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Sample records for aktiv morbus crohn

  1. MR enterography sequence evaluation for patients with Crohn's disease; Sequenz-Evaluation fuer die MR-Enterografie fuer Patienten mit Morbus Crohn

    Energy Technology Data Exchange (ETDEWEB)

    Schleder, S.; Dendle, L.M.; Friedrich, C.; Wiggermann, P.; Stroszczynski, C.; Schreyer, A.G. [Universitaetsklinikum Regensburg (Germany). Inst. fuer Roentgendiagnostik; Pawlik, M. [Caritas-Krankenhaus St. Josef, Regensburg (Germany). Klinik fuer Anaesthesiologie, Intensiv- und Notfallmedizin; Ott, C. [Universitaetsklinikum Regensburg (Germany). Klinik und Poliklinik fuer Innere Medizin I; Agha, A. [Universitaetsklinikum Regensburg (Germany). Klinik und Poliklinik fuer Chirurgie

    2013-05-15

    Purpose: To evaluate a routine MR enterography (MRE) protocol for patients with Crohn's disease (CD) in order to assess and rank the subjectively most important sequences regarding diagnostic decisions. Materials and Methods: We prospective ly examined 84 patients (42 male) with known CD using a coronal T2/T1-weighted balanced SSFP (TrueFISP), axial T2-weighted single shot TSE (HASTE) as well as an axial T1-weighted gradient-echo sequence (2D-FLASH) before intravenous contrast application and a 2D-FLASH sequence with axial and coronal orientation after in travenous contrast application. 4 experienced radiologists subjectively evaluate d the sequences independently using a scale between 1 and 5 (1 = excellent; 5 = non-diagnostic) regarding their diagnostic significance for a final radiologic d ecision. The ranking of the different sequences was statistically tested by the Friedman analysis. Results: The following ranking was found: HASTE sequences wer e ranked prior to contrast-enhanced axial gradient-echo (2D-FLASH). The third to fifth ranking was TrueFISP, the axial contrast-enhanced 2D-FLASH and the 2D-FLA SH without contrast, respectively. Differences between the first and second rank were significant (p < 0.05), and all other differences were highly significant (p < 0.01). Conclusion: The stable and fast T2-weighted MR sequences without intravenous contrast represented by axial HASTE and coronal TrueFISP were ranked as number 1 and 3. The examination protocol should be completed by a coronal T 1-weighted gradient-echo-sequence after contrast injection, which can be supplemented by an axial acquisition. The T1-weighted gradient-echo sequence without contrast could be omitted. (orig.)

  2. Aktiv kontra passiv forvaltning

    DEFF Research Database (Denmark)

    Bechmann, Ken L.; Pedersen, Lasse Heje

    2017-01-01

    Fordele og ulemper ved aktiv og passiv forvaltning har fået fornyet opmærksomhed blandt andet i forbindelse med den forestående implementering af MiFID II. Som bidrag til denne diskussion indeholder dette nummer af Finans/Invest tre artikler, der behandler aktiv og passiv forvaltning fra...... forskellige vinkler. Denne leder forklarer, hvorfor valget mellem aktiv og passiv forvaltning er mere kompliceret, end hvad man kunne tro ved første øjekast, og konkluderer, at der vil være plads til - og behov for - begge typer forvaltning....

  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. Laserbehandeling bij morbus Hailey-Hailey

    NARCIS (Netherlands)

    Sprengers, M.; de Coster, D.; Arits, A.H.M.M.; Verstraeten, V.L.R.M.

    2017-01-01

    Hailey-Hailey disease, also referred to as benign familial pemphigus, is a rare genodermatosis that results in painful erosions in erythematous plaques in the skin creases. Heat, sweat and friction usually worsen the disease. Beside pain, morbus Hailey-Hailey also restricts patients activities.

  5. 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...

  6. Pasireotid: Eine neue Therapieoption bei Morbus Cushing

    Directory of Open Access Journals (Sweden)

    Luger A

    2012-01-01

    Full Text Available Im Behandlungsalgorithmus des Morbus Cushing war bisher keine zugelassene pharmakologische Behandlungsmöglichkeit verfügbar. Mit dem Multirezeptor-Somatostatinanalogon Pasireotid steht nun mit der im April 2012 erfolgten Zulassung die erste, spezifisch für die Therapie dieses Krankheitsbildes entwickelte Substanz zur Verfügung. Die Studienevidenz belegt eine schnelle und nachhaltige Reduktion der ACTH- und Kortisolproduktion mit klinischer Besserung bei einem Großteil der Patienten.

  7. 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.

  8. 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

  9. Crohn's disease.

    Science.gov (United States)

    von Roon, Alexander C; Reese, George E; Orchard, Timothy R; Tekkis, Paris P

    2007-11-07

    Crohn's disease is a long-term chronic condition of the gastrointestinal tract. It is characterised by transmural, granulomatous inflammation that occurs in a discontinuous pattern, with a tendency to form fistulae. The cause is unknown but may depend on interactions between genetic predisposition, environmental triggers, and mucosal immunity. We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of medical treatments in adults to induce remission in Crohn's disease? What are the effects of lifestyle interventions in adults with Crohn's disease to maintain remission? What are the effects of surgical interventions in adults with small-bowel Crohn's disease to induce remission? What are the effects of surgical interventions in adults with colonic Crohn's disease to induce remission? What are the effects of medical interventions to maintain remission in adults with Crohn's disease; and to maintain remission following surgery? We searched: Medline, Embase, The Cochrane Library and other important databases up to March 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). We found 60 systematic reviews, RCTs, or observational studies that met our inclusion criteria. In this systematic review we present information relating to the effectiveness and safety of the following interventions: aminosalicylates, antibiotics, azathioprine/mercaptopurine, ciclosporin, corticosteroids (oral), enteral nutrition, fish oil, infliximab, methotrexate, probiotics, resection, segmental colectomy, smoking cessation, and strictureplasty.

  10. MR of the liver in Wilson`s disease; MRT der Leber bei Morbus Wilson

    Energy Technology Data Exchange (ETDEWEB)

    Vogl, T.J. [Strahlenklinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Steiner, S. [Klinikum Grosshadern, Radiologische Klinik und Poliklinik, Univ. Muenchen (Germany); Hammerstingl, R. [Strahlenklinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany); Schwarz, S. [Klinikum Grosshadern, Neurologische Klinik, Univ. Muenchen (Germany); Kraft, E. [Klinikum Grosshadern, Neurologische Klinik, Univ. Muenchen (Germany); Weinzierl, M. [Klinikum Grosshadern, 2. Medizinische Klinik, Univ. Muenchen (Germany); Felix, R. [Strahlenklinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, Freie Univ. Berlin (Germany)

    1994-01-01

    To show that Wilson`s disease is one likely cause of multiple low-intensity nodules of the liver we obtained MR images in 16 patients with clinically and histopathologically confirmed Wilson`s disease. Corresponding to morphological changes MRI enabled the subdivision of the patients into two groups. Using a T{sub 2}-weighted spin-echo sequence (TR/TE=2000/45-90) liver parenchyma showed multiple tiny low-intensity-nodules surrounded by high-intensity septa in 10 out of 16 patients. 5 patients had also low-intensity nodules in T{sub 1}-weighted images (TR/TE=600/20). In patients of this group histopathology revealed liver cirrhosis (n=7) and fibrosis (n=2). Common feature of this patient group was marked inflammatory cell infiltration into fibrous septa, increase of copper concentration in liver parenchyma and distinct pathological changes of laboratory data. In the remaining 6 patients no pathological change of liver morphology was demonstrated by MRI corresponding to slight histopathological changes of parenchyma and normal laboratory data. As low-intensity nodules surrounded by high intensity septa can be demonstrated in patients with marked inflammatory infiltration of liver parenchyma MRI may help to define Wilson patients with poorer prognosis. In patients with low-intensity nodules of the liver and unknown cause of liver cirrhosis laboratory data and histopathology should be checked when searching for disorders of copper metabolism. (orig.) [Deutsch] Im Rahmen einer prospektiven Studie wurde die Leber bei 16 Patienten mit klinisch gesichertem Morbus Wilson magnetresonanztomographisch untersucht. Zum Einsatz kamen T{sub 1}- und T{sub 2}-gewichtete Spin-Echo-Sequenzen vor und nach Applikation von Gd-DTPA (0,1 mmol/kg KG). Anhand der MRT-Befunde konnten zwei unterschiedliche Patientenkollektive definiert werden. 10 Patienten wiesen in der T{sub 2}-gewichteten Sequenz hypointense Regeneratknoten auf und zeigten histopathologisch ausgepraegte Befunde einer

  11. 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

  12. Meeting the Challenge of Crohn's Disease

    Science.gov (United States)

    ... page please turn JavaScript on. Feature: Crohn's Disease Meeting the Challenge of Crohn's Disease Past Issues / Winter ... Living with Crohn's Disease / What Is Crohn's Disease / Meeting the Challenge of Crohn's Disease Winter 2016 Issue: ...

  13. 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

  14. 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

  15. 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

  16. 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

  17. Radiation therapy for early stages of Morbus Ledderhose

    Energy Technology Data Exchange (ETDEWEB)

    Heyd, Reinhard [Dept. of Radiotherapy, Klinikum Offenbach (Germany); Dorn, Anne Pia; Mueller-Schimpfle, Marcus [Central Inst. of Radiology, Municipal Hospitals, Frankfurt/Main-Hoechst (Germany); Herkstroeter, Markus [Radiotherapeutic Practice at the Municipal Hospitals, Frankfurt/Main-Hoechst (Germany); Roedel, Claus; Fraunholz, Ingeborg [Dept. of Radiotherapy and Oncology, Univ. Hospital Frankfurt/Main (Germany)

    2010-01-15

    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.)

  18. 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.)

  19. Graves' disease and toxic nodular goiter - radioiodine therapy; Morbus Basedow und Autonomie - Radioiodtherapie

    Energy Technology Data Exchange (ETDEWEB)

    Schicha, H.; Dietlein, M. [Koeln Univ. (Germany). Klinik und Poliklinik fuer Nuklearmedizin

    2002-04-01

    At the 15th conference on the human thyroid in Heidelberg in 2001 the following aspects of the radioiodine therapy of benign thyroid disorders were presented: General strategies for therapy of benign thyroid diseases, criterions for conservative or definitive treatment of hyperthyroidism as first line therapy and finally preparation, procedural details, results, side effects, costs and follow-up care of radioiodine therapy as well as legal guidelines for hospitalization in Germany. The diagnosis Graves' hyperthyroidism needs the decision, if rather a conservative treatment or if primary radioiodine therapy is the best therapeutic approach. In the USA 70-90% of these patients are treated with radioiodine as first line therapy, whereas in Germany the conservative therapy for 1-1.5 years is recommended for 90%. This review describes subgroups of patients with Graves' disease showing a higher probability to relapse after conservative treatment. Comparing benefits, adverse effects, costs, and conveniences of both treatment strategies the authors conclude that radioiodine therapy should be preferred as first line therapy in 60-70% of the patients with Graves' hyperthyroidism. (orig.) [German] In dem vorliegenden Beitrag wird ueber die Radioiodtherapie gutartiger Schilddruesenerkrankungen referiert. Dies betrifft gesetzliche Regelungen in Deutschland, grundlegende Ueberlegungen zur Therapie benigner Schilddruesenerkrankungen, die Diskussion konservative versus definitive Therapieindikation der Hyperthyreose und schliesslich die Themenkomplexe Vorbereitung, Durchfuehrung, Ergebnisse, Nebenwirkungen und Komplikationen, Kosten sowie Nachsorge der Radioiodtherapie. Im Vordergrund steht die Abgrenzung der konservativen Therapieindikation gegenueber der primaeren Radioiodtherapie des Morbus Basedow in Deutschland. Waehrend in den USA 70-90% der Morbus-Basedow-Faelle primaer mit Radioiodtherapie behandelt werden, wird in Deutschland bei 90% zunaechst ein

  20. What Is Crohn's Disease?

    Science.gov (United States)

    ... card! You can find the assessment here . Click video below to learn more about Crohn's Disease Get Involved Read the Latest News Attend Upcoming Events Find a Support Group I’ll Be Determined Explore treatment options, learn how to make better choices, and join the community at I'll ...

  1. Osteomalacia in Crohn's disease.

    Science.gov (United States)

    Dedeoglu, Meryem; Garip, Yesim; Bodur, Hatice

    2014-01-01

    Osteomalacia is a metabolic bone disorder characterized by impaired mineralization of the bone matrix. Vitamin D deficiency due to malabsorption syndromes may cause osteomalacia. This is a case of a patient with a 6-year history of seronegative spondyloarthropathy associated with Crohn's disease who was admitted to our outpatient clinic with symptoms of osteomalacia. Osteomalacia is a metabolic bone disease characterized by an impaired mineralization of the bone matrix, frequently caused by disorders in vitamin D or phosphate metabolism. Vitamin D deficiency due to malabsorption syndromes (e.g., Crohn's disease, ulcerative colitis, celiac disease, and jejuno-ileal bypass for obesity) may cause osteomalacia. A 43-year-old male presented with fatigue, low back pain, and morning stiffness. He had a 6-year history of seronegative spondyloarthropathy associated with Crohn's disease. Laboratory findings revealed low serum calcium, low 25-hydroxy vitamin D3, normal phosphorus, elevated parathyroid hormone, and alkaline phosphatase levels. Radiographs revealed grade IV sacroiliitis and Looser zones. He was diagnosed with osteomalacia due to the malabsorption of vitamin D. His symptoms and signs were relieved with supplements of vitamin D and calcium. Osteomalacia should be considered in differential diagnosis when assessing low back pain in the patients with chronic inflammatory bowel disease. Vitamin D deficiency should be treated with vitamin D supplementation in patients with Crohn's disease to prevent osteomalacia.

  2. Experiental Civic Learning by using "Projekt: Aktive Bürger"

    Directory of Open Access Journals (Sweden)

    Klaus Koopmann

    2002-01-01

    Full Text Available Various social and political developments seem to sum up to a process of 'de-civilization' which impede - rather than facilitate - the project of a humane and democratic society. In order to make this project a successful one it is necessary to reclaim citizens as politically acting subjects. The ability to act as enlightened and autonomous citizens will be sustainably acquired by experiencing extensive participation in society and in politics. Civic education should foster this process of 'revi-talization of citizenship' by offering youth meaningful participatory experiences of social and po-litical relevance. That is: Civic education should create, organize and offer learning strategies that are oriented towards the notion of reflective acting as experiential learning. Experiential learning processes, aimed at the sustainable acquisition of competencies which are relevant in politics and civil society, will particularly unfold in the course of the (interactive dealing of the individual(s with the authentic political and social problems and processes that surround and concern them. This also includes reflection and co-operation. One example of how to practice an experiential and prob-lem-centred learning strategy is well being demonstrated by the civic education program "Projekt: Aktive Bürger", the German adaptation of "We the People ... Project Citizen" designed by the American Center for Civic Education.

  3. MRI of vulvar Crohn disease

    Energy Technology Data Exchange (ETDEWEB)

    Pai, Deepa; Dillman, Jonathan R.; Mahani, Maryam Ghadimi; Strouse, Peter J. [University of Michigan Health System, Department of Radiology, Section of Pediatric Radiology, C.S. Mott Children' s Hospital, F3503, Ann Arbor, MI (United States); Adler, Jeremy [University of Michigan Health System, Department of Pediatrics and Communicable Diseases, Division of Pediatric Gastroenterology, C. S. Mott Children' s Hospital, Ann Arbor, MI (United States)

    2011-04-15

    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.)

  4. 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.

  5. Colorectal cancer complicating Crohn's disease.

    Science.gov (United States)

    Freeman, H J

    2001-04-01

    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 with Crohn's disease was used. Altogether, there were six patients with colorectal cancer (ie, overall rate of 0.7%). All of these patients were men with an initial diagnosis of Crohn's disease established at a mean age of approximately 28 years, with either ileocolonic disease or colonic disease alone, but not with ileal disease alone. Although there was a predominance of women in the overall study population (ie, 56.1%), no women developed colorectal cancer. The clinical behaviour of Crohn's disease was classified as nonstricturing in all six patients with colorectal cancer, but in two patients, Crohn's disease was complicated by a perirectal abscess or a fistula. All cancers were located in the rectum and were diagnosed 30 years, 22 years, seven years, 18 years, 20 years and 40 years after Crohn's disease was initially diagnosed. In three patients, the cancer was detected in a residual rectal stump after a partial colon resection at least 10 years earlier. In five patients, localized extension of disease through the serosa, nodal or distant metastases (ie, liver, lung) was found at the time of cancer diagnosis; two patients have since died. The present study confirms that Crohn's disease involving the colon may be a possible risk factor for the development of colorectal cancer, at least in younger men, but, in this study, not in women. However, part of this increased risk in men may have been related to the presence of a rectal stump, rather than to Crohn's disease per se.

  6. Colorectal Cancer Complicating Crohn's Disease

    Directory of Open Access Journals (Sweden)

    Hugh J Freeman

    2001-01-01

    Full Text Available 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 with Crohn's disease was used. Altogether, there were six patients with colorectal cancer (ie, overall rate of 0.7%. All of these patients were men with an initial diagnosis of Crohn's disease established at a mean age of approximately 28 years, with either ileocolonic disease or colonic disease alone, but not with ileal disease alone. Although there was a predominance of women in the overall study population (ie, 56.1%, no women developed colorectal cancer. The clinical behaviour of Crohn's disease was classified as nonstricturing in all six patients with colorectal cancer, but in two patients, Crohn's disease was complicated by a perirectal abscess or a fistula. All cancers were located in the rectum and were diagnosed 30 years, 22 years, seven years, 18 years, 20 years and 40 years after Crohn's disease was initially diagnosed. In three patients, the cancer was detected in a residual rectal stump after a partial colon resection at least 10 years earlier. In five patients, localized extension of disease through the serosa, nodal or distant metastases (ie, liver, lung was found at the time of cancer diagnosis; two patients have since died. The present study confirms that Crohn's disease involving the colon may be a possible risk factor for the development of colorectal cancer, at least in younger men, but, in this study, not in women. However, part of this increased risk in men may have been related to the presence of a rectal stump, rather than to Crohn's disease per se.

  7. Nutrition in paediatric Crohn's disease

    African Journals Online (AJOL)

    Keywords: Crohn's disease; linear growth; Tumour Necrosis Factor-α; nutritional support; enteral ... hormone (GH) stimulation, is the key mediator of GH effects at the ... deficit documented in children with CD seems to be directly linked to.

  8. Emergency surgery for Crohn's disease.

    Science.gov (United States)

    Smida, Malek; Miloudi, Nizar; Hefaiedh, Rania; Zaibi, Rabaa

    2016-03-01

    Surgery has played an essential role in the treatment of Crohn's disease. Emergency can reveal previously unknown complications whose treatment affects prognosis. Indicate the incidence of indications in emergent surgery for Crohn's disease. Specify the types of procedures performed in these cases and assess the Results of emergency surgery for Crohn's disease postoperatively,  in short , medium and long term. Retrospective analysis of collected data of 38 patients, who underwent surgical resection for Crohn's disease during a period of 19 years from 1992 to 2011 at the department of surgery in MONGI SLIM Hospital, and among them 17 patients underwent emergency surgery for Crohn's disease. In addition to socio-demographic characteristics and clinical presentations of our study population, we evaluated the indications, the type of intervention, duration of evolution preoperative and postoperative complications and overall prognosis of the disease. Of the 38 patients with Crohn's disease requiring surgical intervention, 17/38 patients underwent emergency surgery. Crohn's disease was inaugurated by the complications requiring emergency surgery in 11 patients. The mean duration of symptoms prior to surgery was 1.5 year. The most common indication for emergency surgery was acute intestinal obstruction (n=6) followed by perforation and peritonitis (n=5). A misdiagnosis of appendicitis was found in 4 patients and a complicated severe acute colitis for undiagnosed Crohn's disease was found in 2 cases. The open conventional surgery was performed for 15 patients. Ileocolic resection was the most used intervention. There was one perioperative mortality and 5 postoperative morbidities. The mean of postoperative hospital stay was 14 days (range 4-60 days). Six patients required a second operation during the follow-up period. The incidence of emergency surgery for Crohn's disease in our experience was high (17/38 patients), and is not as rare as the published estimates

  9. Surgical management of Crohn's disease.

    Science.gov (United States)

    Lu, Kim C; Hunt, Steven R

    2013-02-01

    Although medical management can control symptoms in a recurring incurable disease, such as Crohn's disease, surgical management is reserved for disease complications or those problems refractory to medical management. In this article, we cover general principles for the surgical management of Crohn's disease, ranging from skin tags, abscesses, fistulae, and stenoses to small bowel and extraintestinal disease. Copyright © 2013 Elsevier Inc. All rights reserved.

  10. US contribution in Crohn's disease

    Energy Technology Data Exchange (ETDEWEB)

    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.

  11. Radioiodine treatment of Grave's disease; Radiojodtherapie des Morbus Basedow

    Energy Technology Data Exchange (ETDEWEB)

    Heidenreich, P.; Vogt, H.; Dorn, R.; Graf, G.; Kopp, J. [Klinik fuer Nuklearmedizin, Zentralklinikum Augsburg (Germany)

    2001-09-01

    In Germany radioiodine therapy of Grave's disease is performed in patients older than 20 years, after at least one year of unsuccessful antithyroid therapy, intolerance against antithyroid medication, recurrences after surgical interventions and small goiters. Hyperthyroidism is eliminated with an ablative dose concept (300 Gy) in more than 90% associated with rate of hypothyroidism in the outcome of also more than 90%. Adverse prognostic factors are an insufficient dose to the thyroid and/or concomitant antithyreoid medication. Radioiodine therapy in Germany must be an inpatient single time approach due to quality assurance and radiation protection reasons. The mean hospitalization is only 3-4 days with the patient being discharged at an annual dose of less than 1 mSv at 2 m distance (dose rate at discharge < 3,5 {mu}Sv/h at 2 m). An adjuvant treatment with cortisone is recommended in a simultaneous endocrine ophthalmopathy to prevent from deterioration. Radioiodine therapy of Grave's disease is cost effective with a low probability of side-effects and is not associated with an increased genetic or somatic risk. Therapy control and life span follow up has to be carried out by the expert physician legally responsible for the radioiodine therapy. (orig.) [German] Die Radiojodtherapie des Morbus Basedow wird in Deutschland, bei Patienten aelter als 20 Jahre, erst nach mindestens einjaehriger, erfolgloser thyreostatischer Therapie, bei Thyreostatikaunvertraeglichkeit, Rezidiven nach Operation und kleinen Strumen durchgefuehrt. Die Beseitigung der Hyperthyreose wird mit einem ablativen Dosiskonzept (300 Gy) in > 90%, verbunden mit einer Hypothyreoserate von ebenfalls > 90% erreicht. Prognostisch unguenstige Einflussfaktoren sind eine zu niedrig gewaehlte Herddosis und/oder eine begleitende Thyreostase. Aus Gruenden der Qualitaetssicherung und des Strahlenschutzes muss in Deutschland die Radiojodtherapie stationaer als Einzeittherapie durchgefuehrt werden. Die

  12. Pathogenesis of Graves` disease and therapeutic implications; Pathogenese des Morbus Basedow und therapeutische Implikationen

    Energy Technology Data Exchange (ETDEWEB)

    Seif, F.J. [Tuebingen Univ. (Germany). Medizinische Klinik und Poliklinik

    1997-12-01

    Graves` disease presents itself clinically mainly as hyperthyroidism and infiltrative ophthalmopathy and to a minimal extent also as dermopathy and acropachy. Autoimmune processes are the basic pathogenesis. Stimulating antibodies against the TSH receptor cause hyperthyroidism. Autoantibodies and autoreactive T lymphocytes against primarily thyroidal antigens cross-react with similar antigens of the eye muscles and orbital connective tissue, thus spreading the disease from the thyroid to the eyes. The therapeutic goal comprises not only the treatment of hyperthyroidism, but also the induction of a steady immuntolerance in order to minimize the irreversible damage to the eye. The therapeutic armamentarium is formed by antithyroid drugs, glucocorticoids, retrobulbar radition and thyroid ablation, either by nearly total thyroidectomy or by radioiodine. The different indications for both ablative procedures are discussed. (orig.) [Deutsch] Der Morbus Basedow manifestiert sich klinisch hauptsaechlich als Hyperthyreose und infiltrative Orbitopathie, waehrend Demopathie und Akropathie selten sind. Der Krankheit liegt ein Autoimmunprozess zugrunde, wobei stimuliernde Autoantikoerper gegen den TSH-Rezeptor die Hyperthyreose hervorrufen. Autoantikoerper und T-Lymphozyten gegen primaer thyreoidale Antigene verursachen durch Kreuzreaktion mit aehnlichen Antigenen an den Augenmuskeln und orbitalem Bindegewebe die Orbitopathie. Das therapeutsiche Ziel besteht nicht nur in der Behandlung der Hyperthyreose, sondern vor allem in der Induktion einer immuntoleranten Remission, um die irreversiblen Schaeden am Auge zu minimieren. Die Therapie umfasst Thyreostatika, Glukokortikoide und Orbitaspitzenbestrahlung sowie eine Schilddruesenablation entweder durch fast totale Schilddruesenresektion oder durch Radiojodtherapie. Die Differentialindikationen fuer die beiden ablativen Massnahmen werden eroertert. (orig.)

