imaging. Multiple clinical parameters were analyzed for association with treatment success or failure. All cases were classified as technical successes. Nineteen cases were classified as clinical successes (76%), including 7 patients (28%) who required no surgery within 1 year of percutaneous drainage and 12 patients (48%) who had elective bowel resection within 1 year. There was a statistically significant association between resumption of immunosuppressive therapy within 8 weeks of drainage and both clinical success (P < 0.01) and avoidance of surgery after 1 year (P < 0.01). Percutaneous abscess drainage is an effective treatment for Crohn disease-related abscesses in pediatric patients. Early resumption of immunosuppressive therapy is statistically associated with both clinical success and avoidance of bowel resection, suggesting a role for percutaneous drainage in facilitating prompt initiation of medical therapy and preventing surgical bowel resection. (orig.)

  20. Accuracy of abdominal ultrasound and MRI for detection of Crohn disease and ulcerative colitis in children

    Energy Technology Data Exchange (ETDEWEB)

    Ziech, Manon L.W.; Smets, Anne M.J.B.; Lavini, Cristina; Caan, Matthan W.A.; Nederveen, Aart J.; Bipat, Shandra; Stoker, Jaap [Academic Medical Center, Department of Radiology, Amsterdam (Netherlands); Hummel, Thalia Z.; Benninga, Marc A.; Kindermann, Angelika [Emma Children' s Hospital, Academic Medical Center, Department of Pediatric Gastroenterology, Amsterdam (Netherlands); Nievelstein, Rutger A.J. [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Roelofs, Joris J.T.H. [Academic Medical Center, Department of Pathology, Amsterdam (Netherlands)

    2014-11-15

    Endoscopy is currently the primary diagnostic technique for inflammatory bowel disease (IBD) in children. To assess the accuracy of US and dynamic contrast-enhanced MRI for diagnosing inflammatory bowel disease and for distinguishing Crohn disease and ulcerative colitis in comparison to a reference standard. Consecutive children with suspected IBD underwent diagnostic workup including ileocolonoscopy and upper gastrointestinal endoscopy as the reference standard, abdominal US, and MR enterography and colonography at 3 T. The protocol included a dynamic contrast-enhanced 3-D sequence. Sensitivity, specificity and kappa values were calculated for one ultrasonographer and two MRI observers. We included 28 children (15 boys) with mean age 14 years (range 10-17 years). The diagnosis was IBD in 23 children (72%), including 12 with Crohn disease, 10 with ulcerative colitis and 1 with indeterminate colitis. For the diagnosis of inflammatory bowel disease the sensitivity was 55% for US and 57% (both observers) for MR entero- and colonography, and the specificity was 100% for US and 100% (observer 1) and 75% (observer 2) for MR entero- and colonography. Combined MRI and US had sensitivity and specificity of 70% and 100% (observer 1) and 74% and 80% (observer 2), respectively. With the addition of a dynamic contrast-enhanced MR sequence, the sensitivity increased to 83% and 87%. US and MRI could only distinguish between Crohn disease and ulcerative colitis when terminal ileum lesions were present. US and MR entero- and colonography have a high accuracy for diagnosing inflammatory bowel disease in children but cannot be used to distinguish Crohn disease and ulcerative colitis. (orig.)

  1. High fat diet accelerates pathogenesis of murine Crohn's disease-like ileitis independently of obesity.

    Directory of Open Access Journals (Sweden)

    Lisa Gruber

    Full Text Available BACKGROUND: Obesity has been associated with a more severe disease course in inflammatory bowel disease (IBD and epidemiological data identified dietary fats but not obesity as risk factors for the development of IBD. Crohn's disease is one of the two major IBD phenotypes and mostly affects the terminal ileum. Despite recent observations that high fat diets (HFD impair intestinal barrier functions and drive pathobiont selection relevant for chronic inflammation in the colon, mechanisms of high fat diets in the pathogenesis of Crohn's disease are not known. The aim of this study was to characterize the effect of HFD on the development of chronic ileal inflammation in a murine model of Crohn's disease-like ileitis. METHODS: TNF(ΔARE/WT mice and wildtype C57BL/6 littermates were fed a HFD compared to control diet for different durations. Intestinal pathology and metabolic parameters (glucose tolerance, mesenteric tissue characteristics were assessed. Intestinal barrier integrity was characterized at different levels including polyethylene glycol (PEG translocation, endotoxin in portal vein plasma and cellular markers of barrier function. Inflammatory activation of epithelial cells as well as immune cell infiltration into ileal tissue were determined and related to luminal factors. RESULTS: HFD aggravated ileal inflammation but did not induce significant overweight or typical metabolic disorders in TNF(ΔARE/WT. Expression of the tight junction protein Occludin was markedly reduced in the ileal epithelium of HFD mice independently of inflammation, and translocation of endotoxin was increased. Epithelial cells showed enhanced expression of inflammation-related activation markers, along with enhanced luminal factors-driven recruitment of dendritic cells and Th17-biased lymphocyte infiltration into the lamina propria. CONCLUSIONS: HFD feeding, independently of obesity, accelerated disease onset of small intestinal inflammation in Crohn's disease