  13. El cólera morbus en cinco municipios del Estado de México, en 1850

    Directory of Open Access Journals (Sweden)

    María del Pilar Iracheta

    1998-01-01

    Full Text Available El artículo pretende hacer un análisis sobre los efectos del cólera morbus en cinco municipios del Estado de México (Toluca, Temoaya, Calimaya, Otzolotepec y Capulhuac durante los meses de junio y julio de 1850, aunque la enfermedad se manifestó hasta noviembre de ese año. Asimismo, se trata de señalar algunos elementos que permitieron la propagación del cólera. También se trata de medir los efectos de la enfermedad en los municipios referidos, tomando como base los factores como la edad y el sexo.

  14. El cólera morbus en cinco municipios del Estado de México, en 1850

    OpenAIRE

    María del Pilar Iracheta; Hilda Lagunas

    1998-01-01

    El artículo pretende hacer un análisis sobre los efectos del cólera morbus en cinco municipios del Estado de México (Toluca, Temoaya, Calimaya, Otzolotepec y Capulhuac) durante los meses de junio y julio de 1850, aunque la enfermedad se manifestó hasta noviembre de ese año. Asimismo, se trata de señalar algunos elementos que permitieron la propagación del cólera. También se trata de medir los efectos de la enfermedad en los municipios referidos, tomando como base...

  15. El cólera morbus en cinco municipios del Estado de México, en 1850

    OpenAIRE

    María del Pilar Iracheta

    1998-01-01

    El artículo pretende hacer un análisis sobre los efectos del cólera morbus en cinco municipios del Estado de México (Toluca, Temoaya, Calimaya, Otzolotepec y Capulhuac) durante los meses de junio y julio de 1850, aunque la enfermedad se manifestó hasta noviembre de ese año. Asimismo, se trata de señalar algunos elementos que permitieron la propagación del cólera. También se trata de medir los efectos de la enfermedad en los municipios referidos, tomando como base los factores como la edad y e...

  16. [Socioprofessional consequences of Crohn disease].

    Science.gov (United States)

    Duclos, B; Planchon, F; Jouin, H; Chamouard, P; Schieber, J P; Ubrich-Leuilliot, M; Baumann, R; Weill, J P

    1990-01-01

    To evaluate evolutivity and social repercussions of Crohn's disease, the same gastroenterologist interviewed 151 out of 197 patients with Crohn's disease (77.5 percent) who had been hospitalized from 1964 to 1986 in our unit. The other 46 could not be traced or refused to participate. There was no difference regarding age, sex, duration of illness, pattern of lesions and operations between the two groups. At the time of observation, mean follow-up was 7.8 years and two thirds of the patients had inactive disease. During the previous year, the course of the disease was quiescent in 50 percent of all patients; this rate increased with duration of follow-up and time from surgery. A constant rate of stable course was observed (20 percent) irrespective of duration of disease and time of surgery. The interviews were compared with those obtained from an age and sex-matched group of 70 previously healthy subjects admitted to the hospital for less than one month. The education and socioeconomic levels were higher in patients with Crohn's disease than in controls, in spite of the fact that 25 percent of patients whose disease begun during scholarship complained of difficulties at school, and nearly 20 percent of all patients were partially or totally unable to work. Sports and cultural activities were the same in Crohn's disease and in the control group. Tobacco intake was slightly higher at time of diagnosis but it was equal in both groups at the time of the interview. Non allopathic advice or treatment were sought by 48 percent of Crohn's disease patients (7 percent in controls).(ABSTRACT TRUNCATED AT 250 WORDS)

  17. 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

  18. Mellom myndighet og medieaktør. Nyhetsformidling i seks nett-aktive kommuner

    Directory of Open Access Journals (Sweden)

    Signe Bock Segaard

    2012-01-01

    Full Text Available

    Artikkelen belyser hvordan kommuner som nyhetsformidlere fyller sine hjemmesider med innhold ved å undersøke hvor aktive de er som nyhetsformidlere på nettet, hvilken type e-formidling de praktiserer og hvorvidt de opplever dilemmaer knyttet til e-formidling. Analysen hviler på spenningen mellom et journalistisk formidlingsideal om å understøtte demokratiske verdier og en strategisk kommunikasjonsidé, hvor hensikten er omdømmebygging og branding. Empirisk relateres undersøkelsen til data fra en rekke danske og norske kommuner, som skiller seg ut ved å være særlig aktive på nettet. Analysen danner avslutningsvis grunnlag for en drøftelse av hvordan kommunal e-formidling kan forstås i lys av kommunen som offentlig myndighet samt som markedsaktør, tjenesteprodusent og demokratiaktør. Spørsmålet er om kommunal e-formidling er en demokratisk gevinst. Analysen viser at kommunal e-formidling kjennetegnes av en tendens til profesjonalisering, sentralisering og byråkratisering, samt at vurderingen av den demokratiske gevinsten til dels betinges av hvordan kommunene i praksis forholder seg til utvelgelseskriterier. I tillegg viser analysen at noen kommuner er mer strategisk og andre mer journalistisk orientert i sitt formidlingsarbeid, men at den ene orientering ikke utelukker den andre.

  19. 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...

  20. 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....

  1. Epithelioid sarcoma of the plantar fascia mimicking Morbus Ledderhose - A severe pitfall for clinical and histopathological misinterpretation.

    Science.gov (United States)

    Toepfer, Andreas; Harrasser, Norbert; Dreyer, Florian; Mogler, Carolin; Walther, Markus; von Eisenhart-Rothe, Rüdiger

    2017-12-01

    Plantar fibromatosis, also known as Morbus Ledderhose, is a well known and frequently encountered disorder of the planta pedis. When conservative treatment fails, surgical therapy with complete resection is the therapeutical procedure of choice. Soft tissue sarcoma is a heterogeneous and rare malignant disease of the musculoskeletal system with over 50 histopathological subtypes which can potentially arise in any localization but is most commonly found at the extremities. Here, we report the case of an epithelioid sarcoma of the sole of the foot which was initially and repeatedly clinically and histopathologically misinterpreted as plantar fibromatosis, receiving insufficient resection and subsequently ending in amputation of the lower leg. Copyright © 2017 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  2. Influence of thyroid metabolism on radioiodine therapy in Graves` disease; Einfluss der Stoffwechsellage auf die Radioiodtherapie beim Morbus Basedow

    Energy Technology Data Exchange (ETDEWEB)

    Boerner, A.R. [Forschungszentrum Juelich (Germany). Inst. fuer Medizin; Weckesser, M.; Boy, C.; Schmidt, D.; Langen, K.J.; Mueller-Gaertner, H.W. [Duesseldorf Univ. (Germany). Nuklearmedizinische Klinik]|[Forschungszentrum Juelich (Germany). Inst. fuer Medizin

    1997-12-01

    Radioiodine therapy is one of two definitive methods of treatment in Graves` disease beside near-total thyreoidectomy. Simple strategies like optimization of thyroid metabolism help to improve efficacy in radioiodine therapy thus lowering applied radioiodine doses, radiation exposure to the patient and to the environment and avoiding multiple vain therapeutic efforts. These strategies are likely to reduce costs at the same time. (orig.) [Deutsch] Die Radioiodtherapie ist eine der beiden definitiven Therapiemethoden bei Morbus Basedow neben der nahezu totalen Thyreoidektomie. Ziel ist es, mit einfachen Methoden wie der optimalen Einstellung der Stoffwechsellage die Effizienz der Radioiodtherapie zu optimieren im Hinblick auf eine Reduktion der einzusetzenden Aktivitaet, der Gesamtstrahlenexposition fuer Patient und Umwelt und durch Vermeidung mehrfacher, vergeblicher therapeutischer Ansaetze. Diese Optimierung traegt auch zur Reduktion der Gesamtkrankheitskosten bei. (orig.)

  3. Hvorfor Aktivering?

    DEFF Research Database (Denmark)

    Tranæs, Torben

    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...... 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?...

  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. Radiological assessement of Crohn's disease

    International Nuclear Information System (INIS)

    Florio, F.; Palladino, M.; Stella, P.; Barbi, E.

    1987-01-01

    Fifty-eight consecutive cases of patients affected by Crohn's disease, with ileum (23/58), colon (10/58) and ileo-colic (25/58) involvement were studied. A good overall sensitivity was reached by the radiological procedures employed (barium meal, barium enema, enterclysis). Enterclysis is proposed as a second-step method for the study of ileum involvement, because it provides a quite precise assessement of disease stage and extent. Some criteria for a rational use of current radiological procedures in follow-up of both surgically and medically treated patients are proposed. Moreover it is suggested that better coordination of anatomo-radiological and clinical aspects could improve the therapeutic approach and prognostic judgement in such cases

  6. 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...... natalizumab in several countries outside the European Union). However, despite the use of biologics for more than a decade, questions still remain about the true efficacy and the best treatment regimens - especially about when to discontinue treatment. Furthermore, a need for optimizing treatment...... with biologics still exists, as 20-40% of patients with CD (depending on selection criteria) do not have any relevant response to the current biological agents (i.e. primary failures). A better patient selection might maximize the clinical outcome while minimizing the complications associated with this type...

  7. 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.)

  8. Responsiveness of Endoscopic Indices of Disease Activity for Crohn's Disease

    NARCIS (Netherlands)

    Khanna, Reena; Zou, Guangyong; Stitt, Larry; Feagan, Brian G.; Sandborn, William J.; Rutgeerts, Paul; McDonald, John W. D.; Dubcenco, Elena; Fogel, Ronald; Panaccione, Remo; Jairath, Vipul; Nelson, Sigrid; Shackelton, Lisa M.; Huang, Bidan; Zhou, Qian; Robinson, Anne M.; Levesque, Barrett G.; D'Haens, Geert

    2017-01-01

    The Crohn's Disease Endoscopic Index of Severity (CDEIS) and the Simple Endoscopic Score for Crohn's Disease (SES-CD) are commonly used to assess Crohn's disease (CD) activity; however neither instrument is fully validated. We evaluated the responsiveness to change of the SES-CD and CDEIS using data

  9. 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.)

  10. Diagnosis and management of Crohn's disease.

    Science.gov (United States)

    Wilkins, Thad; Jarvis, Kathryn; Patel, Jigneshkumar

    2011-12-15

    Crohn's disease is a chronic inflammatory condition affecting the gastrointestinal tract at any point from the mouth to the rectum. Patients may experience diarrhea, abdominal pain, fever, weight loss, abdominal masses, and anemia. Extraintestinal manifestations of Crohn's disease include osteoporosis, inflammatory arthropathies, scleritis, nephrolithiasis, cholelithiasis, and erythema nodosum. Acute phase reactants, such as C-reactive protein level and erythrocyte sedimentation rate, are often increased with inflammation and may correlate with disease activity. Levels of vitamin B12, folate, albumin, prealbumin, and vitamin D can help assess nutritional status. Colonoscopy with ileoscopy, capsule endoscopy, computed tomography enterography, and small bowel follow-through are often used to diagnose Crohn's disease. Ultrasonography, computed axial tomography, scintigraphy, and magnetic resonance imaging can assess for extraintestinal manifestations or complications (e.g., abscess, perforation). Mesalamine products are often used for the medical management of mild to moderate colonic Crohn's disease. Antibiotics (e.g., metronidazole, fluoroquinolones) are often used for treatment. Patients with moderate to severe Crohn's disease are treated with corticosteroids, azathioprine, 6-mercaptopurine, or anti-tumor necrosis factor agents (e.g., infliximab, adalimumab). Severe disease may require emergent hospitalization and a multidisciplinary approach with a family physician, gastroenterologist, and surgeon.

  11. 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.

  12. Crohn's disease of the vulva.

    Science.gov (United States)

    Barret, Maximilien; de Parades, Vincent; Battistella, Maxime; Sokol, Harry; Lemarchand, Nicolas; Marteau, Philippe

    2014-07-01

    Crohn's disease (CD) of the vulva is a rare, yet under recognized condition. Fistulae arising from the digestive tract account for the greater part of genital lesions in CD. However, cutaneous so-called metastatic lesions of the vulva have been reported in the literature. They are clinically challenging for gastroenterologists as well as for gynecologists, with numerous differential diagnoses, especially among venereal diseases, and require a multidisciplinary approach. The most frequently observed features of the disease are labial swelling, vulvar ulcers, and hypertrophic lesions. Biopsy samples for histological study are mandatory, in order to establish the diagnosis of vulvar CD. Treatment options include oral prolonged courses of metronidazole and systemic immunosuppressive therapy such as corticosteroids and azathioprine, with promising data published on the efficacy of infliximab. Surgery remains restricted to medical treatment failures or resection of unsightly lesions. Prospective studies or case series with long follow-up data are still missing to guide the treatment of this condition. © 2013. Published by Elsevier B.V. All rights reserved.

  13. Biologics in Paediatric Crohn's Disease

    Directory of Open Access Journals (Sweden)

    Oliver Gouldthorpe

    2011-01-01

    Full Text Available Crohn's disease affects increasing numbers of children worldwide. Generally, childhood-onset disease runs a more severe course than in adults and has a greater impact on quality of life. Therapy in children must take account of a different set of risks for toxicity compared to adults, but also to their longevity. Biologic drugs present remarkable advantages in terms of disease control for children, especially in those whose disease cannot be controlled with conventional therapies, but their long-term risks are still being assessed. Data regarding biologic use in children is limited and mostly amounts to case series, but results have been promising, both in terms of controlling disease activity and improving growth parameters. Adverse reactions are infrequent in the short term, but loss of response is a long-term problem, particularly in children. More information is needed about very long term risks. Infliximab and adalimumab are the most studied agents in children, while there is relatively limited data on certolizumab and natalizumab. Further collection of data on these agents is still needed, but this should not restrict access to these agents for children in whom no other agent is effective.

  14. Crohn's disease in adolescence: presentation and treatment.

    Science.gov (United States)

    Cullen, Mick; Barnes, Claire

    2015-05-13

    Crohn's disease is a chronic inflammatory bowel condition that affects more than 115,000 people in the UK. This article focuses on Crohn's disease in adolescents. Management of the condition in this group should address adolescent-specific characteristics and treatment goals. Key elements include optimising growth, pubertal development and social functioning, including education. The condition can affect an individual's mental and emotional wellbeing significantly, as well as their physical health. As adolescence is a time of great change, the additional burden of a chronic illness can prove difficult to manage. The authors provide information on the presentation of Crohn's disease in adolescence and insights into the particular issues encountered by this group.

  15. '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

  16. Optimizing biological therapy in Crohn's disease.

    Science.gov (United States)

    Gecse, Krisztina Barbara; Végh, Zsuzsanna; Lakatos, Péter László

    2016-01-01

    Anti-TNF therapy has revolutionized the treatment of inflammatory bowel diseases, including both Crohn's disease and ulcerative colitis. However, a significant proportion of patients does not respond to anti-TNF agents or lose response over time. Recently, therapeutic drug monitoring has gained a major role in identifying the mechanism and management of loss of response. The aim of this review article is to summarize the predictors of efficacy and outcomes, the different mechanisms of anti-TNF/biological failure in Crohn's disease and identify strategies to optimize biological treatment.

  17. 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.

  18. 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

  19. 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 ...

  20. Muramyl dipeptide responsive pathways in Crohn's disease

    DEFF Research Database (Denmark)

    Salem, Mohammad; Seidelin, Jakob Benedict; Rogler, Gerhard

    2012-01-01

    Crohn's disease (CD) is one of main disease entities under the umbrella term chronic inflammatory bowel disease. The etiology of CD involves alterations in genetic, microbiological, and immunological factors. This review is devoted to the role of the bacterial wall compound muramyl dipeptide (MDP...

  1. Pulmonary radio-responses to surface field radiotherapy of Morbus Hodgkin using a 4 MeV linear accelerator

    International Nuclear Information System (INIS)

    Krueger, H.U.

    1982-01-01

    In 119 patients suffering from Morbus Hodgkin who were treated between 1974 and 1979, the pulmonary radioresponse was retroperspectively investigated. Besides incidence and degree of severity also the course over the time of the individual stages of radio-response where 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 diseasedependent 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. (orig./MG) [de

  2. PET and SPECT investigations in Alzheimer's disease; Nuklearmedizin und Demenz - Anwendung bei Morbus Alzheimer

    Energy Technology Data Exchange (ETDEWEB)

    Asenbaum, S. [Universitaetsklinik fuer Nuklearmedizin, Universitaetsklinik fuer Neurologie, Wien (Austria); Abteilung fuer klinische Neurologie, Universitaetsklinik fuer Neurologie, Waehringer Guertel 18-20, 1090, Wien (Austria)

    2003-07-01

    Nuclear medicine offers a wide range of possibilities to investigate dementia. Various SPECT and PET tracers will be introduced in this article first. Different questions concerning evaluation of dementia are discussed taking Alzheimer's disease (AD) as an example. It is important to perform nuclear medicine investigations on high technical level, using standardized methods as statistical parametric mapping (SPM) for evaluation. If neuroprotective therapies are available, an early diagnosis, the determination of risk factors and longitudinal investigations will be the focus of interest and the main goal of nuclear medicine. Apart from measuring cerebral perfusion and glucose metabolism the development of new ligands, concerning the cholinergic system and the visualization of amyloid plaques, is of great importance. (orig.) [German] Nuklearmedizin bietet bei der Erfassung und Beurteilung eines dementiellen Prozesses eine Vielzahl von Untersuchungsmoeglichkeiten. Anhand des Morbus Alzheimer (DAT) werden in dem vorliegenden Artikel neben einer kurzen Schilderung der zur Verfuegung stehenden Methoden die verschiedenen nuklearmedizinisch relevante Fragestellungen angefuehrt, zu deren Beantwortung die funktionelle Bildgebung Informationen liefern kann. Durch den Einsatz bestimmter, standardisierter Auswerteverfahren wie statistical parametric mapping (SPM) ist es moeglich, entscheidende Hinweise zur Diagnose und Differenzialdiagnose der DAT zu erlangen. In Zukunft werden, insbesondere bei einer Verfuegbarkeit neuroprotektiver Therapien, eine moeglichst fruehe Diagnosestellung und die Erfassung von Risikofaktoren sowie die Moeglichkeit einer Verlaufsbeobachtung in den Mittelpunkt des Interesses und in das Zentrum nuklearmedizinischer Untersuchungen ruecken. Vor allem fuer diese Anforderungen ist neben der qualitaetsvollen Untersuchung von zerebraler Perfusion und Glukosestoffwechsel eine Weiterentwicklung spezieller Liganden v. a. das cholinerge System betreffend und

  3. 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

  4. 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.

  5. Tumor necrosis factor alpha antibody (infliximab) therapy profoundly down-regulates the inflammation in Crohn's ileocolitis

    NARCIS (Netherlands)

    Baert, F. J.; D'Haens, G. R.; Peeters, M.; Hiele, M. I.; Schaible, T. F.; Shealy, D.; Geboes, K.; Rutgeerts, P. J.

    1999-01-01

    Anti-tumor necrosis factor alpha monoclonal antibody treatment (infliximab) reduces clinical signs and symptoms in patients with Crohn's disease. The effects of infliximab on mucosal histopathologic abnormalities in Crohn's ileocolitis were studied. Thirteen patients with steroid-refractory Crohn's

  6. Fistulizing Crohn's disease: Diagnosis and management.

    Science.gov (United States)

    Gecse, Krisztina; Khanna, Reena; Stoker, Jaap; Jenkins, John T; Gabe, Simon; Hahnloser, Dieter; D'Haens, Geert

    2013-06-01

    Fistulizing Crohn's disease represents an evolving, yet unresolved, issue for multidisciplinary management. Perianal fistulas are the most frequent findings in fistulizing Crohn's disease. While enterocutaneous fistulas are rare, they are associated with considerable morbidity and mortality. Detailed evaluation of the fistula tract by advanced imaging techniques is required to determine the most suitable management options. The fundamentals of perianal fistula management are to evaluate the complexity of the fistula tract, and exclude proctitis and associated abscess. The main goals of the treatment are abscess drainage, which is mandatory, before initiating immunosuppressive medical therapy, resolution of fistula discharge, preservation of continence and, in the long term, avoidance of proctectomy with permanent stoma. The management of enterocutaneous fistulas comprises of sepsis control, skin care, nutritional optimization and, if needed, delayed surgery.

  7. 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.

  8. 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.

  9. Model-based online optimisation. Pt. 1: active learning; Modellbasierte Online-Optimierung moderner Verbrennungsmotoren. T. 1: Aktives Lernen

    Energy Technology Data Exchange (ETDEWEB)

    Poland, J.; Knoedler, K.; Zell, A. [Tuebingen Univ. (Germany). Lehrstuhl fuer Rechnerarchitektur; Fleischhauer, T.; Mitterer, A.; Ullmann, S. [BMW Group (Germany)

    2003-05-01

    This two-part article presents the model-based optimisation algorithm ''mbminimize''. It was developed in a corporate project of the University Tuebingen and the BMW Group for the purpose of optimising internal combustion engines online on the engine test bed. The first part concentrates on the basic algorithmic design, as well as on modelling, experimental design and active learning. The second part will discuss strategies for dealing with limits such as knocking. (orig.) [German] Dieser zweiteilige Beitrag stellt den modellbasierten Optimierungsalgorithmus ''mbminimize'' vor, der in Kooperation von der Universitaet Tuebingen und der BMW Group fuer die Online-Optimierung von Verbrennungsmotoren entwickelt wurde. Der vorliegende erste Teil konzentriert sich auf das grundlegende algorithmische Design, auf Modellierung, Versuchsplanung und aktives Lernen. Der zweite Teil diskutiert Strategien zur Behandlung von Limits wie Motorklopfen.