  2. Literature-Related Discovery: Common Factors for Parkinson’s Disease and Crohn’s Disease

    Science.gov (United States)

    2010-01-01

    amines in cooked foods: an analysis and implications for research. 58 61 Neurodegenerative diseases diagnosis Progression of symptoms in the early...studies A prospective study of diet and the risk of symptomatic diverticular disease in men. Heterogeneity at the HLA-DRB1 locus and risk for multiple...A meta-analysis. World Journal of Gastroenterology. 12:23. 3636-3644. 2006. Baumgart DC. The Diagnosis and Treatment of Crohn’s Disease and

  3. N-cadherin is overexpressed in Crohn's stricture fibroblasts and promotes intestinal fibroblast migration.

    LENUS (Irish Health Repository)

    Burke, John P

    2012-02-01

    BACKGROUND: Intestinal fibroblasts mediate stricture formation in Crohn\\'s disease (CD). Transforming growth factor-beta (TGF-beta) is important in fibroblast activation, while cell attachment and migration is regulated by the adhesion molecule N-cadherin. The aim of this study was to investigate the expression and function of N-cadherin in intestinal fibroblasts in patients with fibrostenosing CD. METHODS: Intestinal fibroblasts were cultured from seromuscular biopsies from patients undergoing resection for terminal ileal fibrostenosing CD (n = 14) or controls patients (n = 8). N-cadherin expression was assessed using Western blot and quantitative reverse-transcription polymerase chain reaction (qRT-PCR). Fibroblasts were stimulated with TGF-beta and selective pathway inhibitors Y27632, PD98050, and LY294002 were used to examine the Rho\\/ROCK, ERK-1\\/2, and Akt signaling pathways, respectively. Cell migration was assessed using a scratch wound assay. N-cadherin was selectively overexpressed using a plasmid. RESULTS: Fibroblasts from fibrostenosing CD express increased constitutive N-cadherin mRNA and protein and exhibit enhanced basal cell migration relative to those from directly adjacent normal bowel. Control fibroblasts treated with TGF-beta induced N-cadherin in a dose-dependent manner which was inhibited by Rho\\/ROCK and Akt pathway modulation. Control fibroblasts exhibited enhanced cell migration in response to treatment with TGF-beta or transfection with an N-cadherin plasmid. CONCLUSIONS: Fibroblasts from strictures in CD express increased constitutive N-cadherin and exhibit enhanced basal cell migration. TGF-beta is a potent inducer of N-cadherin in intestinal fibroblasts resulting in enhanced cell migration. The TGF-beta-mediated induction of N-cadherin may potentiate Crohn\\'s stricture formation.

  4. Analysis of factors affecting the quality of life of those suffering from Crohn's disease.

    Science.gov (United States)

    Chrobak-Bień, Joanna; Gawor, Anna; Paplaczyk, Małgorzata; Małecka-Panas, Ewa; Gąsiorowska, Anita

    2017-08-31

    Crohn's disease is an inflammatory bowel disease of unknown etiology. Its chronic nature, as well as symptoms of intestinal and overall significantly impedes the daily functioning of patients. Alternately occurring periods of exacerbation and remission are the cause of reduced quality of life of patients. Understanding the factors that caused the decrease in the quality of life, it allows us to understand the behavior and the situation of the patient and the ability to cope with stress caused by the disease. The aim of the study was to analyze the factors affecting the quality of life of people with Crohn's disease. The study group consisted of 50 people diagnosed with Crohn's disease. Respondents were treated at the Department of General Surgery and Colorectal Medical University of Lodz and Gastroenterological Clinic at the University Clinical Hospital No. 1 in Lodz. Quality of Life Survey was carried out by a diagnostic survey using a research tool SF-36v2 and surveys of its own design. Analysis of the results demonstrated that the quality of life of patients with Crohn's disease was reduced, especially during exacerbations. Evaluation of the quality of life of respondents in physical terms was slightly higher than in the mental aspect. Higher education subjects and the lack of need for surgical treatment significantly improves the quality of life. The occurrence of chronic disease reduces the quality of life of respondents. Elderly patients are better able to adapt to the difficult situation caused by the disease. The quality of life of women and men is at a similar level and patients in remission of the disease have a better quality of life of patients during exacerbations.