  10. Cost of illness of Crohn's disease.

    Science.gov (United States)

    Bodger, Keith

    2002-01-01

    Crohn's disease is a chronic inflammatory bowel disease of unknown aetiology which affects around 35,000 people in the UK (population 56.8 million). The potential for onset in early adult life, disease chronicity and a need for hospitalisation and surgery mean that the disease can be associated with substantial healthcare costs. Cost-of-illness studies focusing on direct medical costs have identified that over half the average costs associated with the disease relate to hospital costs. Estimates of the contribution of drug costs to the total direct economic burden have varied between 4.6 and 25%. Figures for average annual direct costs per patient in the US have been put at between US dollars 6561 (1990 values) and US dollars 12,417 (1994 values), whereas European studies have given much lower cost estimates (US dollars 655, 1994 values). However, all studies have highlighted that much of the total cost of illness relates to extensive interventions required by a small proportion of severely affected individuals. Indirect costs associated with reduced productivity in Crohn's disease can be high, with long periods of absenteeism and early disability. However, most patients (90%) remain in the workforce and life expectancy is relatively normal. A variety of drugs are employed for the treatment of Crohn's disease, both in an attempt to induce clinical remission in active disease and to maintain remission once this has been achieved. Comparative data on cost effectiveness is lacking, though crude estimates based on randomised trials suggest that the frequently prescribed aminosalicylates, which have only modest efficacy, are a relatively costly drug option. The costs associated with adverse drug effects, particularly for corticosteroids, have not been formally quantified. Despite high costs, new drug therapies for more severe disease, such as anti-tumour necrosis factor (TNF-alpha) antibodies, may prove a cost-effective option if the need for hospitalisation is reduced

  11. 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

  12. 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.

  13. Aktive Steuerung des Transmissionsverhaltens stochastischer Störquellen durch flächige Leichtbaustrukturen [Active feedforward control of the transmission of stochastic disturbances through lightweight panel structures

    OpenAIRE

    Misol, Malte

    2014-01-01

    Leichtbaustrukturen weisen eine geringe Schalldämmung bei tiefen Frequenzen auf. Ihr Einsatz bei Gebäuden, Fahr- oder Flugzeugen ist daher mit negativen Auswirkungen auf die Innenraumakustik verbunden. Adaptronische Maßnahmen, wie die aktive Struktur-Akustik-Regelung (ASAC), können passive Maßnahmen der Schalldämmung flankieren oder ersetzen. Gegenstand dieser Arbeit ist die Beeinflussung der Transmission stochastischer Störquellen durch ein- und doppelwandige Leichtbaustruktursysteme mithilf...

  14. The cost of hospitalization in Crohn's disease.

    Science.gov (United States)

    Cohen, R D; Larson, L R; Roth, J M; Becker, R V; Mummert, L L

    2000-02-01

    The aim of this study was to evaluate the demographics, resource use, and costs associated with hospitalization of Crohn's disease patients. All patients hospitalized at our institution from 7/1/96 to 6/30/97 with a primary diagnosis of "Crohn's Disease" were analyzed using a computerized database. Data are presented "per hospitalization." A total of 175 hospitalizations (147 patients) were identified. Mean patient age was 36.5 yr; 61% were female; 82% Caucasian. Payer mix was most commonly contracted (57%), commercial (21%), or Medicare (13%). 57% of hospitalizations had a primary surgical procedure; the remainder were medical. Average length of stay was 8.7 days (surgical, 9.6 days; medical, 7.5 days). The average cost of hospitalization, excluding physician fees, was $12,528 (surgical, $14,409; medical, $10,020), whereas average charges were $35,378 (surgical, $46,354; medical, $20,744), including physician fees, which averaged $7,249 (surgical, $11,217; medical, $1,959). Mean reimbursements were $21,968 (surgical, $28,946; medical, $12,666) with average weighted reimbursement rates of 60.17% of hospital charges, 69.57% of physician fees. The distribution of costs across subcategories was: Surgery (39.6%), Pharmacy (18.6%), Laboratory (3.8%), Radiology (2.1%), Pathology (0.8%), Endoscopy (0.3%), and Other Hospital Costs (34.9%). Of the hospitalizations, 87% included treatment with steroids, 23% with immunomodulators, and 14% with aminosalicylates; 27% included the administration of total parenteral nutrition, which accounted for 63% of the total pharmacy costs. Surgery accounts for the majority of hospitalizations, nearly 40% of their total costs, and 75% of overall charges and reimbursements. Therapy that decreases the number of surgical hospitalizations should substantially reduce inpatient Crohn's disease costs, as well as overall costs.

  15. Inflammatory activity in Crohn disease: ultrasound findings.

    Science.gov (United States)

    Migaleddu, Vincenzo; Quaia, Emilio; Scano, Domenico; Virgilio, Giuseppe

    2008-01-01

    Improvements in the ultrasound examination of bowel disease have registered in the last years the introduction of new technologies regarding high frequency probes (US), highly sensitive color or power Doppler units (CD-US), and the development of new non-linear technologies that optimize detection of contrast agents. Contrast-enhanced ultrasound (CE-US) most importantly increases the results in sonographic evaluation of Crohn disease inflammatory activity. CE-US has become an imaging modality routinely employed in the clinical practice for the evaluation of parenchymal organs due to the introduction of new generation microbubble contrast agents which persist in the bloodstream for several minutes after intravenous injection. The availability of high frequency dedicated contrast-specific US techniques provide accurate depiction of small bowel wall perfusion due to the extremely high sensitivity of non-linear signals produced by microbubble insonation. In Crohn's disease, CE-US may characterize the bowel wall thickness by differentiating fibrosis from edema and may grade the inflammatory disease activity by assessing the presence and distribution of vascularity within the layers of the bowel wall (submucosa alone or the entire bowel wall). Peri-intestinal inflammatory involvement can be also characterized. CE-US can provide prognostic data concerning clinical recurrence of the inflammatory disease and evaluate the efficacy of drugs treatments.

  16. MR enterography of ileocolovesicular fistula in pediatric Crohn disease

    Energy Technology Data Exchange (ETDEWEB)

    Sakala, Michelle D. [Wayne State University School of Medicine, Detroit, MI (United States); Dillman, Jonathan R.; Ladino-Torres, Maria F. [University of Michigan Health System, Department of Radiology, C.S. Mott Children' s Hospital, Section of Pediatric Radiology, Ann Arbor, MI (United States); McHugh, Jonathan B. [University of Michigan Health System, Department of Pathology, Ann Arbor, MI (United States); Adler, Jeremy [University of Michigan Health System, Department of Pediatrics and Communicable Diseases, C. S. Mott Children' s Hospital, Division of Pediatric Gastroenterology, Ann Arbor, MI (United States)

    2011-05-15

    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.)

  17. 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

  18. 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

  19. What is Crohn's Disease | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... your health care provider about what to expect. Biological therapies. Biological therapies are medicines that are given by an ... the skin. There are currently five FDA-approved biological drugs that treat inflammation in Crohn's disease. Antibiotics. ...

  20. 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

    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...... D levels (51nmol/l) than patients who did not smoke (76nmol/l), plevels. CONCLUSIONS: Active Crohn's disease was associated with low serum 25-OH vitamin D. Patients who smoked had lower 25-OH...

  1. 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

  2. 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....

  3. '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....... Granulomas were identified in 62% of the biopsies with microerosions and by examination of two consecutive biopsies from each of these patients, in 85% indicating a positive correlation. In patients with microerosions and a primary diagnosis of UC, granulomas were found in 38% and by examination of two...... biopsies in 54%. Patients with granulomas and a few other patients were reclassified as CD, but there still remained some patients with microerosions, who most probably had UC. In conclusion, microerosions are observed mainly in CD with colonic involvement. There is a high incidence of granulomas in biopsy...

  4. 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.

  5. 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...... dependency was used to assess treatment response: 'immediate outcome' (30 days after infliximab start)--complete/partial/no response. 'Long-term outcome': (i) prolonged response: maintenance of complete/partial response; (ii) infliximab dependency: relapse .../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...

  6. The Diagnostic Role of Magnetic Resonance Enterography as a Complementary Test to Colonoscopy in Active Crohn?s Disease

    OpenAIRE

    Aryan, Arvin; Azizi, Zahra; Teimouri, Azam; Ebrahimi Daryani, Nasser; Aletaha, Najme; Jahanbakhsh, Ali; Nouritaromlou, Mohammad Kazem; Alborzi, Forough; Mami, Masoud; Basirat, Vahid; Javid Anbardan, Sanam

    2016-01-01

    BACKGROUND According to recent studies comparing magnetic resonance enterography (MRE) with ileocolonoscopy for assessing inflammation of small bowel and colonic segments in adults with active Crohn?s disease (CD), we aimed to compare the accuracy of these two diagnostic methods in Iranian population. METHODS During 2013-2014 a follow-up study was done on 30 patients with active CD in a gastroenterology clinic affiliated to Tehran University of Medical Sciences. MRE and ileocolonoscopy were p...

  7. PET-Studies in parkinson's disease; Untersuchungen mit der Positronen-Emissions-Tomographie (PET) bei Patienten mit Morbus Parkinson

    Energy Technology Data Exchange (ETDEWEB)

    Schwarz, J. [Klinik fuer Neurologie, Univ. Leipzig (Germany)

    2002-09-01

    Positron-emission-tomography (PET) has enabled to study the metabolism and blood flow in specific brain areas. Besides, there is a variety of radiotracers that allow quantification of the function of distinct molecules. In respect to Parkinson's disease, PET allowed for the first time to assess the number of dopaminergic neurons in vivo. Thus, helping confirming a dopaminergic deficit, measuring disease progression and also help to determine the function of dopaminergic grafts. Current research has shifted to determine the role of related neurotransmitter systems in the pathophysiology of Parkinson's disease. (orig.) [German] Die positronen-emissions-tomographie (PET) bietet neben der Messung von Metabolismus und Blutfluss die Moeglichkeit der Darstellung von einzelnen Molekuelen. Bei Patienten mit Morbus Parkinson hat es diese Technik erstmals erlaubt, die Anzahl der dopaminergen Neurone zu quantifizieren, wodurch die Diagnose gesichert, die Progression der Erkrankung beurteilt und auch das Anwachsen von Implantaten beurteilt werden kann. Die PET hat einen wesentlichen Beitrag zu unserem heutigen Wissen ueber die Pathophysiologie dieser Erkrankung beigetragen. (orig.)

  8. PET activation in basal ganglia disorders: Parkinson`s disease and dystonia; PET-Aktivierungsstudien bei Basalganglienerkrankungen: Morbus Parkinson und Dystonien

    Energy Technology Data Exchange (ETDEWEB)

    Ceballos-Baumann, A.O. [Neurologische Klinik, Technische Univ. Muenchen (Germany); Boecker, H. [Neurologische Klinik, Technische Univ. Muenchen (Germany); Conrad, B. [Neurologische Klinik, Technische Univ. Muenchen (Germany)

    1997-03-01

    This article reviews PET activation studies with performance of different motor paradigms (joy-stick movements, imagination of movement, writing) in patients with movement disorders. The focus will be on Parkinson`s disease (PD) and dystonia. PET findings will be related to clinical and electrophysiological observations. PET activation studies before and after therapeutic interventions such as pallidotomy in Parkinson`s disease and botulinum toxin in writer`s cramp are described. The contribution of PET activation studies to the understanding of the pathophysiology of dystonia and PD is discussed. (orig.) [Deutsch] Der Beitrag beschreibt verschiedene PET-Aktivierungsstudien mit motorischen Paradigmen (`joystick`-Bewegungen, Vorstellung von Bewegung, Schreiben) bei Bewegungsstoerungen, im wesentlichen bei Patienten mit Dystonie, einer Hyperkinese, und Morbus Parkinson als Hypokinese. Die experimentellen Befunde werden mit der Klinik in Bezug gebracht. Neue Untersuchungen vor und nach therapeutischen Interventionen, wie die stereotaktische Pallidotomie bei Parkinson und die Botulinum-Toxin-Therapie bei Schreibkrampf, werden beschrieben. Der Beitrag von PET-Aktivierungsstudien zum Verstaendnis der Pathophysiologie von Bewegungsstoerungen wird diskutiert. (orig.)

  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. Hematologic manifestations of Crohn's disease: two clinical cases

    Directory of Open Access Journals (Sweden)

    O. V. Taratina

    2017-01-01

    Full Text Available Inflammatory bowel diseases (IBD are commonly associated with extraintestinal manifestations, hematological disorders being the most special among them. In some cases, they dominate the clinical picture masking the intestinal manifestations of the underlying disease. Aplastic anemia is an extremely rare extraintestinal IBD manifestation. There are only two clinical cases of aplastic anemia associated with ulcerative colitis and non with Crohn's disease reported in the literature. Combination of Crohn's disease and В₁₂-deficient anemia is more prevalent, but is seen usually only after more than 20 cm of the ileus has been resected. The first clinical case presented in this paper is a  combination of severe fistula-forming Crohn's disease with a constriction in the terminal part of the ileus and profound pancytopenia as an outcome of aplastic anemia. This profound pancytopenia is associated with an extremely high risk of life-threatening complications both of surgical treatment, as well as of several chemotherapeutic agents, which made the management of this patient difficult. The second clinical case demonstrates the manifestation of Crohn's disease as ileocolitis starting from the symptoms of cobalamin deficiency: severe В₁₂-deficient anemia, funicular myelosis and sensory ataxia, with blunted intestinal symptoms. This made the initial diagnosis and timely treatment difficult. Replacement therapy with cobalamin injections and treatment with glucocorticoids and antibacterials led to endoscopically confirmed remission of Crohn's disease and normalization of hematological parameters, with persistent polyneuropathy. Thus, management of patients with Crohn's disease should be multidisciplinary. In the case of anemia, leucopenia and/or thrombocytopenia in IBD patients it is necessary to exclude potential myelodysplasia and bone marrow aplasia. In the event of megaloblastic anemia and/or progressive polyneuropathy one should bear in mind

  11. 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.

  12. 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.

  13. Amino acid-responsive Crohn's disease: a case study

    Directory of Open Access Journals (Sweden)

    Alvin Stein

    2010-12-01

    Full Text Available Alvin Stein1, Marty Hinz2, Thomas Uncini31Stein Orthopedic Associates, Plantation, FL, USA; 2Clinical Research, NeuroResearch Clinics Inc., Cape Coral, FL, USA; 3Laboratory, Fairview Regional Medical Center-Mesabi, Hibbing, MN, USAPurpose: This paper reviews the clinical course of a case of severe Crohn's disease and discusses the scientific ramifications of a novel treatment approach.Patients and methods: A case study of a 37-year-old male with a 22-year history of Crohn's disease whose clinical course had experienced no sustained remissions. The patient was treated with a protocol that utilized serotonin and dopamine amino acid precursors administered under the guidance of organic cation transporter assay interpretation.Results: Within 5 days of achieving the necessary balance of serotonin and dopamine, the patient experienced remission of symptoms. This remission has been sustained without the use of any Crohn's disease medications.Conclusion: In Crohn's disease, it is known that there is an increase of both synthesis and tissue levels of serotonin in specific locations. It is asserted that this is prima facie evidence of a significant imbalance in the serotonin–dopamine system, leading to serotonin toxicity. The hypothesis formulated is that improperly balanced serotonin and dopamine transport, synthesis, and metabolism is a primary defect contributing to the pathogenesis of Crohn's disease.Keywords: serotonin, dopamine, organic cation transporters, OCT

  14. Surgical care of the pediatric Crohn's disease patient.

    Science.gov (United States)

    Stewart, Dylan

    2017-12-01

    Despite the significant advances in the medical management of inflammatory bowel disease over the last decade, surgery continues to play a major role in the management of pediatric Crohn's disease (CD). While adult and pediatric Crohn's disease may share many clinical characteristics, pediatric Crohn's patients often have a more aggressive phenotype, and the operative care given by the pediatric surgeon to the newly diagnosed Crohn's patient is very different in nature to the surgical needs of adult patients after decades of disease progression. Children also have the unique surgical indication of growth failure to consider in the overall clinical decision making. While surgery is never curative in CD, it has the ability to transform the disease process in children, and appropriately timed operations may have tremendous impact on a child's physical and mental maturation. This monograph aims to address the surgical care of Crohn's disease in general, with a specific emphasis on the surgical treatment of small intestinal and ileocecal involvement. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Vedolizumab in the treatment of Crohn's disease.

    Science.gov (United States)

    Tarabar, Dino; Hirsch, Ayal; Rubin, David T

    2016-01-01

    Vedolizumab, a recent addition to the therapeutic armamentarium in Crohn's disease, is promising in efficacy, durability of remission and safety. It is the first gut selective biologic treatment, acting by targeting α4β7-integrin, a receptor expressed on activated lymphocytes and binding to MAdCAM1, a cell adhesion molecule selectively expressed in the circulatory system of the digestive tract, preventing trafficking of lymphocytes to the gut. The pivotal GEMINI studies have demonstrated the efficacy and safety of vedolizumab in achieving clinical response and clinical remission in patients with moderately to severely active CD who are naïve or have previously failed therapy with TNF-antagonists, immunomodulators or dependent on steroids. Vedolizumab had a favorable safety profile and specifically showed no evidence of PML, reactivation of latent TB or hepatitis B. Overall, the number of malignancies in the clinical trials was small; however, long-term exposure was limited. Vedolizumab can be given as a first-line therapy or following treatment failure, and was tolerated as part of combination therapy. More medications with similar and novel therapeutic mechanisms are anticipated in the coming years.

  16. 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.

  17. Increasing incidence of Crohn's disease in Victorian children.

    Science.gov (United States)

    Phavichitr, Nopaorn; Cameron, Donald J S; Catto-Smith, Anthony G

    2003-03-01

    The incidence of Crohn's disease has been increasing in Western communities, but there are no published studies which have examined this change in children in Australia. The centralization of pediatric gastroenterology services in Victoria provides an opportunity to examine these changes within one state. We undertook a retrospective study over a 31-year period of all children aged 16 years or less initially diagnosed with Crohn's disease at either the Royal Children's Hospital, or Monash Medical Center, Melbourne, Victoria. We identified 351 patients who met the diagnostic criteria between 1971 and 2001. The incidence of Crohn's disease in children aged 16 years or less rose from 0.128 to 2.0 per 100,000 per year over the three decades (r = 0.964, P Victorian children. The pattern of disease has also changed with colonic disease now more frequent, and inflammatory indices less abnormal. The increased use of endoscopy has established the frequent involvement of the upper gastrointestinal tract.

  18. 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.

  19. 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.

  20. Crohn's disease in Japan: diagnostic criteria and epidemiology.

    Science.gov (United States)

    Yao, T; Matsui, T; Hiwatashi, N

    2000-10-01

    New diagnostic criteria for Crohn's disease and a review of Japanese epidemiologic studies are presented. New diagnostic criteria for Crohn's disease were established by the Research Committee of Inflammatory Bowel Disease, set up by the Japanese Ministry of Health and Welfare. For a definite diagnosis one of the following three conditions is required: 1) longitudinal ulcer or luminal deformity induced by longitudinal ulcer or cobblestone pattern, 2) intestinal small aphthous ulcerations arranged in a longitudinal fashion for at least three months plus noncaseating granulomas, and 3) multiple small aphthous ulcerations in both the upper and lower digestive tract not necessarily with longitudinal arrangement, for at least three months, plus noncaseating granulomas. Moreover, ulcerative colitis, ischemic enterocolitis, and acute infectious enterocolitis should be excluded. Data from the Japanese Ministry of Health and Welfare, in addition to data collected from two study groups, these being the two largest studies in Japan, are reviewed with regard to epidemiology. The number of patients with Crohn's disease has increased remarkably. The prevalence and the annual incidence of patients with Crohn's disease in Japan were estimated to be approximately 2.9 and 0.6 per 10(5) population in 1986, respectively, and 13.5 and 1.2 per 10(5) population in 1998. Characteristic features of Crohn's disease in Japan are that the male-female ratio exceeds 2, and that there is no second peak of incidence in the age group of 55 to 65 years. Clinically, Crohn's disease with only multiple small aphthous ulcerations, which is the earliest stage of the disease that is diagnosable, was found in 5 percent of patients.

  1. Managing refractory Crohn's disease: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Tanida S

    2015-04-01

    Full Text Available Satoshi Tanida, Keiji Ozeki, Tsutomu Mizoshita, Hironobu Tsukamoto, Takahito Katano, Hiromi Kataoka, Takeshi Kamiya, Takashi Joh Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Aichi Prefecture, Japan Abstract: The goals of treatment for active Crohn's disease (CD are to achieve clinical remission and improve quality of life. Conventional therapeutics for moderate-to-severe CD include 5-aminosalicylic acid, corticosteroids, purine analogs, azathioprine, and 6-mercaptopurine. Patients who fail to respond to conventional therapy are treated with tumor necrosis factor (TNF-α inhibitors such as infliximab and adalimumab, but their efficacy is limited due to primary nonresponse or loss of response. It is suggested that this requires switch to another TNF-α inhibitor, a combination therapy with TNF-α blockade plus azathioprine, or granulocyte and monocyte adsorptive apheresis, and that other therapeutic options having different mechanisms of action, such as blockade of inflammatory cytokines or adhesion molecules, are needed. Natalizumab and vedolizumab are neutralizing antibodies directed against integrin a4 and a4ß7, respectively. Ustekinumab is a neutralizing antibody directed against the receptors for interleukin-12 and interleukin-23. Here, we provide an overview of therapeutic treatments that are effective and currently available for CD patients, as well as some that likely will be available in the near future. We also discuss the advantages of managing patients with refractory CD using a combination of TNF-α inhibitors plus azathioprine or intensive monocyte adsorptive apheresis. Keywords: adalimumab, granulocyte and monocyte adsorptive apheresis, combination therapy, complete remission

  2. Perforated Meckel's diverticulitis complicating active Crohn's ileitis: a case report.

    Science.gov (United States)

    Schwenter, Frank; Gervaz, Pascal; de Saussure, Philippe; McKee, Thomas; Morel, Philippe

    2009-01-13

    In Crohn's disease, the extension of active terminal ileitis into a Meckel's diverticulum is possible, but usually has no impact on clinical decision-making. We describe an original surgical approach in a young woman presenting with a combination of perforated Meckel's diverticulitis and active Crohn's ileitis. We report the case of a 22-year-old woman with Crohn's disease, who was admitted for abdominal pain, fever and diarrhoea. CT scan demonstrated active inflammation of the terminal ileum, as well as a fluid collection in the right iliac fossa, suggesting intestinal perforation. Laparoscopy was performed and revealed, in addition to extensive ileitis, a 3 x 3 cm abscess in connection with perforated Meckel's diverticulitis. It was therefore possible to avoid ileocaecal resection by only performing Meckel's diverticulectomy; pathological examination of the surgical specimen revealed the presence of transmural inflammation with granulomas and perforation of the diverticulum at its extremity. Crohn's disease of the ileum may be responsible for Meckel's diverticulitis and cause perforation which, in this case, proved to be a blessing in disguise and spared the patient an extensive small bowel resection.

  3. 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....

  4. Endoscopic and histologic healing of Crohn's (ileo-) colitis with azathioprine

    NARCIS (Netherlands)

    D'Haens, G.; Geboes, K.; Rutgeerts, P.

    1999-01-01

    The correlation between disease activity and endoscopic findings in Crohn's disease is poor. Corticosteroids induce symptom relief without consistent improvement of endoscopic lesions. Our aim was to examine the effect of azathioprine therapy on healing of inflammatory lesions in patients with

  5. 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...... mechanism contributes to both diseases, providing new possibilities for functional studies and therapy development....

  6. 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). Patien...

  7. 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.

  8. 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

  9. Top-down approach to biological therapy of Crohn's disease.

    Science.gov (United States)

    Hirschmann, Simon; Neurath, Markus F

    2017-03-01

    Crohn's disease (CD) is a chronic, immune-mediated condition with a potentially disabling and destructive course. Despite growing data on when to use a therapeutic 'top-down' strategy, clinical management of this complex disorder is still challenging. Currently, the discussion of 'top-down' strategy in CD mostly includes biological therapy alone or in combination. Areas covered: This article is based on a review of existing literature regarding the use of biological therapy in a 'top-down' approach for the treatment of Crohn's disease. The authors reviewed all the major databases including MEDLINE as well as DDW and ECCO abstracts, respectively. Expert opinion: A 'top-down' therapeutic approach in Crohn's disease is strongly supported by existing data in patients with several risk factors for a severe course of disease. Moreover, there is an increasing amount of published data recommending a more individualised therapeutic strategy to identify candidates for 'top-down' treatment, based on enhanced diagnostics using biomarkers. Emerging therapeutic approaches besides existing therapy concepts using biologicals may possibly redefine the 'top-down' therapeutic strategy for Crohn's disease in the future.

  10. Facial biometrics of peri-oral changes in Crohn's disease.

    Science.gov (United States)

    Zou, L; Adegun, O K; Willis, A; Fortune, Farida

    2014-05-01

    Crohn's disease is a chronic relapsing and remitting inflammatory condition which affects any part of the gastrointestinal tract. In the oro-facial region, patients can present peri-oral swellings which results in severe facial disfigurement. To date, assessing the degree of facial changes and evaluation of treatment outcomes relies on clinical observation and semi-quantitative methods. In this paper, we describe the development of a robust and reproducible measurement strategy using 3-D facial biometrics to objectively quantify the extent and progression of oro-facial Crohn's disease. Using facial laser scanning, 32 serial images from 13 Crohn's patients attending the Oral Medicine clinic were acquired during relapse, remission, and post-treatment phases. Utilising theories of coordinate metrology, the facial images were subjected to registration, regions of interest identification, and reproducible repositioning prior to obtaining volume measurements. To quantify the changes in tissue volume, scan images from consecutive appointments were compared to the baseline (first scan image). Reproducibility test was performed to ascertain the degree of uncertainty in volume measurements. 3-D facial biometric imaging is a reliable method to identify and quantify peri-oral swelling in Crohn's patients. Comparison of facial scan images at different phases of the disease revealed precisely profile and volume changes. The volume measurements were highly reproducible as adjudged from the 1% standard deviation. 3-D facial biometrics measurements in Crohn's patients with oro-facial involvement offers a quick, robust, economical and objective approach for guided therapeutic intervention and routine assessment of treatment efficacy on the clinic.

  11. 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.).

  12. Active pollution reduction in the 'off-road' sector. Proceedings; Aktive Schadstoffminderung im 'Off-road' Bereich. Tagungsband

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-07-01

    The state of the art and trends in off-gas purification and filters were gone into. The focus was on technical aspects, performance information and cost of diesel engines with high-efficiency exhaust purification systems as well as on sulfur-free fuels. [German] Mit der Tagung 'Aktive Schadstoffminderung im ''Off-road'' Bereich' bieten wir eine besondere Gelegenheit zur Information und Auseinandersetzung mit dem derzeitigen Stand und den Entwicklungsperspektiven der Abgasreinigung und Filtertechnik bei Neubeschaffungen und in der Nachruestung. Gerade in staedtischen Ballungsgebieten, aber auch in geschlossenen Raeumen und Produktionshallen sind die Reduzierung der lokalen Emissionen und Vermeidung von Geruchsbelaestigungen unabdingbar. Im Mittelpunkt stehen Technik, Betriebserfahrungen und Kosten von Dieselmotoren mit hocheffizienter Abgasreinigung sowie schwefelfreie Kraftstoffe. (orig.)

  13. Radiological aspects of Crohn's disease in small intestine: iconographic assay; Aspectos radiologicos da doenca de Crohn no intestino delgado: ensaio iconografico

    Energy Technology Data Exchange (ETDEWEB)

    Barros, Nestor de; Juliano, Adriana G.; Polizini, Jose M.R.; Rejtman, Debora; Cerri, Giovanni Guido; Rocha, Manoel de Souza [Sao Paulo Univ., SP (Brazil). Faculdade de Medicina. Dept. de Radiologia

    1999-12-01

    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.

  14. {sup 1}H-MR-spectroscopic imaging in patients with Alzheimer`s disease; {sup 1}H-MR-spektroskopische Bildgebung bei Patienten mit klinisch gesichertem Morbus Alzheimer

    Energy Technology Data Exchange (ETDEWEB)

    Block, W [Radiogische Klinik der Univ. Bonn (Germany); Traeber, F [Radiogische Klinik der Univ. Bonn (Germany); Kuhl, C K [Radiogische Klinik der Univ. Bonn (Germany); Fric, M [Psychiatrische Universitaetsklinik, Bonn (Germany); Keller, E [Radiogische Klinik der Univ. Bonn (Germany); Lamerichs, R [Philips Medical Systems, Best (Netherlands); Rink, H [Radiogische Klinik der Univ. Bonn (Germany); Moeller, H J [Psychiatrische Universitaetsklinik, Bonn (Germany); Schild, H H [Radiogische Klinik der Univ. Bonn (Germany)

    1995-09-01

    To detect regional differences in accompanying metabolic changes, {sup 1}H-Magnetic Resonance Spectroscopic Imaging was performed in 16 patients with Alzheimer`s disease (AD); the clinical diagnosis was based upon DSM-III-R and NINCDS-ADRDA guidelines. In the hippocampal region metabolic maps of the local distribution of N-acetylaspartate (NAA), choline (Cho), creatine compounds (P(Cr)) and lactate were determined. Ratios of Cho/NAA, (P)Cr/NAA and Cho/(P)Cr calculated from selected hippocampal spectra were compared to those from healthy volunteers (n=17). AD patients demonstrated an increase of Cho/NAA and (P)Cr/NAA ratios caused by increased choline compounds and decreased NAA. These alterations were observed in 11/12 cases in the hippocampal and in 7/12 in the temporo-occipital region. Hippocampal Cho/NAA ratios (0.56{+-}0.19) were significantly elevated compared with controls. The observed elevation of choline compounds in the hippocampus supports the hypothesis that alterations in the cholinergic system play an important role in Alzheimer`s disease. The observed reduction of NAA is due to neuronal degeneration. (orig./MG) [Deutsch] Zur Darstellung von regionalen metabolischen Veraenderungen bei Morbus Alzheimer wurden mit dem Verfahren des {sup 1}H-Magnetic-Resonance-Spectroscopic-Imaging 16 Patienten untersucht, deren Diagnose klinisch entsprechend DSM-III-R- und NINCDS-ADRDA-Kriterien gestellt wurde. In Hoehe des Hippocampus wurden transaxiale ``Metabolitenkarten`` der regionalen Verteilung von N-Acetyl-Aspartat (NAA), cholinhaltiger Verbindungen (Cho), Gesamtkreatin (P(Cr)) und Laktat erstellt. Zur Quantifizierung der Unterschiede zum Normalkollektiv (n=17) wurden die Metabolitenquotienten Cho/NAA, (P)Cr/NAA und Cho/(P)Cr, insbesondere aus der Hippocampusregion, ermittelt. Das Krankheitsbild des M. Alzheimer stellte sich durch eine Erhoehung der Quotienten Cho/NAA und Cho/(P)Cr dar, wobei neben einer Cholinerhoehung die Reduktion des Neurotransmitters NAA

  15. Thyroid volume reduction following radioiodine therapy in patients with autonomous goitre and Graves` disease; Volumenreduktion der Schilddruese nach Radiojodtherapie bei Patienten mit Schilddruesenautonomie und Morbus Basedow

    Energy Technology Data Exchange (ETDEWEB)

    Dederichs, B. [Klinik und Poliklinik fuer Nuklearmedizin, Univ. Koeln (Germany); Otte, R. [Klinik und Poliklinik fuer Nuklearmedizin, Univ. Koeln (Germany); Klink, J.E. [Klinik und Poliklinik fuer Nuklearmedizin, Univ. Koeln (Germany); Schicha, H. [Klinik und Poliklinik fuer Nuklearmedizin, Univ. Koeln (Germany)

    1996-10-01

    Aim: It is well known that radioiodine therapy (RITh) leads to a significant thyroid volume reduction (TVR). But until now only little data has been presented due to the course of time and the extent of TVR. Method: Therefore the data of 33 patients with Graves` disease (GD), 36 patients with multifocal (MAG) and 31 with solitary (SAG) autonomous goitre were analyzed retrospectively. Results: All the patients showed a highly significant (p<0.001) TVR, which continued up to 1 year after RITh. Receiving equal effective radiation doses, the extent of TVR was significantly greater for GD than for MAG. This difference developed within six weeks up to 3 months after RITh. Conclusion: This observation suggests that the underlying thyroid disease affects the therapeutic effect of RITh and may be partially explained by the total suppression of non-autonomous thyroid tissue in AG at the time of RITh. In patients with SAG with a 1.7 times higher effective radiation dose than in MAG relative TVR was about 1.6 times stronger in SAG than in MAG. This demonstrates a direct relation between the effective radiation dose and the extent of the TVR after RITh. (orig.) [Deutsch] Ziel: Es ist bekannt, dass die Radiojodtherapie (RJTh) zu einer relvanten Schilddruesenvolumenreduktion (SVR) fuehrt. Bisher wurden jedoch nur vereinzelt systematische Daten zum zeitlichen Verlauf und quantitativen Ausmass der SVR veroeffentlicht. Methode: Daher fuehrten wir eine retrospektive Auswertung der Daten von 33 Patienten mit Morbus Basedow (MB), 36 Patienten mit multifokaler (MFA) und 31 mit unifokaler (UFA) Autonomie der Schilddruese durch. Ergebnisse: Fuer alle Patientengruppen ergab sich eine hochsignifikante (p<0,001) SVR, welche sich bis ein Jahr nach RJTh signifikant fortsetzte. Obwohl die effektive Herddosis nicht signifikant verschieden war, war das Ausmass der SVR fuer Patienten mit MB signifikant groesser als fuer Patienten mit MFA. Dieser Unterschied war bereits innerhalb der ersten 6

  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. Det aktive menneskes triumf?

    DEFF Research Database (Denmark)

    Nielsen, Mathias Herup

    2015-01-01

    This article analyses the system of categorisation currently used for describing and labelling social assistance recipients in Denmark as either qualified or not qualified for work. Rather than studying concrete situations, where ‘clients’ meet ‘system’, the article offers instead an analysis...... the article describes this transformation of the categorisation system by drawing on an archive of relevant governance documents – first and foremost documents from Ministries directed at front workers and imposing them to categorise the unemployed according to certain logics. Theoretically the article...

  18. 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.

  19. 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.

  20. High frequency of helicobacter negative gastritis in patients with Crohn's disease.

    OpenAIRE

    Halme, L; Kärkkäinen, P; Rautelin, H; Kosunen, T U; Sipponen, P

    1996-01-01

    The frequency of gastric Crohn's disease has been considered low. This study was undertaken to determine the prevalence of chronic gastritis and Helicobacter pylori infection in patients with Crohn's disease. Oesophagogastroduodenoscopy was performed on 62 consecutive patients suffering from ileocolonic Crohn's disease. Biopsy specimens from the antrum and corpus were processed for both histological and bacteriological examinations. H pylori antibodies of IgG and IgA classes were measured in ...

  1. Radioiodine therapy of Graves' disease - a dosimetric comparison of different strategies concerning antithyroid drugs; Radioiodtherapie des Morbus Basedow - dosimetrischer Vergleich verschiedener Therapieregime bezueglich der Thyreostatikabgabe

    Energy Technology Data Exchange (ETDEWEB)

    Urbannek, V.; Voth, E.; Moka, D.; Schicha, H. [Klinik und Poliklinik fuer Nuklearmedizin, Medizinische Einrichtungen der Univ. zu Koeln (Germany)

    2001-08-01

    -half-life, but it is inferior to stopping ATD 2 days prior to RITh. (orig.) [German] Ziel: Eine thyreostatische Medikation (TM) waehrend einer Radioiodtherapie (RITh) fuehrt im Vergleich zu nicht thyreostatisch behandelten Patienten zu einer prozentualen Zunahme an Therapieversagern oder erfordert einen erhoehten Verbrauch an Radioiod (RI). Andererseits ist aus klinischen Gruenden und wegen des in der Hyperthyreose beschleunigten lodstoffwechsels vor RITh eine Kompensation der Stoffwechsellage anzustreben. Ziel dieser Studie war daher, am Beispiel des Morbus Basedow den Einfluss der TM auf die Biokinetik von RI zu untersuchen, um die RITh bei thyreostatisch vorbehandelten Patienten zu optimieren. Methoden: Eingeschlossen wurden 385 konsekutive Patienten, die wegen eines Morbus Basedow erstmalig eine RITh erhielten: Kollektiv A (n = 74): Durchfuehrung der RITh unter laufender TM; Kollektiv B (n = 111): Beginn der RITh unter TM, Absetzen von TM 1-5 Tage nach RITh, falls RI-Uptake unzureichend oder RI-HWZ verkuerzt (n = 61); Kollektiv C (n = 200): Absetzen von TM 2 Tage vor RITh bei allen Patienten. Betrachtet wurde der Einfluss von thyreostatischer Medikation auf den RI-Uptake, die RI-HWZ sowie die an der Schilddruese erzielte Energiedosis in Abhaengigkeit vom SD-Volumen und der eingesetzen RI-Aktivitaet [Therapieeffizienzquotient TEQ, (2)]. Ergebnisse: Im RI-Test (alle Patienten unter TM) war der RI-Uptake in den drei Kollektiven vergleichbar. Bei der RITh waren RI-Uptake, RI-HWZ{sub eff} und damit auch TEQ im Kollektiv C signifikant groesser als in den Kollektiven A und B (jeweils p<0,001). Im Kollektiv B wurde die TM bei 61 der 111 Patienten 1-5 Tage nach RITh abgesetzt. In diesem Unterkollektiv stieg die RI-HWZ von 4,4 {+-} 1,7 d auf 5,1 {+-} 1,6 d nach Absetzen der TM an (p = 0,001). Schlussfolgerung: Absetzen von TM 2 Tage vor RITh fuehrt im Vergleich zur Durchfuehrung der RITh unter TM zu einer Steigerung der Effizienz (TEQ) von etwa 50% und damit zu einer deutlichen

  2. 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.

  3. 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.

  4. 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...

  5. 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 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.

  6. ORAL MANIFESTATIONS OF CROHN'S DISEASE: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Muhvić-Urek Miranda

    2015-12-01

    Full Text Available Crohn´s disease is a chronic inflammatory bowel disease still with unknown etiology. In 0.5-20 % of patients, extraintestinal lesions in the oral cavity can be presented in forms of orofacial granulomatosis, cobblestone and corrugated oral mucosa, mucosal tags, deep linear ulcerations with hyperplastic folds, pyostomatits vegetans, aphthous ulcers, angular cheilitis, labial/facial edema and gingival erythema/edema. We describe a case of a 28-year-old male who was presented with oral lesions of Crohn´s disease and treatment procedure. The patient was candidate for biologic treatment so dental procedures and preparation of the patient for treatment are described. Good communication and cooperation between the patient's doctor and dentist are important for successful treatment.

  7. 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.

  8. The TB--Crohn's affair--a never ending dilemma.

    Science.gov (United States)

    Praveen, S; Razman, J

    2008-08-01

    An 80 year old lady presented with signs and symptoms of sub-acute intestinal obstruction which failed conservative management. CT scan abdomen revealed circumferential ileum thickening with proximal bowel dilatation. Laparotomy and segmental resection was done. Pathological findings were suggestive of chronic granulomatous ileits with differential of Crohn's disease and gastrointestinal tuberculosis. The patient was presumed to have gastrointestinal tuberculosis and commenced on anti tuberculosis treatment despite inconclusive evidence for confirmation and showed marked clinical improvement.

  9. 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......, skin, and liver) manifestations: 20.1% versus 10.4% (p colitis compared to proctitis in UC increased the risk of EIM. CONCLUSION: In a European inception cohort, EIMs in IBD...

  10. 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 bet...... of a patient's disease, in part genetically determined, and the major driver to changes in disease behaviour over time. FUNDING: International Inflammatory Bowel Disease Genetics Consortium members funding sources (see Acknowledgments for full list)....

  11. Enterovesical fistulas complicating Crohn's disease: clinicopathological features and management.

    Science.gov (United States)

    Yamamoto, T; Keighley, M R

    2000-08-01

    Enterovesical fistula is a relatively rare condition in Crohn's disease. This study was undertaken to examine clinicopathological features and management of enterovesical fistula complicating Crohn's disease. Thirty patients with enterovesical fistula complicating Crohn's disease, treated between 1970 and 1997, were reviewed. Urological symptoms were present in 22 patients; pneumaturia in 18, urinary tract infection in 7, and haematuria in 2. In 5 patients clinical symptoms were successfully managed by conservative treatment, and they required no surgical treatment for enterovesical fistula. Twenty-five patients required surgery. All the patients were treated by resection of diseased bowel and pinching off the dome of the bladder. No patients required resection of the bladder. The Foley catheter was left in situ for an average of 2 weeks after operation. Three patients developed early postoperative complications; two bowel anastomotic leaks, and one intra-abdominal abscess. All these complications were associated with sepsis and multiple fistulas at the time of laparotomy. After a median follow-up of 13 years, 3 patients having postoperative sepsis (anastomotic leak or abscess) developed a recurrent fistula from the ileocolonic anastomosis to the bladder, which required further surgery. In the other 22 patients without postoperative complications there has been no fistula recurrence. In conclusion, the majority of patients with enterovesical fistula required surgical treatment: resection of the diseased bowel and oversewing the defect in the bladder. The fistula recurrence was uncommon, but the presence of sepsis and multiple fistulas at the time of laparotomy increased the incidence of postoperative complications and fistula recurrence.

  12. 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.

  13. 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.

  14. 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.

  15. 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

  16. 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

  17. 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

  18. 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.)

  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. Development of the Crohn's disease digestive damage score, the Lémann score

    DEFF Research Database (Denmark)

    Pariente, Benjamin; Cosnes, Jacques; Danese, Silvio

    2011-01-01

    is to outline the methods to develop an instrument that can measure cumulative bowel damage. The project is being conducted by the International Program to develop New Indexes in Crohn's disease (IPNIC) group. This instrument, called the Crohn's Disease Digestive Damage Score (the Lémann score), should take...

  1. 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.

  2. Natalizumab for induction of remission in Crohn's disease.

    Science.gov (United States)

    Macdonald, J K; McDonald, J W D

    2006-07-19

    The pathogenesis of Crohn's disease involves migration of leukocytes into gut tissue and subsequent inflammation. Natalizumab (Tysabri, Elan Pharmaceuticals and Biogen Idec) a recombinant humanized IgG4 monoclonal antibody that blocks adhesion and subsequent migration of leukocytes into the gut by binding the alpha4 integrin is a member of a new class of molecules known as selective adhesion molecule (SAM) inhibitors. The results of animal studies suggest that alpha4 integrin blockade could be a useful therapy for inflammatory bowel disease. The results of randomized controlled trials suggest that natalizumab may be an effective therapy for active Crohn's disease. This systematic review summarizes the current evidence on the use of natalizumab for the induction of remission in Crohn's disease. To determine the efficacy and safety of natalizumab for induction of remission in Crohn's disease. A computer assisted search of the Cochrane Central Register of Controlled Trials, the Cochrane Inflammatory Bowel Disease and Functional Bowel Disorders Review Group Specialized Trials Register, MEDLINE and EMBASE was performed to identify relevant publications between 1966 and June 2005. The medical subject heading (MeSH) terms "Crohn disease" or "inflammatory bowel disease", "Natalizumab" or "Antegren" or "Tysabri" and "Antibodies, Monoclonal" were used to perform key word searches of each database. Manual searches of reference lists from potentially relevant papers were performed in order to identify additional studies that may have been missed using the computer-assisted search strategy. Abstracts from major gastroenterological meetings were searched to identify research submitted in abstract form only. Personal contacts, leaders in the field, and the manufacturers were contacted to identify other studies which may not be published. We included only randomized controlled trials comparing natalizumab to a placebo or control therapy for the induction of remission in Crohn

  3. 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 maturity....... Training and brace treatment yield good results for milder curves, while surgical correction is the most effective for severe curves > 70°. Indications for surgery are subject of debate as complications are not uncommon....

  4. The new active driving safety system ESP (Electronic Stability Program) developed by Mercedes Benz; Das neue aktive Fahrsicherheitssystem ESP (Elektronisches-Stabilitaets-Programm) von Mercedes-Benz

    Energy Technology Data Exchange (ETDEWEB)

    Paul, J. [Mercedes-Benz AG, Stuttgart (Germany); Klinkner, W. [Mercedes-Benz AG, Stuttgart (Germany); Mueller, A. [Mercedes-Benz AG, Stuttgart (Germany)

    1995-12-31

    The new electronic stability program (ESP) offered by Mercedes-Benz as a world novelty in March 1995 is the consequent further development of the anti-lock braking system and the anti-slip control. An improved assessment of the handling properties by a steering wheel sensor, a yaw velocity sensor, a brake pressure sensor and a hydraulic system that brakes each wheel individually and is controlled by a complex logic allow the supervision and the active control of the cross-dynamic handling properties up to limiting ranges. The handling of the vehicle in critical situations (e.g. strong oversteering or understeering) has been considerably improved. (orig.) [Deutsch] Das neue elektronische-Stabilitaets-Programm (ESP), von Mercedes-Benz ab Maerz 1995 als Weltneuheit angeboten, stellt eine konsequente Weiterentwicklung des Antiblockier-Bremssystems (ABS) und der Antriebsschlupfregelung (ASR) dar. Eine erweiterte Fahrzustandserfassung durch Lenkradwinkel-, Giergeschwindigkeit- und Bremsdrucksensor, eine Hydraulik, die jedes Rad individuell abbremsen kann, angesteuert durch eine komplexe Regelungslogik, erlauben erstmals eine Ueberwachung und aktive Regelung des querdynamischen Fahrzustands bis in den Grenzbereich. Die Beherrschbarkeit des Fahrzeugs wird in kritischen Situationen (z.B. starkes Ueber- oder Untersteuern) entscheidend verbessert. (orig.)

  5. Saccharomyces boulardii does not prevent relapse of Crohn's disease.

    Science.gov (United States)

    Bourreille, Arnaud; Cadiot, Guillaume; Le Dreau, Gérard; Laharie, David; Beaugerie, Laurent; Dupas, Jean-Louis; Marteau, Philippe; Rampal, Patrick; Moyse, Dominique; Saleh, Ashraf; Le Guern, Marie-Emmanuelle; Galmiche, Jean-Paul

    2013-08-01

    Saccharomyces boulardii is a probiotic yeast that has been shown to have beneficial effects on the intestinal epithelial barrier and digestive immune system. There is preliminary evidence that S boulardii could be used to treat patients with Crohn's disease (CD). We performed a randomized, placebo-controlled trial to evaluate the effects of S boulardii in patients with CD who underwent remission during therapy with steroids or aminosalicylates. We performed a prospective study of 165 patients who achieved remission after treatment with steroids or salicylates; they were randomly assigned to groups given S boulardii (1 g/day) or placebo for 52 weeks. The primary end point was the percentage of patients in remission at week 52. Time to relapse, Crohn's disease activity index scores, and changes in parameters of inflammation were secondary end points. CD relapsed in 80 patients, 38 in the S boulardii group (47.5%) and 42 in the placebo group (53.2%, a nonsignificant difference). The median time to relapse did not differ significantly between patients given S boulardii (40.7 weeks) vs placebo (39.0 weeks). There were no significant differences between groups in mean Crohn's disease activity index scores or erythrocyte sedimentation rates or in median levels of C-reactive protein. In a post hoc analysis, nonsmokers given S boulardii were less likely to experience a relapse of CD than nonsmokers given placebo, but this finding requires confirmation. Although the probiotic yeast S boulardii is safe and well tolerated, it does not appear to have any beneficial effects for patients with CD in remission after steroid or salicylate therapies. Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.