  5. Clinical and radiographic presentation of superior mesenteric vein thrombosis in Crohn's disease: a single center experience.

    Science.gov (United States)

    Kopylov, Uri; Amitai, Marianne M; Lubetsky, Aharon; Eliakim, Rami; Chowers, Yehuda; Ben-Horin, Shomron

    2012-06-01

    Mesenteric vein thrombosis (MVT) is a rare and frequently underdiagnosed complication of Crohn's disease (CD). This study describes the clinical and radiological characteristics of CD /patients with superior mesenteric vein thrombosis (MVT) diagnosed by CT/MRI. The database of Crohn's disease patients treated in Sheba Medical Center between 2005-2010 was searched for MVT diagnosis. Imaging studies of identified patients were retrieved and reviewed by an experienced abdominal radiologist. MVT was defined by superior mesenteric vein obliteration and/or thrombus in the vessel lumen on abdominal imaging. The clinical and radiologic data of these patients were collected from the medical records. MVT was demonstrated in 6/460 CD patients. Five patients had stricturing disease, and one patient had a combined fistulizing and stricturing disease phenotype. All patients had small bowel disease, but 3/6 also had colonic involvement. No patient had a prior thromboembolic history or demonstrable hypercoagulability. One patient had an acute SMV thrombus demonstrable on CT scanning, the remaining patients showed an obliteration of superior mesenteric vein. Two patients received anticoagulation upon diagnosis of thrombosis. No subsequent thromboembolic events were recorded. The incidence of mesenteric vein thrombosis is likely to be underestimated in patients with Crohn's disease. Both CT and MRI imaging demonstrate the extent of enteric disease and coincident SMV thrombosis. In our cohort, thrombosis was associated with stricturing disease of the small bowel. The clinical impact of SMV thrombosis and whether anticoagulation is mandatory for all of these patients remains to be determined. Copyright © 2011 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

  6. MRI predictors of treatment response for perianal fistulizing Crohn disease in children and young adults

    International Nuclear Information System (INIS)

    Shenoy-Bhangle, Anuradha; Nimkin, Katherine; Gee, Michael S.; Goldner, Dana; Israel, Esther J.; Bradley, William F.

    2014-01-01

    Magnetic resonance imaging (MRI) is considered the imaging standard for diagnosis and characterization of perianal complications associated with Crohn disease in children and adults. To define MRI criteria that could act as potential predictors of treatment response in fistulizing Crohn disease in children, in order to guide more informed study interpretation. We performed a retrospective database query to identify all children and young adults with Crohn disease who underwent serial MRI studies for assessment of perianal symptoms between 2003 and 2010. We examined imaging features of perianal disease including fistula number, type and length, presence and size of associated abscess, and disease response/progression on follow-up MRI. We reviewed imaging studies and electronic medical records. Statistical analysis, including logistic regression, was performed to associate MR imaging features with treatment response and disease progression. We included 36 patients (22 male, 14 female; age range 8-21 years). Of these, 32 had a second MRI exam and 4 had clinical evidence of complete response, obviating the need for repeat imaging. Of the parameters analyzed, presence of abscess, type of fistula according to the Parks classification, and multiplicity were not predictors of treatment outcome. Maximum length of the dominant fistula and aggregate fistula length in the case of multiple fistulae were the best predictors of treatment outcome. Maximum fistula length <2.5 cm was a predictor of treatment response, while aggregate fistula length ≥2.5 cm was a predictor of disease progression. Perianal fistula length is an important imaging feature to assess on MRI of fistulizing Crohn disease. (orig.)

  7. Ileitis caused by Yersinia enterocolitica - X-ray differential diagnosis of Crohn's disease

    International Nuclear Information System (INIS)

    Lingg, G.; Hering, L.; Tanneberger, D.

    1981-01-01

    The article gives a brief description of the characteristic features of the clinical and roentgenological course and the various stages of enteritis caused by Yersinia. Basing on three cases of ileitis caused by Yersinia, the far-reaching similarity with the early changes and even the advanced stages of Crohn's diseases are demonstrated. Attention is drawn to the possibilities of differentiating between the two disease patterns. (orig.) [de

  8. Ileitis caused by Yersinia enterocolitica - X-ray differential diagnosis of Crohn's disease

    Energy Technology Data Exchange (ETDEWEB)

    Lingg, G.; Hering, L.; Tanneberger, D.

    1981-12-01

    The article gives a brief description of the characteristic features of the clinical and roentgenological course and the various stages of enteritis caused by Yersinia. Basing on three cases of ileitis caused by Yersinia, the far-reaching similarity with the early changes and even the advanced stages of Crohn's diseases are demonstrated. Attention is drawn to the possibilities of differentiating between the two disease patterns.

  9. Infliximab dependency in pediatric Crohn's disease: Long-term follow-up of an unselected cohort

    OpenAIRE

    Ridder, Lissy; Rings, Edmond; Damen, Gerard; Kneepkens, Frank; Schweizer, J.; Kokke, Freddy; Benninga, Marc; Norbruis, Obbe; Hoekstra, Hans; Gijsbers, Carolien; Escher, Johanna

    2008-01-01

    textabstractBackground: Infliximab is effective for induction and maintenance of remission in Crohn's disease. It is unknown how long patients should be kept on infliximab therapy. The primary aim of this study was to assess duration of effective maintenance therapy and infliximab dependency in pediatric CD patients initially responding to infliximab therapy. Methods: All pediatric patients treated with infliximab by pediatric gastroenterologists in the Netherlands because of severe luminal o...

  10. Role of percutaneous abscess drainage in the management of young patients with Crohn disease

    International Nuclear Information System (INIS)

    Pugmire, Brian S.; Gee, Michael S.; Kaplan, Jess L.; Winter, Harland S.; Hahn, Peter F.; Gervais, Debra A.; Doody, Daniel P.

    2016-01-01

    Intra-abdominal abscess is a common complication of Crohn disease in children. Prior studies, primarily in adults, have shown that percutaneous abscess drainage is a safe and effective treatment for this condition; however, the data regarding this procedure and indications in pediatric patients is limited. Our aim was to determine the success rate of percutaneous abscess drainage for abscesses related to Crohn disease in pediatric patients with a focus on treatment endpoints that are relevant in the era of biological medical therapy. We retrospectively reviewed 25 cases of patients ages ≤20 years with Crohn disease who underwent percutaneous abscess drainage. Technical success was defined as catheter placement within the abscess with reduction in abscess size on post-treatment imaging. Clinical success was defined as (1) no surgery within 1 year of drainage or (2) surgical resection following drainage with no residual abscess at surgery or on preoperative imaging. Multiple clinical parameters were analyzed for association with treatment success or failure. All cases were classified as technical successes. Nineteen cases were classified as clinical successes (76%), including 7 patients (28%) who required no surgery within 1 year of percutaneous drainage and 12 patients (48%) who had elective bowel resection within 1 year. There was a statistically significant association between resumption of immunosuppressive therapy within 8 weeks of drainage and both clinical success (P < 0.01) and avoidance of surgery after 1 year (P < 0.01). Percutaneous abscess drainage is an effective treatment for Crohn disease-related abscesses in pediatric patients. Early resumption of immunosuppressive therapy is statistically associated with both clinical success and avoidance of bowel resection, suggesting a role for percutaneous drainage in facilitating prompt initiation of medical therapy and preventing surgical bowel resection. (orig.)

  11. Accuracy of abdominal ultrasound and MRI for detection of Crohn disease and ulcerative colitis in children

    International Nuclear Information System (INIS)

    Ziech, Manon L.W.; Smets, Anne M.J.B.; Lavini, Cristina; Caan, Matthan W.A.; Nederveen, Aart J.; Bipat, Shandra; Stoker, Jaap; Hummel, Thalia Z.; Benninga, Marc A.; Kindermann, Angelika; Nievelstein, Rutger A.J.; Roelofs, Joris J.T.H.