  6. 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.

  7. 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

  8. Radiographic appearances in Crohn's disease. I. Accuracy of radiographic methods

    Energy Technology Data Exchange (ETDEWEB)

    Hildell, J; Lindstroem, C; Wenckert, A [Departments of Diagnostic Radiology, Pathology and Surgery, Malmoe Allmaenna Sjukhus, Malmoe, Sweden

    1979-01-01

    Preoperative films of 176 patients operated upon for Crohn's disease were reviewed and compared with microscopic findings in the resected specimens in order to assess the accuracy of the radiographic techniques used. It was found that a diagnosis of the presence and the extent of the disease was often dependent on the demonstration of minor mucosal ulcers and less marked submucosal edema. These lesions were not adequately demonstrated by any of the techniques used for small bowel examination, but were consistently revealed by the double-contrast technique used for examination of the colon.

  9. 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.

  10. Crohn's disease and risk of fracture: does thyroid disease play a role?

    Institute of Scientific and Technical Information of China (English)

    Nakechand Pooran; Pankaj Singh; Simmy Bank

    2003-01-01

    AIM: To assess the role of thyroid disease as a risk for fractures in Crohn's patients.METHODS: A cross-sectional study was conducted from 1998 to 2000. The study group consisted of 210 patients with Crohn's disease. A group of 206 patients without inflammatory bowel disease served as controls. Primary outcome was thyroid disorder. Secondary outcomes included use of steroids, immunosuppressive medications, surgery and incidence of fracture.RESULTS: The prevalence of hyperthyroidism was similar in both groups. However, the prevalence of hypothyroidism was lower in Crohn's patients (3.8 % vs 8.2 %, P=0.05).Within the Crohn's group, the use of immunosuppressive agents (0 % vs11 %), steroid usage (12.5 % vs37 %), small bowel surgery (12.5 % vs 28 %) and large bowel surgery (12.5 % vs27 %) were lower in the hypothyroid subset as compared to the euthyroid subset. Seven (3.4 %) Crohn'spatients suffered fracture, all of whom were euthyroid.CONCLUSION: Thyroid disorder was not found to be associated with Crohn's disease and was not found to increase the risk for fractures. Therefore, screening for thyroid disease is not a necessary component in the management of Crohn's disease.

  11. Measurement of thyrotropin receptor antibodies (TRAK) with a second generation assay in patients with Graves' disease; Die Bestimmung von Thyreotropin-Rezeptor-Antikoerpern (TRAK) mit einem Assay der zweiten Generation bei Patienten mit Morbus Basedow

    Energy Technology Data Exchange (ETDEWEB)

    Zoephel, K.; Wunderlich, G.; Franke, W.G. [Klinik und Poliklinik fuer Nuklearmedizin, Technische Univ. Dresden (Germany); Koch, R. [Inst. fuer Medizinische Informatik und Biometrie, Technische Univ. Dresden (Germany)

    2000-06-01

    Aim: The detection of TSH-receptor-antibodies (TRAb) in patients (pts) with Graves' disease (GD) is routinely used in nuclear medicine laboratories. It is performed by commercial, porcine radioreceptorassays (RRA) measuring TSH binding inhibitory activity. A second generation assay using the human, recombinant TSH-receptor was developed during the last years. The manufacturer composed this new assay as a coated tube RRA (CT RRA) and claimed a higher sensitivity for GD. Methods: TRAb was measured in 207 pts with various thyroid disorders and 205 healthy controls using the new coated tube RRA (Fa. B.R.A.H.M.S. Diagnostica GmbH, Berlin, Germany) as well as a conventional RRA (Fa. Medipan Diagnostica GmbH, Selchow, Germany): 60 pts suffering from GD showing a relapse after anti-thyroid drug treatment and before radioiodine therapy, 109 pts with disseminated autonomia (DA) and 38 pts suffering from Hashimoto's thyroiditis. A ROC-analysis was performed to find the optimal decision threshold level for positivity. Results: We found 42/60 TRAb-positive pts with GD in the established RRA (threshold 6 U/L) and 52/60 in the CT RRA, respectively. The sensitivity increased from 70% (RRA) to 86,7% (CT RRA). The CT RRA found 2 false positives (one Hashimoto's and one healthy control) and the RRA detected 3 Hashimoto's and 2 healthy controls as false positive. Conclusion: The increased sensitivity of CT RRA for GD provides an advantage compared to conventional RRA, especially in GD-patients relapsing afte antithyroid drug treatment. Functional sensitivity and Interassayvariation of CT RRA are very precisely compared to conventional RRA. Handling of the new assay is also improved. (orig.) [German] Ziel: Die Bestimmung der TSH-Rezeptorantikoerper (TRAK) bei Patienten mit Morbus Basedow ist fester Bestandteil der nuklearmedizinischen In-vitro-Diagnostik. Seit kurzem ist die Bestimmung mit einem TRAK-Assay moeglich, bei dem im Gegensatz zu den herkoemmlichen

  12. 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.

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

    Science.gov (United States)

    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 Crohn's disease, such as pyoderma gangrenosum, uveitis and arthropathy. Maintenance treatment with infliximab is effective and is regarded as safe as long as the necessary safety measures are heeded. Infusion reactions occur in 3 to 17% of the patients and are associated with the formation of antibodies to infliximab. A reduction in infusion reactions is possible by the concurrent administration of steroids and the use of immunosuppressants (azathioprine, 6-mercaptopurine, methotrexate). Furthermore, immunosuppressants increase the duration of the response to infliximab. For these reasons, the concomitant use of immunosuppressants with infliximab is recommended. Infections and most specifically tuberculosis need to be ruled out before infliximab is administered. Up to now, there are no indications for a connection between an increased risk for malignancies and treatment with infliximab.

  14. 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.

  15. 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

  16. 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

  17. 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....

  18. 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) ...

  19. Contribution of rs11465788 in IL23R gene to Crohn's disease ...

    Indian Academy of Sciences (India)

    Multiple studies have shown that IL23 cytokine plays an essential role in the development of autoimmune diseases ... milial risk of IBD provide strong evidence, that the genetic ..... variant in German Crohn's disease patients: combined analysis.

  20. Medium-term follow-up of Crohn's disease in Cape Town

    African Journals Online (AJOL)

    1989-08-09

    Aug 9, 1989 ... Normally distributed data, such as age, were tested in the different groups by ... extent of disease at diagnosis had been determined by small ..... Brahme F, Lindstrom C, Wenckert A. Crohn's disease in a defined popula- tion.

  1. 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 ...

  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. Simultaneous central retinal artery occlusion and optic nerve vasculitis in Crohn disease

    Directory of Open Access Journals (Sweden)

    Razek Georges Coussa

    2017-04-01

    Conclusions and importance: To our knowledge, this is the first case of unilateral CRAO and bilateral optic nerve occlusive vasculitis in Crohn disease, which should be considered as an etiology of retinal vascular occlusive disorders especially in young patients. It is important for ophthalmologists to be aware of the ophthalmic risks associated with Crohn disease as aggressive treatment with systemic steroids and immunosuppressive agents is often needed.

  4. Intestinal microbiology in Crohn's disease: a study of Escherichia coli as a potential etiologic agent

    OpenAIRE

    Martínez Medina, Margarita

    2009-01-01

    Crohn's disease is a chronic inflammatory bowel disorder of unknown aetiology. Genetic and immunologic features that confer susceptibility on the host, together with external or environmental factors such as microorganisms and lifestyle, are thought to be involved. The main purpose of this work was to describe the bacterial populations particularly related with Crohn's disease patients in order to identify putative etiologic agents. The results are in agreement with previous research on the ...

  5. Computed tomography evaluation of the sacroiliac joints in Crohn disease

    International Nuclear Information System (INIS)

    Scott, W.W. Jr.; Fishman, E.K.; Kuhlman, J.E.; Caskey, C.I.; O'Brien, J.J.; Walia, G.S.; Bayless, T.M.

    1990-01-01

    Computed tomography (CT) was used in a prospective study of the sacroiliac joints in 86 patients with Crohn disease to determine the type and frequency of sacroiliac joint abnormalities present in this population. The CT findings were correlated with review of the clinical history in 64 patients. Computed tomography demonstrated changes of sacroiliitis in 29% of the study group. This high prevalence of sacroiliac joint abnormality was found even in those under 30 years of age. It exceeds the 11-19% previously reported from plain film examination, reflecting the greater sensitivity of CT. In the subgroup of 64 patients studied clinically, 19 (30%) had abnormal sacroiliac joints on CT, but only 2 (3%) reported symptoms related to the sacroiliac joints. (orig.)

  6. 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.

  7. 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.

  8. [Postoperative recurrence of Crohn's disease, and its prevention].

    Science.gov (United States)

    Lakatos, László; Lakatos, Péter László

    2010-05-23

    Crohn's disease is a chronic, progressive disabling condition ultimately leading to stricturing and/or penetrating complications. The need for surgery may be as high as 70% in patients with severe active disease or complications. However, relapse may develop in a significant proportion of the patients after surgery leading to frequent re-operations. Despite emerging data, postoperative prevention is still controversial. After careful evaluation of the individual risk a tailored therapy should be considered. In patients with small risk for relapse mesalazine or in selected cases no-treatment may be an option. In patients with a moderate-to-high risk azathioprine should be considered together with metronidazole in the three months. Follow-up ileocolonoscopy 6-12 months after the surgery is helpful in the determination of endoscopic severity and may assist in the optimization of the therapy. In most severe cases anti-TNF agents may be appropriate for postoperative prevention and therapy.

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

    Energy Technology Data Exchange (ETDEWEB)

    Dillman, Jonathan R.; Ladino-Torres, Maria F.; Strouse, Peter J. [University of Michigan Health System, Department of Radiology, C.S. Mott Children' s Hospital, Section of Pediatric Radiology, Ann Arbor, MI (United States); Adler, Jeremy; DeMatos-Malliard, Vera [University of Michigan Health System, Department of Pediatrics and Communicable Diseases, C. S. Mott Children' s Hospital, Division of Pediatric Gastroenterology, Ann Arbor, MI (United States); McHugh, Jonathan B. [University of Michigan Health System, Department of Pathology, Ann Arbor, MI (United States); Khalatbari, S. [University of Michigan Institute for Clinical Health Research (MICHR), Ann Arbor, MI (United States)

    2011-12-15

    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.)

  10. 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.

  11. 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

  12. 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.

  13. Low serum and bone vitamin K status in patients with longstanding Crohn's disease: another pathogenetic factor of osteoporosis in Crohn's disease?

    Science.gov (United States)

    Schoon, E; Muller, M; Vermeer, C; Schurgers, L; Brummer, R; Stockbrugger, R

    2001-01-01

    BACKGROUND—A high prevalence of osteoporosis is reported in Crohn's disease. The pathogenesis is not completely understood but is probably multifactorial. Longstanding Crohn's disease is associated with a deficiency of fat soluble vitamins, among them vitamin K. Vitamin K is a cofactor in the carboxylation of osteocalcin, a protein essential for calcium binding to bone. A high level of circulating uncarboxylated osteocalcin is a sensitive marker of vitamin K deficiency.
AIMS—To determine serum and bone vitamin K status in patients with Crohn's disease and to elucidate its relationship with bone mineral density.
METHODS—Bone mineral density was measured in 32 patients with longstanding Crohn's disease and small bowel involvement, currently in remission, and receiving less than 5 mg of prednisolone daily. Serum levels of vitamins D and K, triglycerides, and total immunoreactive osteocalcin, as well as uncarboxylated osteocalcin ("free" osteocalcin) were determined. The hydroxyapatite binding capacity of osteocalcin was calculated. Data were compared with an age and sex matched control population.
RESULTS—Serum vitamin K levels of CD patients were significantly decreased compared with normal controls (p<0.01). "Free" osteocalcin was higher and hydroxyapatite binding capacity of circulating osteocalcin was lower than in matched controls (p<0.05 and p<0.001, respectively), indicating a low bone vitamin K status in Crohn's disease. In patients, an inverse correlation was found between "free" osteocalcin and lumbar spine bone mineral density (r=−0.375, p<0.05) and between "free" osteocalcin and the z score of the lumbar spine (r=−0.381, p<0.05). Multiple linear regression analysis showed that "free" osteocalcin was an independent risk factor for low bone mineral density of the lumbar spine whereas serum vitamin D was not.
CONCLUSIONS—The finding that a poor vitamin K status is associated with low bone mineral density in longstanding Crohn

  14. Does an individual estimation of halflife improve the results of radioiodine therapy of Graves' disease?; Verbessert die individuelle Bestimmung der effektiven Halbwertszeit die Ergebnisse der Radioiodtherapie des Morbus Basedow?

    Energy Technology Data Exchange (ETDEWEB)

    Schneider, P.; Koerber, C.; Koerber-Hafner, N.; Haenscheid, H.; Reiners, Chr. [Klinik und Poliklinik fuer Nuklearmedizin der Univ. Wuerzburg (Germany)

    2002-12-01

    significantly improve. In addition, no influence of antithyroid medication on therapy success was found. (orig.) [German] Ziel: Der Einfluss unseres Dosimetriekonzepts auf den Erfolg der radioiodtherapie (RIT) bei Morbus Basedow wurde bezueglich dreier Fragen untersucht: Verbessert die individuelle praetherapeutische Bestimmung der Halbwertszeit (HWZ) im Radioiodtest den Therapieerfolg? Erlaubt die intratherapeutische Dosimetrie eine akkurate Dosiskalkulation? Zeigt eine thyreostatische Medikation einen messbaren Einfluss auf den Therapieerfolg? Methode: 126 Patienten erhielten wegen eines Morbus Basedow eine praetherapeutische Dosimetrie (Zieldosis: 200 Gy) mit zwei Methoden, die eine Bestimmung der HWZ oder eine Naeherungsloesung einschliesst. Die Behandlung wurde nach 6-9 Monaten als erfolgreich betrachtet, wenn der Zustand eu- oder hypothyreot war. Bei Hyperthyreose oder supprimiertem basalen TSH-Wert nach Absetzen der Thyreostatika wurde die RIT als Misserfolg gewertet. Thyreostatika, applizierte Aktivitaet, Dosis, spezifische Dosis pro Gewebe und HWZ wurden mittels der multiplen Regressionsanalyse bezueglich ihres Effekts auf den Therapieerfolg untersucht. Mit Logit-Transformation wurden relevante Parameter auf die Chancenverteilung einer erfolgreichen oder erfolglosen RIT untersucht. Ergebnisse: Von 126 Patienten wurden 42 (33,3%) ohne Erfolg und 84 (66,6%) erfolgreich therapiert. Bei Patienten mit geschaetzter intratherapeutischer HWZ entsprach die Erfolgsquote der bei individuell bestimmter HWZ. Die Wahrscheinlichkeit eines Therapieerfolgs war bei der intratherapeutisch geschaetzten HWZ hoeher (Odds: 10,0) als bei der individuell gemessenen. Die erzielte Dosis zeigte eine stark von der Organmasse abhaengige Streuung, die zu sehr unterschiedlichen spezifischen Dosen fuehrte. Die thyreostatische Medikation hatte keinen Einfluss. Schlussfolgerung: Durch individuelle praetherapeutische Dosimetrie mit kompletter Radioiodkinetik gegenueber einer einfachen individuellen

  15. Long term results of surgery in Perthes disease: Comparison of X-ray and MR-studies; Spaetergebnisse nach operativer Behandlung des Morbus Perthes: Vergleich der roentgenologischen und kernspintomographischen Untersuchung

    Energy Technology Data Exchange (ETDEWEB)

    Tosch, U. [Strahlenklinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, Berlin (Germany); Sparmann, M. [Orthopaedische Klinik im Oskar-Helene-Heim, Berlin (Germany); Stelling, E. [Orthopaedische Klinik im Oskar-Helene-Heim, Berlin (Germany); Tomala, D. [Strahlenklinik und Poliklinik, Universitaetsklinikum Rudolf Virchow, Berlin (Germany)

    1995-05-01

    Twenty patients treated by surgery for Perthes` disease were studied between 4 and 9 years postoperatively. In the clinical investigation eight patients complained of persistent stress-induced pain. In nine patients flexion, extension, ab- and adduction of the hip joint was limited. In the MRI-Study of ten hip joints a reduction of fatty marrow was seen in the femoral head. In 11 hip joints of patients complaining of persistent pain, a deformation of the femoral head (n = 2), a dysplasia of the femoral metaphysis (n = 2), and diaphysis (n = 4) or both (n = 2) were seen. In another five patients an additional dysplasia of the acetabulum was visualized. All these findings were diagnosed by X-ray studies as well. However, only by MRI were the extents of the postoperative defects of femoral spongiosa diagnosed in fifteen hip joints. (orig.) [Deutsch] 20 wegen eines Morbus Perthes operierte Patienten wurden 4-9 Jahre nach einer Umstellungsosteotomie klinisch, radiologisch und kernspintomographisch untersucht. Bei der klinischen Nachuntersuchung gaben 8 Patienten persistierende Beschwerden bei Belastung an. Bei der koerperlichen Untersuchung war die Flexion und Extension bei 9 sowie die Abduktion und Adduktion bei einem Patienten eingeschraenkt. Bei der kernspintomographischen Untersuchung liessen sich bei 10 Hueftgelenken Residuen des M. Perthes im Fettmark des Femurkopfs nachweisen. An 11 Hueftkoepfen wurden pathologische Veraenderungen wie eine Femurkopfentrundung (n = 2), eine Deformierung der Femurmeta- (n = 3) und -diaphyse (n = 4) bis hin zur hirtenstabfoermigen Konfiguration (n = 2) nachgewiesen. Bei 5 Patienten wurde eine Pfannendysplasie gefunden. Diese Befunde waren auch roentgenologisch darzustellen. Als postoperative Defekte waren im Schaftmark des Femurs eine langstreckige Hoehlenbildung mit Zysten oder durch Fettmark aufgefuellte Spongiosadefekte bei 15 Hueftgelenken nur kernspintomographisch nachweisbar. (orig.)

  16. Treatment of therapy-resistant perineal metastatic Crohn's disease after proctectomy using anti-tumor necrosis factor chimeric monoclonal antibody, cA2 - Report of two cases

    NARCIS (Netherlands)

    van Dullemen, HM; de Jong, E; Slors, F; Tytgat, GNJ; van Denventer, SJH

    PURPOSE: Two young females with well-documented Crohn's disease and nonhealing perineal wounds following proctectomy compatible with "metastatic Crohn's disease" are described, We hypothesized that metastatic Crohn's disease would be a tumor necrosis factor-dependent inflammatory-reaction and have

  17. 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

  18. The operative management of children with complex perianal Crohn's disease.

    Science.gov (United States)

    Seemann, Natashia M; King, Sebastian K; Elkadri, Abdul; Walters, Thomas; Fish, Joel; Langer, Jacob C

    2016-12-01

    Perianal Crohn's disease (PCD) can affect both quality of life and psychological wellbeing. A subset of pediatric patients with complex PCD require surgical intervention, although appropriate timing and treatment regimens remain unclear. This study aimed to describe a large pediatric cohort in a tertiary center to determine the range of surgical management in children with complex PCD. A retrospective review of children requiring operative intervention for PCD over 13 years (2002-2014) was performed. PCD was divided into simple and complex based on the type of surgical procedure, and the two groups were compared. The 57 children were divided into two groups: the simple group (N=43) underwent abscess drainage ± seton insertion alone, and the complex group (N=14) underwent loop ileostomy ± more extensive surgery. In the complex group, females were more predominant (57% of complex vs 30% of simple), and the average age at diagnosis was lower. Anti-TNF therapy was utilized in 79.1% of simple and 100% of complex PCD. All 14 complex patients underwent a defunctioning ileostomy, with 7 requiring further operations (subtotal colectomy=4, proctocolectomy ± anal sparing=5, plastic surgery reconstruction with perineal flap/graft=4). Complex PCD represents a small but challenging subset of patients in which major surgical intervention may be necessary to alleviate the symptoms of this debilitating condition. retrospective case study with no control group - level IV. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. 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.

  20. 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.

  1. [DIETARY HABITS AND FEEDING BELIEFS OF PEOPLE WITH CROHN'S DISEASE].

    Science.gov (United States)

    García-Sanjuán, Sofía; Lillo-Crespo, Manuel; Sanjuán-Quiles, Ángela; Richart-Martínez, Miguel

    2015-12-01

    Crohn's disease (CD) is a chronic illness of unknown etiology. The consequences that CD causes nutritionally depend on several factors. However, little is known about the nutritional practices that CD affected people adopt once diagnosed. to explore the experience of those affected in relation to food intake, with the future goal of understanding those experiences and design effective and appropriate interventions. a qualitative design based on ethnographic approach was used. 19 semi-structured interviews were conducted in Alicante, until data saturation was reached and later the analysis of categories and subcategories was developed. 5 categories with their subcategories were identified from the data collected on the experience of feeding: 1) Beliefs about nutrition and CD, 2) Changing eating habits, 3) Finding information about food and CD, 4) The role of professionals, 5) Self-management. knowledge of the dietary habits of the person with CD, may provide professional workforce with the appropriate information for management and support in terms of prevention, health promotion and health education, useful for the organization of health institutions, where those things are not usually taken into account since the CD approach is purely based on clinical and pathological aspects. Consequently, it appears a need of a new CD perspective based on health, focused on promoting healthy habits and from a multidisciplinary approach. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

  2. 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...

  3. Radiological sacroiliitis, a hallmark of spondylitis, is linked with CARD15 gene polymorphisms in patients with Crohn's disease

    OpenAIRE

    Peeters, Harald; Vander Cruyssen, Bert; Laukens, Debby; Coucke, Paul; MARICHAL, DENIS; VAN DEN BERGHE, MARTINA; Cuvelier, Claude; Remaut, Erik; Mielants, Herman; De Keyser, Filip; De Vos, Martine

    2004-01-01

    Background: Sacroiliitis is a common extraintestinal manifestation of Crohn's disease but its association with the HLA-B27 phenotype is less evident. Polymorphisms in the CARD15 gene have been linked to higher susceptibility for Crohn's disease. In particular, associations have been found with ileal and fibrostenosing disease, young age at onset of disease, and familial cases.

  4. Biologic treatment or immunomodulation is not associated with postoperative anastomotic complications in abdominal surgery for Crohn's disease

    DEFF Research Database (Denmark)

    El-Hussuna, Alaa Abdul-Hussein H; Andersen, Jens; Bisgaard, Thue

    2012-01-01

    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.......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....

  5. Acute lower gastrointestinal bleeding in Crohn's disease: characteristics of a unique series of 34 patients. Belgian IBD Research Group

    NARCIS (Netherlands)

    Belaiche, J.; Louis, E.; D'Haens, G.; Cabooter, M.; Naegels, S.; de Vos, M.; Fontaine, F.; Schurmans, P.; Baert, F.; de Reuck, M.; Fiasse, R.; Holvoet, J.; Schmit, A.; van Outryve, M.

    1999-01-01

    Acute lower gastrointestinal bleeding is a rare complication of Crohn's disease, which represents a diagnostic and therapeutic challenge. The aim of this study was to define epidemiological characteristics and therapeutic options of hemorrhagic forms of Crohn's disease. Thirty-four cases of

  6. 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.