    2014-01-01

    Endoscopy is currently the primary diagnostic technique for inflammatory bowel disease (IBD) in children. To assess the accuracy of US and dynamic contrast-enhanced MRI for diagnosing inflammatory bowel disease and for distinguishing Crohn disease and ulcerative colitis in comparison to a reference standard. Consecutive children with suspected IBD underwent diagnostic workup including ileocolonoscopy and upper gastrointestinal endoscopy as the reference standard, abdominal US, and MR enterography and colonography at 3 T. The protocol included a dynamic contrast-enhanced 3-D sequence. Sensitivity, specificity and kappa values were calculated for one ultrasonographer and two MRI observers. We included 28 children (15 boys) with mean age 14 years (range 10-17 years). The diagnosis was IBD in 23 children (72%), including 12 with Crohn disease, 10 with ulcerative colitis and 1 with indeterminate colitis. For the diagnosis of inflammatory bowel disease the sensitivity was 55% for US and 57% (both observers) for MR entero- and colonography, and the specificity was 100% for US and 100% (observer 1) and 75% (observer 2) for MR entero- and colonography. Combined MRI and US had sensitivity and specificity of 70% and 100% (observer 1) and 74% and 80% (observer 2), respectively. With the addition of a dynamic contrast-enhanced MR sequence, the sensitivity increased to 83% and 87%. US and MRI could only distinguish between Crohn disease and ulcerative colitis when terminal ileum lesions were present. US and MR entero- and colonography have a high accuracy for diagnosing inflammatory bowel disease in children but cannot be used to distinguish Crohn disease and ulcerative colitis. (orig.)

  12. Osteonecrosis in a Patient with Crohn's Disease Unrelated to Corticosteroid Use

    Directory of Open Access Journals (Sweden)

    Ali Khan

    2001-01-01

    Full Text Available Osteonecrosis is a feared complication of corticosteroid use. However, a direct association between corticosteroid use and osteonecrosis has never been proven. The present report examines the case of a patient with longstanding Crohn's disease who had never been treated with corticosteroids and who developed osteonecrosis of the talus. The association of systemic inflammatory disorders with osteonecrosis and the possible association with vascular thrombosis are discussed.

  13. Serial observations in Crohn's disease: can hydro-MRI replace follow-through examinations?

    International Nuclear Information System (INIS)

    Schunk, K.; Metzmann, U.; Kersjes, W.; Schadmand-Fischer, S.; Kreitner, K.F.; Duchmann, R.; Protzer, U.; Wanitschke, R.; Thelen, M.

    1997-01-01

    To compare the value of hydro-MRI with follow-through examinations in the follow-up of Crohn's disease. 22 patients known to be suffering from Crohn's disease were examined via 1.5 T-MR system; an oral contrast examination using 1000 ml of a 2.5% mannitol solution was performed in all patients. T 2 -weighted TSE sequences and T 1 -weighted SE sequences were performed before and after the intravenous injection of Gd-DTPA. To reduce movement artifacts caused by peristalsis of the gut, intravenous injection of 40 mg Buscopan was given. The findings of hydro-MRI were compared with the follow-through examinations. In the upper gastrointestinal tract, the follow-through examination showed clear advantages compared with hydro-MRI for the demonstration of inflammatory changes in the gut; Hydro-MRI was, however, somewhat more reliable in the ileum and colon. It was also more sensitive than the follow-through for the demonstration of enteric fistulae (four as compared with two cases), and in demonstration extraluminal changes (free fluid in six against zero, and inflammatory adherent loops (four against zero)). Amongst the 22 patients, hydro-MRI was equal (in 10) or better (in 8) than the follow-through examination for demonstrating the intestinal manifestations of Crohn's disease, and follow-through was better in only four. For follow-up of Crohn's disease, hydro-MRI is at least as good as follow-through examination, and is even preferable, because of the absence of radiation exposure of the usually young patients. (orig.) [de

  14. Nocturnal growth hormone and gonadotrophin secretion in growth retarded children with Crohn's disease.

    OpenAIRE

    Farthing, M J; Campbell, C A; Walker-Smith, J; Edwards, C R; Rees, L H; Dawson, A M

    1981-01-01

    Although impaired growth hormone secretion in response to pharmacological stimuli occurs in some growth retarded children with Crohn's disease, its relationship to past and future th is uncertain. We have therefore determined the growth hormone and gonadotrophin response to the physiological stimulus of sleep by continuous venous sampling in five severely gonadotrophin profiles, the mean plasma hormone concentrations during the first five hours of sleep were determined. In three of the five p...