  7. 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....

  8. 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

  9. Normal villous architecture with increased intraepithelial lymphocytes: a duodenal manifestation of Crohn disease.

    Science.gov (United States)

    Patterson, Emily R; Shmidt, Eugenia; Oxentenko, Amy S; Enders, Felicity T; Smyrk, Thomas C

    2015-03-01

    To assess a possible association between inflammatory bowel disease (IBD) and the histologic finding in duodenal biopsy specimens of increased intraepithelial lymphocytes (IELs) with normal villous architecture. We identified all patients with duodenal biopsy specimens obtained between 2000 and 2010 showing increased IELs and normal architecture. Among the 74 such patients who also had IBD, we characterized the clinical features of IBD and reviewed all available upper gastrointestinal biopsy specimens. Fifty-eight patients had Crohn disease, 13 had ulcerative colitis, and three had IBD, type unclassified. No duodenal sample with increased IELs had other histologic features of IBD. Among gastric biopsy specimens from 34 patients with Crohn disease, nearly half (16) had focal gastritis. We propose that Crohn disease be included in the differential diagnosis for increased IELs with normal villous architecture in duodenal biopsy specimens, particularly when gastric biopsy specimens show focal gastritis. Copyright© by the American Society for Clinical Pathology.

  10. 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...... was compared with the results of enteroscopy and with surgical, histopathologic, and clinical data. Results: In the 8 control patients leukocyte scan, endoscopy, and histopathology were all negative for the small bowel. In patients with Crohn's disease and small bowel inflammation seen at enteroscopy and...

  11. Indirect costs of inflammatory bowel diseases: Crohn's disease and ulcerative colitis. A systematic review.

    Science.gov (United States)

    Kawalec, Paweł

    2016-04-01

    Crohn's disease and ulcerative colitis are lifelong illnesses which have a significant impact on quality of life and personal burden through a reduction in the ability to work, sick leave and restrictions of leisure time. The aim of this study was to conduct a systematic review of the indirect costs of Crohn's disease and ulcerative colitis. The search was carried out in Medline, EMBASE, the Centre for Reviews and Dissemination, and reference lists of identified articles and reference lists of identified articles were also handsearched. All costs were adjusted to 2013 USD values by using the consumer price index and purchasing power parity. Identified studies were then analysed in order to assess their heterogeneity and possibility of inclusion in the meta-analysis. Eleven of the identified publications presented indirect costs of Crohn's disease or ulcerative colitis. The range of estimated yearly indirect costs per patient was large, from $1 159.09 for loss of earnings to $14 135.64 for lost productivity and sick leave for Crohn's disease. The values for ulcerative colitis ranged from $926.49 to $6 583.17. Because of the imprecise definition of methods of indirect cost calculations as well as heterogeneity of indirect cost components, a meta-analysis was not performed. The indirect costs of ulcerative colitis seem to be slightly lower than in the case of Crohn's disease. A small number of studies referring to indirect costs of Crohn's disease and ulcerative colitis were identified, which indicates the need to conduct further investigations on this problem.

  12. A rare complication of CMV infection in Crohn's disease - hemophagocytic syndrome: a case report.

    Science.gov (United States)

    Pop, Corina Silvia; Becheanu, Gabriel; Calagiu, Dorina; Jantea, Petruţa-Violeta; Rădulescu, Dragoş Mihai; Pariza, George; Mavrodin, Carmen-Iuliana; Bold, Adriana; Costache, Adrian; Nemeş, Roxana Maria

    2015-01-01

    We report a case of CMV (cytomegalovirus) infection in a Crohn's disease patient, resulting in severe hemophagocytic syndrome and death. A 63-year-old man with a 10-year history of ileal and colonic Crohn's disease presented with general malaise, loss of appetite and weight loss over the last month. He was in clinical remission for two years, with maintenance therapy 5-Aminosalicylic acid (5-ASA)-derived Mesalamine. The patient had no prior immunomodulators or suppressive treatment. A colonoscopy was performed and we found appearance suggestive of active Crohn's disease, confirmed by histopathological examination. A diagnosis of an exacerbation of Crohn's disease was established. Although the specific treatment was initiated, patient's general condition degraded progressively and diarrheal stools appeared, followed by an episode of massive gastrointestinal bleeding - hematochezia. We performed a new colonoscopy and the pathological examination revealed Crohn's ileocolitis with superimposed CMV infection. Despite the initiation of Ganciclovir alongside with other intensive care measures, he increasingly deteriorated and chest X-ray confirmed multilobar pneumonia. The occurrence of rapidly progressing pancytopenia and evidence for disseminated intravascular coagulopathy as well as hyperferritinemia, raised the suspicion of hemophagocytic syndrome confirmed by bone marrow aspiration. Hence, CMV-associated hemophagocytic syndrome in the context of recent corticotherapy for Crohn's disease was established. There is enough evidence that supports the gravity of the CMV infection in the case of inflammatory bowel disease (IBD) patients, especially the ones on immunomodulator treatment. The hemophagocytic syndrome reactively occurs in patients with infections in cases of immunodeficiency, displaying a hematological aspect of multiple organ dysfunction syndrome.

  13. 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.

  14. 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.

  15. 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

  16. A rare case of Crohn's ileitis in a patient with constitutional mismatch repair deficiency.

    Science.gov (United States)

    Kaimakliotis, Pavlos; Giardiello, Francis; Eze, Ogechukwu; Truta, Brindusa

    2017-01-01

    Constitutional mismatch repair deficiency (CMMRD), a variant of Lynch syndrome, is a rare disease characterized by café-au-lait spots, oligopolyposis, glioblastoma and lymphoma. A 24-year-old male, under surveillance for CMMRD, developed Crohn's ileitis after total colectomy with end ileostomy for colorectal cancer and failed to respond to oral corticosteroids. The patient underwent induction and maintenance of remission with vedolizumab infusions. We report the first patient with CMMRD developing Crohn's disease. The choice of immunosuppressive therapy in these patients is challenging and needs to be made according to their risk for malignancy.

  17. Conn syndrome and Crohn disease in a pediatric case: an interesting parallel.

    Science.gov (United States)

    Rodriguez, Manuel A; Alkhoury, Fuad; Malvezzi, Leopoldo; Diaz, Alejandro

    2013-01-01

    Conn syndrome is characterized by surreptitious secretion of aldosterone in which patients are found to have hypertension, hypokalemia, and metabolic alkalosis. Although rare, the most common presentation in the pediatric population is bilateral hyperplasia of the adrenal glands as opposed to an adenoma. Crohn disease is part of the spectrum of inflammatory bowel disease, which manifests in children as flare-ups of bloody diarrhea and abdominal pain. The association of concurrent Conn syndrome and Crohn disease has been previously presented in two cases in adults. This is the first pediatric case to be reported in the literature.

  18. Periodontal disease and anemias associated with Crohn's disease. A case report.

    Science.gov (United States)

    Nagpal, Swati; Acharya, Anirudh B; Thakur, Srinath L

    2012-03-01

    Crohn's disease (CD) is an inflammatory bowel disease with oral findings, including periodontal manifestations. Anemias, such as iron deficiency and anemia of chronic disease (ACD), are the most common hematologic complications of CD. Periodontitis has systemic effects, and may tend toward anemia, which can be explained by depressed erythropoiesis. In the report presented here, the authors review a case of Crohn's disease diagnosed 10 years previous to the patient presenting with a changing anemic profile and periodontal disease. A discussion of patient and disease management is included.

  19. Upper Gastrointestinal Involvement in Crohn Disease: Histopathologic and Endoscopic Findings.

    Science.gov (United States)

    Diaz, Liege; Hernandez-Oquet, Rafael Enrique; Deshpande, Amar R; Moshiree, Baharak

    2015-11-01

    Studies describing the prevalence of upper gastrointestinal (GI) Crohn disease (CD) and its histopathologic changes have been inconsistent as a result of different definitions used for upper GI involvement, diverse populations, and varying indications for endoscopy. We reviewed the literature describing endoscopic findings and histologic lesions in gastric and duodenal mucosa of patients with established CD. PubMed, EMBASE, and the Cochrane Library were searched for gastroduodenal biopsy findings in patients with CD from 1970 to 2014. We included all retrospective and prospective studies in adults. We calculated the prevalence of the most common endoscopic and histopathological findings among patients with overall CD and upper GI CD. Of the 385 articles identified, 20 eligible studies were included. A total of 2511 patients had CD and 815 had upper GI CD. In the CD group, the most common histopathological finding was nonspecific gastric inflammation in 32% of patients, followed by gastric granuloma in 7.9%. Focal gastritis was prevalent in 30.9% of patients. In the upper GI CD group, gastric inflammation was present in 84% of patients, followed by duodenal inflammation in 28.2% and gastric granuloma in 23.2%. The most common gastric endoscopic finding in patients with CD was erythema in 5.9%, followed by erosions in 3.7%. Duodenal endoscopic findings included ulcers and erythema in 5.3% and 3.0% of patients, respectively. We found a prevalence of 34% for CD involving the upper GI tract across these 20 studies. Routine upper endoscopy with biopsies of the upper GI tract in the diagnostic workup of patients with CD can correctly classify the distribution and extent of the disease.

  20. Children with Crohn's Disease Frequently Consume Select Food Additives.

    Science.gov (United States)

    Lee, Dale; Swan, C Kaiulani; Suskind, David; Wahbeh, Ghassan; Vanamala, Jairam; Baldassano, Robert N; Leonard, Mary B; Lampe, Johanna W

    2018-06-04

    Certain food additives may promote the pathogenesis of Crohn's disease (CD), but thus far the evaluation of food additive exposures in humans has been limited. The objective of this study was to quantify food additive exposures in children with CD. In a trial for bone health in CD, children were followed over 24 months with evaluation of disease characteristics, dietary intake, and body composition. At baseline, participants completed three 24-h dietary recalls. Foods were categorized, and the ingredient list for each item was evaluated for the presence of select food additives: polysorbate-80, carboxymethylcellulose, xanthan gum, soy lecithin, titanium dioxide, carrageenan, maltodextrin, and aluminosilicates. The frequency of exposures to these food additives was described for study participants and for food categories. At study baseline, 138 participants, mean age 14.2 ± 2.8 years, 95% having inactive or mild disease, were enrolled and dietary recalls were collected. A total of 1325 unique foods were recorded. Mean exposures per day for xanthan gum was 0.96 ± 0.72, carrageenan 0.58 ± 0.63, maltodextrin 0.95 ± 0.77, and soy lecithin 0.90 ± 0.74. The other additives had less than 0.1 exposures per day. For the 8 examined food additives, participants were exposed to a mean (SD) of 3.6 ± 2.1 total additives per recall day and a mean (SD) of 2.4 ± 1.0 different additives per day. Children with CD frequently consume food additives, and the impact on disease course needs further study.

  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. 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

  3. A comprehensive review and update on Crohn's disease.

    Science.gov (United States)

    Gajendran, Mahesh; Loganathan, Priyadarshini; Catinella, Anthony P; Hashash, Jana G

    2018-02-01

    The term inflammatory bowel disease (IBD) refers principally to two major categories of chronic relapsing inflammatory intestinal disorders: Crohn's disease (CD) and ulcerative colitis (UC). In the United States, it is currently estimated that about 1.5 million people suffer from IBD, causing considerable suffering, mortality and economic loss every year. Yet the cause of IBD is unknown, and until we understand more, prevention or cure will not be possible. There is a lot of variation in the incidence and prevalence of CD based on geographic region, environment, immigrant population, and ethnic groups. The annual incidence of CD in North America is reported to be 3.1-20.2 per 100,000 with a prevalence of 201 per 100,000 population. Based on the epidemiological, genetic and immunological data, CD is considered to be a heterogeneous disorder with multifactorial etiology in which genetics and environment interact to manifest the disease. Several genes have been studied so for with respect to CD, but thus far the strong and replicated associations have been identified with NOD2, IL23R and ATG16L1 genes. The risk factors implicated with CD include smoking, low fiber- high carbohydrate diet, altered microbiome and medications such as non-steroidal anti-inflammatory drugs. CD is typically characterized by transmural inflammation of the intestine and could affect any part of the gastrointestinal tract from mouth to perianal area. In terms of distribution of the disease 25% of the patients have colitis only, 25% is ileitis only and 50% have ileocolitis. The Montreal classification is based on the age at diagnosis ( 40), disease location (Ileal, colonic, Ileocolonic) and the disease behavior (nonstricturing/nonpenetrating, stricturing, penetrating). The key features for diagnosing CD comprises a combination of radiographic, endoscopic and pathological findings demonstrating focal, asymmetric, transmural or granulomatous features. Abdominal Computed tomography (CT

  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. 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.

  6. Effect of antitumour necrosis factor-alpha therapy on bone turnover in patients with active Crohn's disease: a prospective study.

    Science.gov (United States)

    Ryan, B M; Russel, M G V M; Schurgers, L; Wichers, M; Sijbrandij, J; Stockbrugger, R W; Schoon, E

    2004-10-15

    Patients with Crohn's disease are at increased risk of osteoporosis. Disease activity and circulating proinflammatory cytokines are thought to play a role in this process. Infliximab, a chimaeric antitumour necrosis factor-alpha antibody is effective in the treatment of Crohn's disease. The aim of this study was to investigate the impact of treatment with infliximab on bone turnover in Crohn's disease patients. This was a prospective trial. Twenty-four patients with active Crohn's disease were treated with infliximab (5 mg/kg). Bone markers were assayed pre- and post-treatment. Bone formation was measured using serum bone-specific alkaline phosphatase and total osteocalcin and bone resorption using serum N-telopeptide cross-linked type 1 collagen. Infliximab therapy caused a significant increase in both markers of bone formation in patients with active Crohn's disease. No significant change in the bone resorption marker serum N-telopeptide cross-linked type 1 was found. Infliximab therapy had a significant beneficial effect on bone metabolism in patients with active Crohn's disease. These findings further support the theory that active ongoing inflammation and high levels of circulating cytokines play a pivotal role in the pathogenesis of bone loss in patients with Crohn's disease.

  7. 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.

  8. High sensitivity of quick view capsule endoscopy for detection of small bowel Crohn's disease

    DEFF Research Database (Denmark)

    Halling, Morten Lee; Nathan, Torben; Kjeldsen, Jens

    2014-01-01

    Capsule endoscopy (CE) has a high sensitivity for diagnosing small bowel Crohn's disease, but video analysis is time consuming. The quick view (qv) function is an effective tool to reduce time consumption. The aim of this study was to determine the rate of missed small bowel ulcerations with qv-C...

  9. 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

  10. Assessment of inflammatory activity in Crohn's disease by means of dynamic contrast-enhanced MRI.

    Science.gov (United States)

    Pupillo, V A; Di Cesare, E; Frieri, G; Limbucci, N; Tanga, M; Masciocchi, C

    2007-09-01

    Our aim was to perform a dynamic study of contrast enhancement of the intestinal wall in patients with Crohn's disease to quantitatively assess local inflammatory activity. We studied a population of 50 patients with histologically proven Crohn's disease. Magnetic resonance imaging (MRI) was performed using a 1.5-T magnet with a phased-array coil and acquisition of T2-weighted single-shot fast spin echo (SSFSE) half Fourier sequences before intravenous administration of gadolinium, and T1-weighted fast spoiled gradient (FSPGR) fat-saturated sequences before and after contrast administration. Before the examination, patents received oral polyethylene glycol (PEG) (1,000 ml for adults; 10 ml/Kg of body weight for children). Regions of interest (ROI) were placed on the normal and diseased intestinal wall to assess signal intensity and rate of increase in contrast enhancement over time. Data were compared with the Crohn's Disease Activity Index (CDAI). The diseased bowel wall showed early and intense uptake of contrast that increases over time until a plateau is reached. In patients in the remission phase after treatment, signal intensity was only slightly higher in diseased bowel loops than in healthy loops. There was a significant correlation between the peak of contrast uptake and CDAI. Dynamic MRI is a good technique for quantifying local inflammatory activity of bowel wall in patients with Crohn's disease.

  11. 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 ...

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

    DEFF Research Database (Denmark)

    Yazdanyar, Shiva; Weischer, Maren; Nordestgaard, Børge

    2009-01-01

    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...

  13. 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

  14. The glucose breath test: a diagnostic test for small bowel stricture(s) in Crohn's disease.

    Science.gov (United States)

    Mishkin, Daniel; Boston, Francis M; Blank, David; Yalovsky, Morty; Mishkin, Seymour

    2002-03-01

    The aim of this study was to determine whether an indirect noninvasive indicator of proximal bacterial overgrowth, the glucose breath test, was of diagnostic value in inflammatory bowel disease. Twenty four of 71 Crohn's disease patients tested had a positive glucose breath test. No statistical conclusions could be drawn between the Crohn's disease activity index and glucose breath test status. Of patients with radiologic evidence of small bowel stricture(s), 96.0% had a positive glucose breath test, while only one of 46 negative glucose breath test patients had a stricture. The positive and negative predictive values for a positive glucose breath test as an indicator of stricture formation were 96.0% and 97.8%, respectively. This correlation was not altered in Crohn's disease patients with fistulae or status postresection of the terminal ileum. The data in ulcerative colitis were nondiagnostic. In conclusion, the glucose breath test appears to be an accurate noninvasive inexpensive diagnostic test for small bowel stricture(s) and secondary bacterial overgrowth in Crohn's disease.

  15. 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.

  16. 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

  17. 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

  18. 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...

  19. Dynamic Contrast-Enhanced Magnetic Resonance Enterography and Dynamic Contrast-Enhanced Ultrasonography in Crohn's Disease

    DEFF Research Database (Denmark)

    Wilkens, Rune; Peters, David A; Nielsen, Agnete Hedemann

    2017-01-01

    Purpose e Cross-sectional imaging methods are important for objective evaluationof small intestinal inflammationinCrohn'sdisease(CD).The primary aim was to compare relative parameters of intestinal perfusion between contrast-enhanced ultrasonography (CEUS) and dynamic contrast-enhanced magnetic...

  20. 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.

  1. 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 with respect to the development of inflammatory bowel disease [IBD] as well as their influence on the course of established IBD. The objective was to reach expert consensus...... to provide evidence-based guidance for clinical practice....

  2. 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

  3. 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.

  4. Human Embryonic Stem Cell Therapy in Crohn's Disease: A Case Report.

    Science.gov (United States)

    Shroff, Geeta

    2016-02-29

    Crohn's disease is a chronic inflammatory disease of the intestines, mainly the colon and ileum, related with ulcers and fistulae. It is estimated to affect 565,000 people in the United States. Currently available therapies, such as antibiotics, thiopurines, and anti-tumor necrosis factor-alpha agents, are only observed to reduce the complications associated with Crohn's disease and to improve quality of life, but cannot cure the disease. Stem cell therapy appears to have certain advantages over conventional therapies. Our study aimed to evaluate the efficacy of human embryonic stem cell therapy in a patient with Crohn's disease. A 21-year-old male with chief complaints of intolerance to specific foods, abdominal pain, and diarrhea underwent human embryonic stem cell therapy for two months. After undergoing human embryonic stem cell therapy, the patient showed symptomatic relief. He had no complaints of back pain, abdominal pain, or diarrhea and had improved digestion. The patient had no signs and symptoms of skin infection, and had improved limb stamina, strength, and endurance. The condition of patient was stable after the therapy. Human embryonic stem cell therapy might serve as a new optimistic treatment approach for Crohn's disease.

  5. 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...

  6. 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

  7. 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

  8. Magnetic resonance imaging for evaluation of disease activity in Crohn's disease: a systematic review

    NARCIS (Netherlands)

    Horsthuis, Karin; Bipat, Shandra; Stokkers, Pieter C. F.; Stoker, Jaap

    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

  9. 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

  10. The effect of pre-operative optimization on post-operative outcome in Crohn's disease resections

    DEFF Research Database (Denmark)

    El-Hussuna, Alaa; Iesalnieks, Igors; Horesh, Nir

    2017-01-01

    BACKGROUND: The timing of surgical intervention in Crohn's disease (CD) may depend on pre-operative optimization (PO) which includes different interventions to decrease the risk for unfavourable post-operative outcome. The objective of this study was to investigate the effect of multi-model PO on...

  11. The development of a magnetic resonance imaging index for fistulising Crohn's disease

    NARCIS (Netherlands)

    Samaan, M. A.; Puylaert, C. A. J.; Levesque, B. G.; Zou, G. Y.; Stitt, L.; Taylor, S. A.; Shackelton, L. M.; Vandervoort, M. K.; Khanna, R.; Santillan, C.; Rimola, J.; Hindryckx, P.; Nio, C. Y.; Sandborn, W. J.; D'Haens, G.; Feagan, B. G.; Jairath, V.; Stoker, J.

    2017-01-01

    Magnetic resonance imaging (MRI) is the gold standard for assessment of perianal fistulising Crohn's disease (CD). The Van Assche index is the most commonly used MRI fistula index. To assess the reliability of the Van Assche index, and to modify the instrument to improve reliability and create a

  12. Less Anti-infliximab Antibody Formation in Paediatric Crohn Patients on Concomitant Immunomodulators

    NARCIS (Netherlands)

    Kansen, Hannah M.; van Rheenen, Patrick F.; Houwen, Roderick H. J.; Ten, Walther Tjon A.; Damen, Gerard M.; Kindermann, Angelika; Escher, Johanna C.; Wolters, Victorien M.

    2017-01-01

    Objectives: To evaluate the effect of immunomodulators on formation of antibodies to infliximab (ATI) in paediatric patients with Crohn disease (CD) and the association of ATI and loss of response. Methods: Retrospective multicentre observational study (January 2009-December 2014) among Dutch

  13. Metabolismo de los hidratos de carbono en los enterocitos de sujetos con enfermedad de Crohn y colitis ulcerosa.

    OpenAIRE

    Estada Gimeno, Úrsula

    2007-01-01

    RESUMEN Introducción: Los pacientes con enfermedad inflamatoria crónica intestinal (EII), enfermedad de Crohn y colitis ulcerosa presentan lesiones en el epitelio intestinal de carácter inflamatorio. Estas lesiones afectan al intestino grueso en la colitis ulcerosa y a cualquier parte del tracto digestivo en la enfermedad de Crohn. En este tipo de enfermos se ha visto que existe una menor absorción de nutrientes, sobre todo en la enfermedad de Crohn, entre ellos la lactosa (el azúcar de la...

  14. 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...

  15. Inherited determinants of Crohn's disease and ulcerative colitis phenotypes: a genetic association study.

    Science.gov (United States)

    Cleynen, Isabelle; Boucher, Gabrielle; Jostins, Luke; Schumm, L Philip; Zeissig, Sebastian; Ahmad, Tariq; Andersen, Vibeke; Andrews, Jane M; Annese, Vito; Brand, Stephan; Brant, Steven R; Cho, Judy H; Daly, Mark J; Dubinsky, Marla; Duerr, Richard H; Ferguson, Lynnette R; Franke, Andre; Gearry, Richard B; Goyette, Philippe; Hakonarson, Hakon; Halfvarson, Jonas; Hov, Johannes R; Huang, Hailang; Kennedy, Nicholas A; Kupcinskas, Limas; Lawrance, Ian C; Lee, James C; Satsangi, Jack; Schreiber, Stephan; Théâtre, Emilie; van der Meulen-de Jong, Andrea E; Weersma, Rinse K; Wilson, David C; Parkes, Miles; Vermeire, Severine; Rioux, John D; Mansfield, John; Silverberg, Mark S; Radford-Smith, Graham; McGovern, Dermot P B; Barrett, Jeffrey C; Lees, Charlie W

    2016-01-09

    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. 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-phenotype associations across 156,154 genetic variants. We generated genetic risk scores by combining information from all known inflammatory bowel disease associations to summarise the total load of genetic risk for a particular phenotype. We used these risk scores to test the hypothesis that colonic Crohn's disease, ileal Crohn's disease, and ulcerative colitis are all genetically distinct from each other, and to attempt to identify patients with a mismatch between clinical diagnosis and genetic risk profile. After quality control, the primary analysis included 29,838 patients (16,902 with Crohn's disease, 12,597 with ulcerative colitis). Three loci (NOD2, MHC, and MST1 3p21) were associated with subphenotypes of inflammatory bowel disease, mainly disease location (essentially fixed over time; median follow-up of 10·5 years). Little or no genetic association with disease behaviour (which changed dramatically over time) remained after conditioning on disease location and age at onset. The genetic risk score representing all known risk alleles for inflammatory bowel disease showed strong association with

  16. 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.

  17. B-Cell Dysregulation in Crohn's Disease Is Partially Restored with Infliximab Therapy.

    Directory of Open Access Journals (Sweden)

    Wilhelmina M C Timmermans

    Full Text Available B-cell depletion can improve a variety of chronic inflammatory diseases, but does not appear beneficial for patients with Crohn's disease.To elucidate the involvement of B cells in Crohn's disease, we here performed an 'in depth' analysis of intestinal and blood B-cells in this chronic inflammatory disease.Patients with Crohn's disease were recruited to study B-cell infiltrates in intestinal biopsies (n = 5, serum immunoglobulin levels and the phenotype and molecular characteristics of blood B-cell subsets (n = 21. The effects of infliximab treatment were studied in 9 patients.Granulomatous tissue showed infiltrates of B lymphocytes rather than Ig-secreting plasma cells. Circulating transitional B cells and CD21low B cells were elevated. IgM memory B cells were reduced and natural effector cells showed decreased replication histories and somatic hypermutation (SHM levels. In contrast, IgG and IgA memory B cells were normally present and their Ig gene transcripts carried increased SHM levels. The numbers of transitional and natural effector cells were normal in patients who responded clinically well to infliximab.B cells in patients with Crohn's disease showed signs of chronic stimulation with localization to granulomatous tissue and increased molecular maturation of IgA and IgG. Therapy with TNFα-blockers restored the defect in IgM memory B-cell generation and normalized transitional B-cell levels, making these subsets candidate markers for treatment monitoring. Together, these results suggest a chronic, aberrant B-cell response in patients with Crohn's disease, which could be targeted with new therapeutics that specifically regulate B-cell function.

  18. 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.)

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

    Energy Technology Data Exchange (ETDEWEB)

    Ziech, M.L.W., E-mail: m.l.ziech@amc.uva.nl [Academic Medical Center, Department of Radiology, Meibergdreef 9, 1105 AZ, Amsterdam (Netherlands); Lavini, C., E-mail: c.lavini@amc.uva.nl [Academic Medical Center, Department of Radiology, Meibergdreef 9, 1105 AZ, Amsterdam (Netherlands); Caan, M.W.A., E-mail: m.w.a.caan@amc.uva.nl [Academic Medical Center, Department of Radiology, Meibergdreef 9, 1105 AZ, Amsterdam (Netherlands); Nio, C.Y., E-mail: C.Y.Nio@amc.uva.nl [Academic Medical Center, Department of Radiology, Meibergdreef 9, 1105 AZ, Amsterdam (Netherlands); Stokkers, P.C.F., E-mail: p.stokkers@slaz.nl [Academic Medical Center, Department of Gastroenterology, Meibergdreef 9, 1105 AZ, Amsterdam (Netherlands); Sint Lucas Andreas Ziekenhuis, Department of Gastroenterology, Jan Tooropstraat 164, 1061 AE, Amsterdam (Netherlands); Bipat, S., E-mail: S.Bipat@amc.uva.nl [Academic Medical Center, Department of Radiology, Meibergdreef 9, 1105 AZ, Amsterdam (Netherlands); Ponsioen, C.Y., E-mail: c.y.ponsioen@amc.uva.nl [Academic Medical Center, Department of Gastroenterology, Meibergdreef 9, 1105 AZ, Amsterdam (Netherlands); Nederveen, A.J., E-mail: a.j.nederveen@amc.uva.nl [Academic Medical Center, Department of Radiology, Meibergdreef 9, 1105 AZ, Amsterdam (Netherlands); Stoker, J., E-mail: j.stoker@amc.uva.nl [Academic Medical Center, Department of Radiology, Meibergdreef 9, 1105 AZ, Amsterdam (Netherlands)

    2012-11-15

    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.

  20. What Is the Risk of Anastomotic Leak After Repeat Intestinal Resection in Patients With Crohn's Disease?

    Science.gov (United States)

    Johnston, W Forrest; Stafford, Caitlin; Francone, Todd D; Read, Thomas E; Marcello, Peter W; Roberts, Patricia L; Ricciardi, Rocco

    2017-12-01

    Approximately half of Crohn's patients require intestinal resection, and many need repeat resections. The purpose of this study was to evaluate the increased risk of clinical anastomotic leak in patients with a history of previous intestinal resection undergoing repeat resection with anastomosis for Crohn's disease. This was a retrospective analysis of prospectively collected departmental data with 100% capture. The study was conducted at the department of colorectal surgery in a tertiary care teaching hospital between July 2007 and March 2016. A cohort of consecutive patients with Crohn's disease who were treated with intestinal resection and anastomosis, excluding patients with proximal fecal diversion, were included. The cohort was divided into 2 groups, those with no previous resection compared with those with previous resection. Clinical anastomotic leak within 30 days of surgery was measured. Of the 206 patients who met criteria, 83 patients had previous intestinal resection (40%). The 2 groups were similar in terms of patient factors, immune-suppressing medication use, and procedural factors. Overall, 20 clinical anastomotic leaks were identified (10% leak rate). There were 6 leaks (5%) detected in patients with no previous intestinal resection and 14 leaks (17%) detected in patients with a history of previous intestinal resection (p leak in patients with Crohn's disease with previous resection compared with no previous resection was 3.5 (95% CI, 1.3-9.4). Patients with 1 previous resection (n = 53) had a leak rate of 13%, whereas patients with ≥2 previous resections (n = 30) had a leak rate of 23%. The number of previous resections correlated with increasing risk for clinical anastomotic leak (correlation coefficient = 0.998). This was a retrospective study with limited data to perform a multivariate analysis. Repeat intestinal resection in patients with Crohn's disease is associated with an increased rate of anastomotic leakage when compared with initial

  1. Evaluation of therapeutic effect of low dose naltrexone in experimentally-induced Crohn's disease in rats.

    Science.gov (United States)

    Tawfik, Dina Ibrahim; Osman, Afaf Sayed; Tolba, Hedayat Mahmoud; Khattab, Aida; Abdel-Salam, Lubna O; Kamel, Mahmoud M

    2016-10-01

    Crohn's disease is a relapsing inflammatory condition afflicting the digestive tract. Drugs used for treatment of Crohn's disease may be associated with serious side effects. Endogenous opioid peptides modulate inflammatory cytokine production. Opioid antagonists have been shown to play a role in healing and repair of tissues. This work was designed to detect the possible beneficial effects of opioid antagonist naltrexone in indomethacin-induced Crohn's disease in rats. Enteritis was induced in male albino rats by two subcutaneous injection of indomethacin in a dose of 7.5mg/kg 24h apart started on day one. Salfasalazine, naltrexone and their combination were administered orally from day one of induction of enteritis to day 10. Disease activity index, serum levels of C-reactive protein and tumor necrosis factor-α, macroscopic and microscopic pathological scores and in vitro motility studies were evaluated. Induction of enteritis resulted in significant increase of disease activity index, significant elevation of serum levels of C-reactive protein and tumor necrosis factor-α, significant deterioration of pathological scores and significant increase in the mean contractility response of the isolated ileal segments compared with normal untreated rats. Treatment with sulfasalazine, low dose of natrexone or their combination resulted in significant improvement of all measured parameters compared with enteritis group. The current finding could provide new interesting opportunity for developing new therapeutic approaches for treatment of Crohn's disease. Use of naltrexone, especially in small dose, has little side effects making it of interest for treatment of Crohn's disease. Also, it provides the possibility of reduced doses of other drugs if it is used as combined therapy. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Altered Markers of Brain Development in Crohn's Disease with Extraintestinal Manifestations - A Pilot Study.

    Directory of Open Access Journals (Sweden)

    Anne K Thomann

    Full Text Available Alterations of brain morphology in Crohn's disease have been reported, but data is scarce and heterogenous and the possible impact of disease predisposition on brain development is unknown. Assuming a systemic course of the disease, brain involvement seems more probable in presence of extraintestinal manifestations, but this question has not yet been addressed. The present study examined the relationship between Crohn's disease and brain structure and focused on the connection with extraintestinal manifestations and markers of brain development.In a pilot study, brains of 15 patients with Crohn's disease (of which 9 had a history of extraintestinal manifestations, i.e. arthritis, erythema nodosum and primary sclerosing cholangitis were compared to matched healthy controls using high resolution magnetic resonance imaging. Patients and controls were tested for depression, fatigue and global cognitive function. Cortical thickness, surface area and folding were determined via cortical surface modeling.The overall group comparison (i.e. all patients vs. controls yielded no significant results. In the patient subgroup with extraintestinal manifestations, changes in cortical area and folding, but not thickness, were identified: Patients showed elevated cortical surface area in the left middle frontal lobe (p<0.05 and hypergyrification in the left lingual gyrus (p<0.001 compared to healthy controls. Hypogyrification of the right insular cortex (p<0.05 and hypergyrification of the right anterior cingulate cortex (p<0.001 were detected in the subgroup comparison of patients with against without extraintestinal manifestations. P-values are corrected for multiple comparisons.Our findings lend further support to the hypothesis that Crohn's disease is associated with aberrant brain structure and preliminary support for the hypothesis that these changes are associated with a systemic course of the disease as indicated by extraintestinal manifestations. Changes

  3. Reinduction with certolizumab pegol in patients with relapsed Crohn's disease: results from the PRECiSE 4 Study

    DEFF Research Database (Denmark)

    Sandborn, William J; Schreiber, Stefan; Hanauer, Stephen B

    2010-01-01

    We sought to determine the efficacy of certolizumab pegol reinduction in patients with active Crohn's disease who respond to induction therapy with certolizumab pegol and then relapse during continuous or interrupted maintenance therapy....

  4. 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

  5. An international study of agglutinins to Eubacterium, Peptostreptococcus and Coprococcus species in Crohn's disease, ulcerative colitis and control subjects.

    Science.gov (United States)

    Wensinck, F; van de Merwe, J P; Mayberry, J F

    1983-01-01

    The world-wide occurrence of agglutinating antibodies to four coccoid anaerobes belonging to Eubacterium, Peptostreptococcus and Coprococcus spp. was investigated in 937 coded sera from patients suffering from Crohn's disease, ulcerative colitis, various other diseases and from healthy controls. Positive results were found in 59% of patients with Crohn's disease, 29% of patients with ulcerative colitis, and 8% of both diseased and healthy control subjects. Patients with Crohn's disease of the colon had more positive tests (67%) than patients with disease confined to the small bowel (46%). The results show that agglutinating antibodies to the coccoid anaerobes occur more frequently in patients with Crohn's disease than in other subjects in widely varying geographic regions.

  6. The Reasons for Discontinuation of Infliximab Treatment in Patients with Crohn's Disease: A Review of Practice at NHS Teaching Hospital

    OpenAIRE

    Krupa, Lukasz Z.; Kennedy, Hugh J.; Jamieson, Crawford P.; Fisher, Nicola; Hart, Andrew R.

    2011-01-01

    Introduction. There is little information on the reasons for discontinuing infliximab treatment in patients with Crohn's disease. The aim of this study was to document these reasons to determine if any were preventable which would allow patients to continue the therapy. Aims & Methods. A review of the medical notes was conducted at the Norfolk and Norwich University Hospital on patients with Crohn's disease treated with infliximab between 2002–2008 to determine the reasons for stopping it. Re...

  7. 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.

  8. Energy expenditure and body composition in children with Crohn's disease: effect of enteral nutrition and treatment with prednisolone

    OpenAIRE

    Azcue, M; Rashid, M; Griffiths, A; Pencharz, P

    1997-01-01

    Background—Malnutrition and growth retardation are common complications of Crohn's disease in children. The contribution of resting energy expenditure (REE) to malnutrition is unclear. 
Aims—To characterise the REE and body composition in children with Crohn's disease and compare them with normal controls and patients with anorexia nervosa; to compare the effects of prednisolone and enteral nutrition on energy expenditure and body composition. 
Subjects—Twenty four children wit...

  9. 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.

  10. Risk of early surgery for Crohn's disease: implications for early treatment strategies.

    Science.gov (United States)

    Sands, Bruce E; Arsenault, Joanne E; Rosen, Michael J; Alsahli, Mazen; Bailen, Laurence; Banks, Peter; Bensen, Steven; Bousvaros, Athos; Cave, David; Cooley, Jeffrey S; Cooper, Herbert L; Edwards, Susan T; Farrell, Richard J; Griffin, Michael J; Hay, David W; John, Alex; Lidofsky, Sheldon; Olans, Lori B; Peppercorn, Mark A; Rothstein, Richard I; Roy, Michael A; Saletta, Michael J; Shah, Samir A; Warner, Andrew S; Wolf, Jacqueline L; Vecchio, James; Winter, Harland S; Zawacki, John K

    2003-12-01

    In this study we aimed to define the rate of early surgery for Crohn's disease and to identify risk factors associated with early surgery as a basis for subsequent studies of early intervention in Crohn's disease. We assembled a retrospective cohort of patients with Crohn's disease diagnosed between 1991 and 1997 and followed for at least 3 yr, who were identified in 16 community and referral-based practices in New England. Chart review was performed for each patient. Details of baseline demographic and disease features were recorded. Surgical history including date of surgery, indication, and procedure were also noted. Risk factors for early surgery (defined as major surgery for Crohn's disease within 3 yr of diagnosis, exclusive of major surgery at time of diagnosis) were identified by univariate analysis. Multiple logistic regression was used to identify independent risk factors. Of 345 eligible patients, 69 (20.1%) required surgery within 3 yr of diagnosis, excluding the 14 patients (4.1%) who had major surgery at the time of diagnosis. Overall, the interval between diagnosis and surgery was short; one half of all patients who required surgery underwent operation within 6 months of diagnosis. Risk factors identified by univariate analysis as significantly associated with early surgery included the following: smoking; disease of small bowel without colonic involvement; nausea and vomiting or abdominal pain on presentation; neutrophil count; and steroid use in the first 6 months. Disease localized to the colon only, blood in the stool, use of 5-aminosalicylate, and lymphocyte count were inversely associated with risk of early surgery. Logistic regression confirmed independent associations with smoking as a positive risk factor and involvement of colon without small bowel as a negative risk factor for early surgery. The rate of surgery is high in the first 3 yr after diagnosis of Crohn's disease, particularly in the first 6 months. These results suggest that

  11. Small bowel carcinomas in celiac or Crohn's disease: distinctive histophenotypic, molecular and histogenetic patterns.

    Science.gov (United States)

    Vanoli, Alessandro; Di Sabatino, Antonio; Martino, Michele; Klersy, Catherine; Grillo, Federica; Mescoli, Claudia; Nesi, Gabriella; Volta, Umberto; Fornino, Daniele; Luinetti, Ombretta; Fociani, Paolo; Villanacci, Vincenzo; D'Armiento, Francesco P; Cannizzaro, Renato; Latella, Giovanni; Ciacci, Carolina; Biancone, Livia; Paulli, Marco; Sessa, Fausto; Rugge, Massimo; Fiocca, Roberto; Corazza, Gino R; Solcia, Enrico

    2017-10-01

    Non-familial small bowel carcinomas are relatively rare and have a poor prognosis. Two small bowel carcinoma subsets may arise in distinct immune-inflammatory diseases (celiac disease and Crohn's disease) and have been recently suggested to differ in prognosis, celiac disease-associated carcinoma cases showing a better outcome, possibly due to their higher DNA microsatellite instability and tumor-infiltrating T lymphocytes. In this study, we investigated the histological structure (glandular vs diffuse/poorly cohesive, mixed or solid), cell phenotype (intestinal vs gastric/pancreatobiliary duct type) and Wnt signaling activation (β-catenin and/or SOX-9 nuclear expression) in a series of 26 celiac disease-associated small bowel carcinoma, 25 Crohn's disease-associated small bowel carcinoma and 25 sporadic small bowel carcinoma cases, searching for new prognostic parameters. In addition, non-tumor mucosa of celiac and Crohn's disease patients was investigated for epithelial precursor changes (hyperplastic, metaplastic or dysplastic) to help clarify carcinoma histogenesis. When compared with non-glandular structure and non-intestinal phenotype, both glandular structure and intestinal phenotype were associated with a more favorable outcome at univariable or stage- and microsatellite instability/tumor-infiltrating lymphocyte-inclusive multivariable analysis. The prognostic power of histological structure was independent of the clinical groups while the non-intestinal phenotype, associated with poor outcome, was dominant among Crohn's disease-associated carcinoma. Both nuclear β-catenin and SOX-9 were preferably expressed among celiac disease-associated carcinomas; however, they were devoid, per se, of prognostic value. We obtained findings supporting an origin of celiac disease-associated carcinoma in SOX-9-positive immature hyperplastic crypts, partly through flat β-catenin-positive dysplasia, and of Crohn's disease-associated carcinoma in a metaplastic (gastric and

  12. Integrated Metagenomics/Metaproteomics Reveals Human Host-Microbiota Signatures of Crohn's Disease

    Science.gov (United States)

    Darzi, Youssef; Mongodin, Emmanuel F.; Pan, Chongle; Shah, Manesh; Halfvarson, Jonas; Tysk, Curt; Henrissat, Bernard; Raes, Jeroen; Verberkmoes, Nathan C.; Jansson, Janet K.

    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. PMID:23209564

  13. Pachydermoperiostosis in a Patient with Crohn's Disease: Treatment and Literature Review.

    Science.gov (United States)

    Mobini, Maryam; Akha, Ozra; Fakheri, Hafez; Majidi, Hadi; Fattahi, Sanam

    2018-01-01

    Pachydermoperiostosis (PDP) is a rare disorder characterized by pachydermia, digital clubbing, periostitis, and an excess of affected males. It is the primary form of hypertrophic osteoarthropathy (HOA) and there are some rare associations of PDP with other disorders. Here we describe a patient with Crohn's disease associated with PDP. A 26-year-old man, who was a known case of Crohn's disease, referred with diffuse swelling in the upper and lower limbs and cutis verticis gyrata since 7 years ago. PDP was suspected and endocrinological and radiological studies were conducted for the evaluation of underlying disease. He was prescribed celecoxib, low-dose prednisolone, and pamidronate to control the swelling, periostitis, azathiopurine, and mesalazine according to gastrointestinal involvement. In conclusion, it is important to identify this condition since a misdiagnosis might subject the patient to unnecessary investigations.

  14. Diagnostic performance of PET/MR in the evaluation of active inflammation in Crohn disease.

    Science.gov (United States)

    Catalano, Onofrio Antonio; Wu, Vincent; Mahmood, Umar; Signore, Alberto; Vangel, Mark; Soricelli, Andrea; Salvatore, Marco; Gervais, Debra; Rosen, Bruce R

    2018-01-01

    This study investigates the performance of PET/MR versus each sub-modality alone in the assessment of active inflammation in patients with Crohn disease, when compared to surgery as standard of reference. Sensitivity for detecting active inflammation was 91.5% for PET, 80% for MR, and 88% for PET/MR. Specificity for active inflammation was 74% for PET, 87% for MR, and 93% for PET/MR. Diagnostic accuracy was 84% for PET, 83% for MR, and 91% for PET/MR. In conclusion, PET/MR is significantly more accurate than either sub-modality alone and more specific than PET alone in the detection of active inflammation in patients with Crohn disease.

  15. 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.

  16. Management of post-operative Crohn's disease in 2017: where do we go from here?

    Science.gov (United States)

    Nguyen, Vu; Kanth, Rajan; Gazo, Joshua; Sorrentino, Dario

    2016-11-01

    Postoperative recurrence (POR) of Crohn's disease is common after surgical resection. How to best manage POR remains uncertain. Areas covered: In this review, we will first describe the natural course and the best modalities to diagnose this surgical sequela. We will then focus on the potential risk factors for relapse and highlight the main shortcomings in the current study designs and endoscopic and clinical scoring systems, which may partly explain the unexpected outcomes of recent clinical trials. Finally, we will propose a strategy to address the management of POR. Expert commentary: Anti-tumor necrosis factor (Anti-TNF) agents are the most effective therapy to prevent POR in Crohn's disease. Patient risk stratification and active monitoring with scheduled ileocolonoscopy are cornerstones of optimal POR management. Further studies are needed to address areas of uncertainty including timing and duration of therapy and the role of therapeutic drug monitoring in this setting.

  17. 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

  18. 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

  19. 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.

  20. 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.)

  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. Diffusion-weighted MRI in Crohn's disease: Current status and recommendations

    OpenAIRE

    Dohan, A.; Taylor, S.; Hoeffel, C.; Barret, M.; Allez, M.; Dautry, R.; Zappa, M.; Savoye-Collet, C.; Dray, X.; Boudiaf, M.; Reinhold, C.; Soyer, P.

    2016-01-01

    Over the past years, technological improvements and refinements in magnetic resonance imaging (MRI) hardware have made high-quality diffusion-weighted imaging (DWI) routinely possible for the bowel. DWI is promising for the detection and characterization of lesions in Crohn's disease (CD) and has been advocated as an alternative to intravenous gadolinium-based contrast agents. Furthermore, quantification using the apparent diffusion coefficient may have value as a biomarker of CD activity and...

  3. The long-term results of resection and multiple resections in Crohn's disease.

    Science.gov (United States)

    Krupnick, A S; Morris, J B

    2000-01-01

    Crohn's disease is a panenteric, transmural inflammatory disease of unknown origin. Although primarily managed medically, 70% to 90% of patients will require surgical intervention. Surgery for small bowel Crohn's is usually necessary for unrelenting stenotic complications of the disease. Fistula, abscess, and perforation can also necessitate surgical intervention. Most patients benefit from resection or strictureplasty with an improved quality of life and remission of disease, but recurrence is common and 33% to 82% of patients will need a second operation, and 22% to 33% will require more than two resections. Short-bowel syndrome is unavoidable in a small percentage of Crohn's patients because of recurrent resection of affected small bowel and inflammatory destruction of the remaining mucosa. Although previously a lethal and unrelenting disease with death caused by malnutrition, patients with short-bowel syndrome today can lead productive lives with maintenance on total parenteral nutrition (TPN). This lifestyle, however, does not come without a price. Severe TPN-related complications, such as sepsis of indwelling central venous catheters and liver failure, do occur. Future developments will focus on more powerful and effective anti-inflammatory medication specifically targeting the immune mechanisms responsible for Crohn's disease. Successful medical management of the disease will alleviate the need for surgical resection and reduce the frequency of short-bowel syndrome. Improving the efficacy of immunosuppression and the understanding of tolerance induction should increase the safety and applicability of small-bowel transplant for those with short gut. Tissue engineering offers the potential to avoid immunosuppression altogether and supplement intestinal length using the patient's own tissues.

  4. Spectrum of lymphoid hyperplasia: colonic manifestations of sarcoidosis, infectious mononucleosis, and Crohn's disease

    Energy Technology Data Exchange (ETDEWEB)

    Ell, S.R.; Frank, P.H.