  15. The association between participation in organised physical activity and level of physical activity and inactivity in adolescent girls [Vztah mezi organizovanou pohybovou aktivitou a úrovní pohybové aktivity a inaktivity u adolescentních dívek

    Directory of Open Access Journals (Sweden)

    Josef Mitáš

    2012-03-01

    Full Text Available BACKGROUND: An increase of leisure time and vigorous physical activity (PA in girls can be supported by their regular participation in organised PA, as it brings numerous health benefits and is an important part of healthy lifestyle. OBJECTIVE: This study aimed to examine whether there are differences in physical activity and inactivity structure and levels in girls who do not participate in any organised PA and girls who regularly participate in physical education or training classes. METHODS: The sample comprised 497 girls (age 17.94 ± 0.52 years from Poland participating never (group 1, or once (group 2, twice (group 3, and three or four times (group 4 a week in any organised PA. The Polish version of the International Physical Activity Questionnaire (IPAQ, accelerometer ActiGraph GT1M and activity and inactivity logs were used to assess the level and structure of physical activity and inactivity. RESULTS: Girls participating in organised PA three or more times a week showed significantly the highest values of steps/day, moderate and vigorous PA, and leisure time PA, but also inactivity in comparison to girls without participation in organised PA. CONCLUSIONS: This study provides the evidence supporting the positive link between a number/week participation in organised PA and PA level. However, the findings from this study also advocate the need of increasing PA and reducing inactivity in girls in school or after-school periods, regardless of the participation in organised PA.[VÝCHODISKA: Nárůst objemu volnočasové a intenzivní pohybové aktivity, díky které je možné dosáhnout množství zdravotních benefitů a je důležitou součástí zdravého životního stylu, je u dívek možné podpořit pravidelnou účastí v organizovaných jednotkách. CÍLE: Cílem této studie bylo analyzovat rozdíly ve struktuře a úrovni pohybové aktivity a inaktivity u dívek, které se nezúčastňují žádné organizované pohybové aktivity

  16. Severe metabolic alkalosis and recurrent acute on chronic kidney injury in a patient with Crohn's disease

    Directory of Open Access Journals (Sweden)

    Schmid Axel

    2010-04-01

    Full Text Available Abstract Background Diarrhea is common in patients with Crohn's disease and may be accompanied by acid base disorders, most commonly metabolic acidosis due to intestinal loss of bicarbonate. Case Presentation Here, we present a case of severe metabolic alkalosis in a young patient suffering from M. Crohn. The patient had undergone multiple resections of the intestine and suffered from chronic kidney disease. He was now referred to our clinic for recurrent acute kidney injury, the nature of which was pre-renal due to profound volume depletion. Renal failure was associated with marked hypochloremic metabolic alkalosis which only responded to high volume repletion and high dose blockade of gastric hypersecretion. Intestinal failure with stomal fluid losses of up to 5.7 litres per day required port implantation to commence parenteral nutrition. Fluid and electrolyte replacement rapidly improved renal function and acid base homeostasis. Conclusions This case highlights the important role of gastrointestinal function to maintain acid base status in patients with Crohn's disease.

  17. Evidence for an increased risk of Crohn's disease in oral contraceptive users.

    Science.gov (United States)

    Lesko, S M; Kaufman, D W; Rosenberg, L; Helmrich, S P; Miller, D R; Stolley, P D; Shapiro, S

    1985-11-01

    The risk of Crohn's disease in relation to oral contraceptive use was evaluated in a hospital-based, case-control study of 57 women with Crohn's disease and 2189 controls with other conditions. The relative risk for oral contraceptive users compared with women who had never used these drugs was 1.9 (95% confidence interval 1.0-3.5). The magnitude of the relative risk estimate was related to the timing and duration of oral contraceptive use. For use within the year before admission to a hospital (recent use), the relative risk estimate was 4.3 (2.1-8.7); the estimate dropped to 1.2 (0.5-2.6) 4 yr after discontinuation of oral contraceptive use. The relative risk estimate for recent use that lasted greater than or equal to 5 yr was 8.0 (3.1-21). The findings are in accordance with earlier reports of an increased risk of Crohn's disease in oral contraceptive users.

  18. Smoking cessation and the course of Crohn's disease: an intervention study.

    Science.gov (United States)

    Cosnes, J; Beaugerie, L; Carbonnel, F; Gendre, J P

    2001-04-01

    To evaluate the benefit of smoking cessation in individuals with Crohn's disease, we performed an intervention study in a large cohort of smokers with the disease. Repeated counseling to stop smoking, with easy access to a smoking cessation program, was given to 474 consecutive smokers with Crohn's disease. Patients who stopped smoking for more than 1 year (quitters) were included in a prospective follow-up study, which compared disease course and therapeutic needs with 2 control groups, continuing smokers and nonsmokers, paired for age, gender, disease location, and activity. There were 59 quitters (12%). Predictors of quitting were the physician, previous intestinal surgery, high socioeconomic status, and in women, oral contraceptive use. During a median follow-up of 29 months (1-54 months), the risk of flare-up in quitters did not differ from that in nonsmokers and was less than in continuing smokers (P Crohn's disease who stop smoking for more than 1 year have a more benign disease course than if they had never smoked.

  19. Assessment of Crohn's disease activity in the small bowel with MR and conventional enteroclysis: preliminary results

    International Nuclear Information System (INIS)

    Gourtsoyiannis, Nicholas; Papanikolaou, Nickolas; Grammatikakis, John; Papamastorakis, George; Prassopoulos, Panos; Roussomoustakaki, Maria

    2004-01-01

    Every single imaging finding that can be disclosed on conventional and MR enteroclysis was correlated with the Crohn's disease activity index (CDAI). Nineteen consecutive patients with Crohn's disease underwent colon endoscopy and both conventional and MR enteroclysis examinations. Seventeen MR imaging findings and seven conventional enteroclysis findings were ranked on a four-point grading scale and correlated with CDAI, with a value of 150 considered as the threshold for disease activity. Six patients had active disease in the colon according to colon endoscopy. In the remaining 13 patients, the presence of deep ulcers (P=0.002), small bowel wall thickening (P=0.022) and gadolinium enhancement of mesenteric lymph nodes (P=0.014) identified on MR enteroclysis images were strongly correlated to disease activity. The product of deep ulcers and enhancement of lymph node ranks identified on MR enteroclysis were the optimum combination for discriminating active from non-active disease (F-test: 55.95, P<0.001). Additionally, the ranking of deep ulcers on conventional enteroclysis provided statistically significant differences between active and non-active patients (F-test: 14.12, P=0.004). Abnormalities strongly suggestive of active Crohn's disease can be disclosed on MR enteroclysis examinations and may provide pictorial information for local inflammatory activity. (orig.)

  20. Imaging of small intestinal Crohn's disease: comparison between MR enteroclysis and conventional enteroclysis

    Energy Technology Data Exchange (ETDEWEB)

    Gourtsoyiannis, Nicholas C.; Grammatikakis, John; Papamastorakis, George; Papanikolaou, Nickolas [University Hospital of Heraklion, Department of Radiology, University of Crete Faculty of Medicine, Heraklion, Crete (Greece); Koutroumbakis, John; Rousomoustakaki, Maria [University of Crete, Department of Gastroenterology, University Hospital of Heraklion, Heraklion (Greece); Prassopoulos, Panos [University of Thrace, Department of Radiology, University Hospital of Alexandroupoli, Alexandroupoli (Greece)

    2006-09-15

    The purpose of this study was to compare MR enteroclysis (MRE) with conventional enteroclysis (CE) in patients with small intestinal Crohn's disease. Fifty-two consecutive patients with known or suspected Crohn's disease underwent MR and conventional enteroclysis, which was considered the gold standard. Eleven imaging features, classified in three groups, mucosal, transmural and extraintestinal, were subjectively evaluated by two experienced radiologists. MRE and CE were in full agreement in revealing, localizing and estimating the length of all involved segments of the small bowel. The sensitivity of MRE for the detection of superficial ulcers, fold distortion and fold thickening was 40, 30 and 62.5%, respectively. The sensitivity of MRE for the detection of deep ulcers, cobble-stoning pattern, stenosis and prestenostic dilatation was 89.5, 92.3, 100 and 100%, respectively. Additional findings demonstrated on MRE images included fibrofatty proliferation in 15 cases and mesenteric lymphadenopathy in 19 cases. MRE strongly correlates with CE in the detection of individual lesions expressing small intestinal Crohn's disease. It provides additional information from the mesenteries; however, its capability to detect subtle lesions is still inferior to conventional enteroclysis. (orig.)