    1981-10-15

    The radiographic pattern of nodular lymphoid hyperplasia, perhaps better called the lymphoid follicular pattern, has variously been described as an indication of disease and as a normal variant in the adult, with current opinion favoring the latter. We report 3 cases wherein this pattern resulted from definite pathologic processes: sarcoidosis, infectious mononucleosis, and Crohn's disease. Although usually of no pathological significance, the benign follicular pattern may reflect a variety of diseases.

  5. Spectrum of lymphoid hyperplasia: Colonic manifestations of sarcoidosis, infectious mononucleosis, and Crohn's disease

    International Nuclear Information System (INIS)

    Ell, S.R.; Frank, P.H.

    1981-01-01

    The radiographic pattern of nodular lmyphoid hyperplasia, perhaps better called the lymphoid follicular pattern, has variously been described as an indication of disease and as a normal variant in the adult, with current opinion favoring the latter. We report 3 cases wherein this pattern resulted from definite pathologic processes: sarcoidosis, infectious mononucleosis, and Crohn's disease. Although usually of no pathological significance, the benign follicular pattern may reflect a variety of diseases. (orig.)

  6. 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.

  7. 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.

  8. Stricturoplasty—a bowel-sparing option for long segment small bowel Crohn's disease

    OpenAIRE

    Limmer, Alexandra M.; Koh, Hoey C.; Gilmore, Andrew

    2017-01-01

    Abstract Stricturoplasty is a surgical option for management of severe stricturing Crohn's disease of the small bowel. It avoids the need for small bowel resection and the associated metabolic complications. This report contrasts the indications and technical aspects of two different stricturoplasty techniques. Case 1 describes an extensive Michelassi (side-to-side isoperistaltic) stricturoplasty performed for a 100 cm segment of diseased small bowel in a 45-year-old patient. Case 2 describes...

  9. MRI predictors of treatment response for perianal fistulizing Crohn disease in children and young adults

    Energy Technology Data Exchange (ETDEWEB)

    Shenoy-Bhangle, Anuradha; Nimkin, Katherine; Gee, Michael S. [Massachusetts General Hospital for Children, Harvard Medical School, Department of Radiology, Boston, MA (United States); Goldner, Dana; Israel, Esther J. [Massachusetts General Hospital for Children, Harvard Medical School, Department of Pediatrics, Boston, MA (United States); Bradley, William F. [Analog Devices, Lyric Labs, Cambridge, MA (United States)

    2014-01-15

    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.)

  10. 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.)

  11. 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

  12. 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.

  13. 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.)

  14. Role of magnetic resonance imaging in the management of perianal Crohn's disease.

    Science.gov (United States)

    Gallego, Jose C; Echarri, Ana

    2018-02-01

    Perianal fistulas are a major problem in many patients with Crohn's disease. These are usually complex fistulas that adversely affect patients' quality of life, and their clinical management is difficult. Medical treatment sometimes achieves cessation of discharge and closure of the external opening; however, it is difficult to assess the status of the rest of the fistula tract. Magnetic resonance imaging is the method of choice with which to evaluate the condition of perianal fistulas and allows for assessment of the status of inaccessible areas. Magnetic resonance imaging also allows the clinician to evaluate other perianal manifestations of Crohn's disease that differ from the fistulas. This imaging technique is therefore a fundamental means of patient monitoring. When used in conjunction with assessment of the patient's morphological findings, it provides information that allows for both quantification of disease severity and evaluation of the response to treatment. New types of magnetic resonance sequences are emerging, such as diffusion, perfusion, and magnetisation transfer. These sequences may serve as biomarkers because they provide information reflecting the changes taking place at the molecular level. This will help to shape a new scenario in the early assessment of the response to treatments such as anti-tumour necrosis factor drugs. • MRI is the method of choice with which to evaluate perianal fistulas. • In perianal Crohn's disease, MRI is a fundamental means of patient monitoring. • The usefulness of the Van Assche score for patient monitoring remains unclear. • New MRI sequences' diffusion, perfusion, and magnetisation transfer may serve as biomarkers.

  15. Impacto del cigarrillo en el tracto gastrointestinal: Efecto diferencial en Enfermedad de Crohn y Colitis Ulcerosa

    Directory of Open Access Journals (Sweden)

    Loni Berkowitz Fiebich

    2017-03-01

    Full Text Available El impacto del consumo de cigarrillo a nivel respiratorio y cardiovascular ha sido extensamente investigado, sin embargo, aún queda mucho por estudiar sobre su impacto en el tracto gastrointestinal. Está demostrado que el tabaquismo es un importante factor de riesgo para desórdenes gastrointestinales, incluyendo úlceras pépticas, Enfermedad de Crohn y distintos tipos de cáncer. Los mecanismos propuestos incluyen daños a nivel de la mucosa, alteraciones en la irrigación del tejido y cambios en la respuesta inmune. Paradojalmente, el consumo de cigarrillo constituye un factor protector para el desarrollo y la progresión de la Colitis Ulcerosa. Esta patología, junto a la Enfermedad de Crohn, conforman las dos entidades más importantes dentro de las Enfermedades Inflamatorias Intestinales y comparten diversas características. El impacto diferencial del consumo de cigarrillo entre ambas ha sido un tema de gran interés en los últimos treinta años, y aún no ha logrado ser esclarecido. En esta revisión describiremos los efectos conocidos del tabaquismo sobre el tracto gastrointestinal, y particularmente en la inflamación intestinal, profundizando en los estudios disponibles que intentan explicar el efecto opuesto del cigarrillo en la Enfermedad de Crohn y la Colitis Ulcerosa

  16. Inflammation, Antibiotics, and Diet as Environmental Stressors of the Gut Microbiome in Pediatric Crohn's Disease.

    Science.gov (United States)

    Lewis, James D; Chen, Eric Z; Baldassano, Robert N; Otley, Anthony R; Griffiths, Anne M; Lee, Dale; Bittinger, Kyle; Bailey, Aubrey; Friedman, Elliot S; Hoffmann, Christian; Albenberg, Lindsey; Sinha, Rohini; Compher, Charlene; Gilroy, Erin; Nessel, Lisa; Grant, Amy; Chehoud, Christel; Li, Hongzhe; Wu, Gary D; Bushman, Frederic D

    2015-10-14

    Abnormal composition of intestinal bacteria--"dysbiosis"-is characteristic of Crohn's disease. Disease treatments include dietary changes and immunosuppressive anti-TNFα antibodies as well as ancillary antibiotic therapy, but their effects on microbiota composition are undetermined. Using shotgun metagenomic sequencing, we analyzed fecal samples from a prospective cohort of pediatric Crohn's disease patients starting therapy with enteral nutrition or anti-TNFα antibodies and reveal the full complement and dynamics of bacteria, fungi, archaea, and viruses during treatment. Bacterial community membership was associated independently with intestinal inflammation, antibiotic use, and therapy. Antibiotic exposure was associated with increased dysbiosis, whereas dysbiosis decreased with reduced intestinal inflammation. Fungal proportions increased with disease and antibiotic use. Dietary therapy had independent and rapid effects on microbiota composition distinct from other stressor-induced changes and effectively reduced inflammation. These findings reveal that dysbiosis results from independent effects of inflammation, diet, and antibiotics and shed light on Crohn disease treatments. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Intestinal permeability to [51Cr]EDTA in children with Crohn's disease and celiac disease

    International Nuclear Information System (INIS)

    Turck, D.; Ythier, H.; Maquet, E.; Deveaux, M.; Marchandise, X.; Farriaux, J.P.; Fontaine, G.

    1987-01-01

    [ 51 Cr]EDTA was used as a probe molecule to assess intestinal permeability in 7 healthy control adults, 11 control children, 17 children with Crohn's disease, and 6 children with untreated celiac disease. After subjects fasted overnight, 75 kBq/kg (= 2 microCi/kg) 51 Cr-labeled EDTA was given by mouth; 24-h urinary excretion of [ 51 Cr]EDTA was measured and expressed as a percentage of the total oral dose. Mean and SD were as follows: control adults 1.47 +/- 0.62, control children 1.59 +/- 0.55, and patients with Crohn's disease or celiac disease 5.35 +/- 1.94. The difference between control children and patients was statistically significant (p less than 0.001). These results show that intestinal permeability to [ 51 Cr]EDTA is increased among children with active or inactive Crohn's disease affecting small bowel only or small bowel and colon, and with untreated celiac disease. The [ 51 Cr]EDTA permeability test could facilitate the decision to perform more extensive investigations in children suspected of small bowel disease who have atypical or poor clinical and biological symptomatology

  18. Endoscopic balloon dilatation of intestinal strictures in Crohn's disease: safe alternative to surgery.

    Science.gov (United States)

    Ajlouni, Yousef; Iser, John H; Gibson, Peter R

    2007-04-01

    Endoscopic balloon dilatation (EBD), a non-surgical treatment option for intestinal strictures in Crohn's disease, appears to be applied infrequently, possibly due to the perceived risk of perforation and early recurrence. This study aimed to determine the outcomes of EBD by a single endoscopist using a defined technique. The records of all patients with Crohn's disease in whom EBD was attempted over a 12-year period were examined to determine the rate of technical success, complications and outcome. A stricture was defined as that which prevented passage of the 14 mm diameter colonoscope. Technical success was defined as the ability to traverse the stricture postdilatation. Patients were selected on the colonoscopic appearance of the stricture and dilatation was performed using through-the-endoscope balloons. Antibiotics were given during and for 7 days postdilatation. EBD was attempted on 83 strictures (31 anastomotic and 52 primary) in 37 patients (15 males) and was successful in 75 (90%) of 31 patients. A single dilatation only was required in 21 patients who had a median follow-up of 20 months (range 6-122 months). Recurrent symptomatic stricture requiring dilatation (eight patients) or surgery (two patients) occurred 8 (1-112) months after the initial dilatation. The only complication occurred in one patient where an intra-abdominal fistula and abscess were probably related to the dilatation. EBD of intestinal strictures associated with Crohn's disease has a low complication rate and leads to prolonged clinical benefit. It should be considered as a real alternative to surgery.

  19. Resected Hepatocellular Carcinoma in a Patient with Crohn's Disease on Azathioprine

    Science.gov (United States)

    Heron, Valérie; Fortinsky, Kyle Joshua; Spiegle, Gillian; Hilzenrat, Nir; Szilagyi, Andrew

    2016-01-01

    Hepatocellular carcinoma rarely occurs in patients without underlying cirrhosis or liver disease. While inflammatory bowel disease has been linked to certain forms of liver disease, hepatocellular carcinoma is exceedingly rare in these patients. We report the twelfth case of hepatocellular carcinoma in a patient with Crohn's disease. The patient is a 61-year-old with longstanding Crohn's disease who was treated with azathioprine and was found to have elevated liver enzymes and a new 3-cm liver mass on ultrasound. A complete workup for underlying liver disease was unremarkable and liver biopsy revealed hepatocellular carcinoma. The patient underwent a hepatic resection, and there is no evidence of recurrence at the 11-month follow-up. The resection specimen showed no evidence of cancer despite the initial biopsy revealing hepatocellular carcinoma. This case represents the third biopsy-proven complete spontaneous regression of hepatocellular carcinoma. Although large studies have failed to show a definite link between azathioprine and hepatocellular carcinoma, the relationship remains concerning given the multiple case reports suggesting a possible association. Clinicians should exercise a high degree of suspicion in patients with Crohn's disease who present with elevated liver enzymes, especially those on azathioprine therapy. PMID:27403102

  20. 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.)

  1. A Qualitative Exploration of the Lived Experiences of Patients Before and After Ileostomy Creation as a Result of Surgical Management for Crohn's Disease.

    Science.gov (United States)

    Morris, Andrew; Leach, Bethan

    2017-01-01

    Patient experiences pre- and post-ileostomy creation as a result of severe Crohn's Disease are underresearched. A qualitative phenomenological design involving a purposeful sampling approach was used to capture the lived physical and psychosocial transition of patients with Crohn's Disease before and after ileostomy formation. Patients were recruited from the membership of the United Kingdom Ileostomy Association; inclusion criteria stipulated participants must speak English and have a diagnosis of Crohn's Disease and subsequent stoma formation. Ten (10) patients (6 women, 4 men, ranging in age from 34 to 83 years with Crohn's Disease and an ileostomy [mean time with stoma 18.3 years, range 3-36 years]) participated in indepth, semistructured interviews with questions on sociodemographic characteristics along with questions informed by the relevant literature regarding life before and after the ileostomy. All interviews were audiorecorded and transcribed verbatim. Interpretative phenomenological analysis was used to examine the data and identify and interpret themes. Participants were asked to comment on these themes to ensure they were a realistic interpretation of their experiences. Two (2) major themes emerged that embodied ileostomy formation: being controlled by Crohn's and transition to a new life with an ileostomy. Crohn's symptoms controlled daily activities such as work and socializing due, in part, to the need to be in close proximity to toilet facilities. The ileostomy facilitated a transition to a new life that allowed patients to re-engage with work and social activities. One minor theme emerged: memories of Crohn's. Participants said their memories of Crohn's affected life with an ileostomy. Where Crohn's controlled every aspect of people's lives pre-ileostomy formation, the creation of the ileostomy was a positive experience because it helped manage Crohn's symptoms. Memories of life pre-ileostomy may affect individuals' behavior post

  2. Spontaneous remission of Crohn's disease following a febrile infection: case report and literature review

    Directory of Open Access Journals (Sweden)

    van Netten Johannes P

    2011-05-01

    Full Text Available Abstract Crohn's disease is a chronic illness that may often follow a relapsing-remitting course. Many of the factors that may be associated with the spontaneous remission of this disease (i.e. not related to specific treatment remain to be determined. In the present report, we review the medical history of a patient with a long history of moderate to severe Crohn's whose complete remission immediately followed the development of a febrile infection. The patient first developed symptoms of Crohn's in her late adolescent years. At the time of diagnosis at age 23, she was placed on mesalamine - without effective control her disease symptoms. Due to progressive deterioration, the patient underwent a bowel resection at age 25. Soon afterwards symptoms recurred, gradually increasing in severity. In February 2005, at age 36, the patient developed a painful abscess associated with a rectal fistula. Other symptoms at the time included chronic bone and stomach pain, swollen joints, and debilitating fatigue. Surgical correction was scheduled in mid-March. In late February, the patient developed a respiratory infection associated with fevers of 103-104°F. After the onset of fever, the abscess pain disappeared and this was soon followed by a disappearance of all other disease symptoms. By the time the corrective surgery occurred, she had no Crohn's symptoms. Her remission lasted 10 weeks when the previous symptoms then reappeared. The patient has subsequently used a variety of conventional therapies, but still suffers from severe symptoms of her disease. In recent years, a growing body of literature has emphasized the important role that innate immunity plays in the etiology of Crohn's disease; however, a key component of innate immunity, the febrile response, has been overlooked. Other cases of spontaneous remission following febrile infection in inflammatory bowel disease have been reported. Moreover, induction of a febrile response was in the past used

  3. Morbus gaucher: A report of two cases

    Directory of Open Access Journals (Sweden)

    Đokić Milomir

    2006-01-01

    Full Text Available Backround. Clinical features of inherited glucocerebrosidase deficiency were first described by Phillippe Charles Ernest Gaucher, French physician (1854-1918. Deficiency of glucocerebrosidase leads to the accumulation of the lipid glucocerebroside within the lysosomes of the monocyte macrophage system. Lipid-laden cells, known as Gaucher cells, lead to hepatosplenomegaly, multiorgan dysfunction and sceletal deterioration. Case report. We reported a 36- year-old male and a 42-year-old female admitted for the clinical examination due to hepatosplenomegaly. The Clinical diagnosis was provided by a bone marrow examination and demonstration of the characteristic Gaucher cells. Both of the patients had type I Gaucher's disease (a mild form of the disease, which is distinguished by the lack of central nervous system involvement and striking phenotypic variation. We had not a possibility of testing β-glucocerebrosidase activity in peripheral leukocytes (a definitive diagnosis of Gaucher's disease. Also, enzyme replacement therapy had not been available in our country. Conclusion. Althoungh rare, Gaucher's disease is also present in our country. Both molecular genetic, and the enzyme β-glucocerebrosidase activity testing in peripheral leukocytes are needed for the definitive diagnosis of this disease.

  4. Effect of tight control management on Crohn's disease (CALM): a multicentre, randomised, controlled phase 3 trial.

    Science.gov (United States)

    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

    2018-12-23

    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 with moderate to severe Crohn's disease who were managed with a tight control algorithm, using clinical symptoms and biomarkers, versus patients managed with a clinical management algorithm. CALM was an open-label, randomised, controlled phase 3 study, done in 22 countries at 74 hospitals and outpatient centres, which evaluated adult patients (aged 18-75 years) with active endoscopic Crohn's disease (Crohn's Disease Endoscopic Index of Severity [CDEIS] >6; sum of CDEIS subscores of >6 in one or more segments with ulcers), a Crohn's Disease Activity Index (CDAI) of 150-450 depending on dose of prednisone at baseline, and no previous use of immunomodulators or biologics. Patients were randomly assigned at a 1:1 ratio to tight control or clinical management groups, stratified by smoking status (yes or no), weight (2 years) after 8 weeks of prednisone induction therapy, or earlier if they had active disease. In both groups, treatment was escalated in a stepwise manner, from no treatment, to adalimumab induction followed by adalimumab every other week, adalimumab every week, and lastly to both weekly adalimumab and daily azathioprine. This escalation was based on meeting treatment failure criteria, which differed between groups (tight control group before and after random assignment: faecal calprotectin ≥250 μg/g, C-reactive protein ≥5mg/L, CDAI ≥150, or prednisone use in the previous week; clinical management group before random assignment: CDAI decrease of 200; clinical management group after random assignment: CDAI decrease of management group, 0·9 years [SD 1·7]; tight control group, 1·0 year [2·3]) were randomly assigned to monitoring groups (n=122 per group

  5. Colorectal cancer in Crohn's disease--review of a 56-year experience in Karolinska Institute University Hospital.

    Science.gov (United States)

    Rubio, Carlos A; Befrits, Ragnar

    2008-01-01

    We previously reported that the frequency of colorectal carcinomas (CRC) in Crohn's disease (CD) had increased at this hospital between 1951 and May 1996. The aim was to compare the frequency of CRC in CD between June 1996 and September 2007 to that found between 1951 and May 1996. For that purpose colectomy specimens with an IBD-CRC diagnosis filed during the last 11 years were reviewed. It was found that 29 patients with IBD developed a CRC at this hospital: 21 had CD (or 1.91 cases/year) and the remaining eight, ulcerative colitis (or 0.72 cases/year). At this hospital, the number of cases of CRC in Crohn's colitis increased from 0.28/year between 1951 and the end of 1989, to 1.69 patients/year between 1990 and May 1996, and to 1.91 patients/year between June 1996 and September 2007 (present report). The marginal increase number of patients with CRC in Crohn's colitis/year during the last 11 years at this hospital might be only apparent, considering that the incidence of Crohn's disease in the county has dramatically increased, and that the localization of Crohn's disease has changed in later years, with a predilection for the colon and rectum.

  6. Intestinal permeability of 51Cr-labelled ethylenediaminetetraacetic acid in patients with Crohn's disease and their healthy relatives

    International Nuclear Information System (INIS)

    Ainsworth, M.; Eriksen, J.; Rasmussen, J.W.; Muckadell, O.B.S. de

    1989-01-01

    An increased intestinal permeability has been proposed as an aetiologic factor in Crohn's disease. The 24-h urinary excretion of 100 μCi 51 Cr-labelled ethylenediaminetetraacetic acid (EDTA) was used to test the permeability in 15 patients with Crohn's disease and in 20 healthy first-degree relatives, who were known to have a genetic predisposition to inflammatory bowel disease. Twenty-eight healthy persons not related to patients with inflammatory bowel disease served as control material. The 51 Cr-EDTA excretion of the relatives was not significantly higher than that of the controls, whereas patients with Crohn's disease had a significantly higher excretion than both the relatives and the controls. Among patients the increased excretion was found only if the small intestine was involved. It is concluded that 1) as a group, patient with Crohn's disease in the small intestine have an increased intestinal permeability, in contrast to their healthy relatives, who have a normal permeability; 2) a considerable overlap of the results of the 51 Cr-EDTA test was found between the groups studied, and the test is not suitable for evaluating individual patients; 3) the results do not support the hypothesis of an increase in intestinal permeability as an aetiologic factor in Crohn's disease. 29 refs

  7. Role of Doppler ultrasonography evaluation of superior mesenteric artery flow volume in the assessment of Crohn's disease activity

    Directory of Open Access Journals (Sweden)

    Fabiana Paiva Martins

    2013-09-01

    Full Text Available Objective To investigate superior mesenteric artery flow measurement by Doppler ultrasonography as a means of characterizing inflammatory activity in Crohn's disease. Materials and Methods Forty patients were examined and divided into two groups – disease activity and remission – according to their Crohn's disease activity index score. Mean superior mesenteric artery flow volume was calculated for each group and correlated with Crohn's disease activity index score. Results The mean superior mesenteric artery flow volume was significantly greater in the patients with active disease (626 ml/min ± 236 × 376 ml/min ± 190; p = 0.001. As a cut off corresponding to 500 ml/min was utilized, the superior mesenteric artery flow volume demonstrated sensitivity of 83% and specificity of 82% for the diagnosis of Crohn's disease activity. Conclusion The present results suggest that patients with active Crohn's disease have increased superior mesenteric artery flow volume as compared with patients in remission. Superior mesenteric artery flow measurement had a good performance in the assessment of disease activity in this study sample.

  8. Postsurgical recurrence of ileal Crohn's disease: an update on risk factors and intervention points to a central role for impaired host-microflora homeostasis.

    LENUS (Irish Health Repository)

    Cunningham, Michael F

    2010-07-01

    A pressing need exists to identify factors that predispose to recurrence after terminal ileal resection for Crohn\\'s disease (CD) and to determine effective prophylactic strategies. This review presents an up-to-date summary of the literature in the field and points to a role for bacterial overproliferation in recurrence.

  9. Focal enhanced gastritis and macrophage microaggregates in the gastric mucosa: potential role in the differential diagnosis between Crohn's disease and ulcerative colitis.

    Science.gov (United States)

    Magalhães-Costa, Marcia Henriques de; Reis, Beatriz Ribeiro dos; Chagas, Vera Lúcia Antunes; Nunes, Tiago; Souza, Heitor Siffert Pereira de; Zaltman, Cyrla

    2014-01-01

    Focally enhanced gastritis and macrophage microaggregates are found in the upper gastrointestinal involvement of Crohn's disease, and may reflect an underlying defective innate immunity. These features, however, are also described in patients with Helicobacter pylori infection. The role of these gastric abnormalities in the diagnosis of Crohn's disease was assessed in a population with high prevalence of H. pylori infection. Thirty-seven Crohn's disease, 26 ulcerative colitis, and 30 control patients were included. The H. pylori status was evaluated by the rapid urease test and histology. The presence of focally enhanced gastritis and macrophage microaggregates was recorded. Focally enhanced gastritis was present in 24% of Crohn's disease patients, 4% of ulcerative colitis patients and 11.5% of controls, presenting an overall sensitivity and specificity for Crohn's disease of 24% and 88%, respectively. Macrophage microaggregates were found in all groups, but were only detected in ulcerative colitis and controls in association with H. pylori infection, with an overall sensitivity and specificity for Crohn's disease of 61% and 69%, respectively. In the absence of H. pylori infection, focally enhanced gastritis and macrophage microaggregates were significantly associated with Crohn's disease (Pgastritis and macrophage microaggregates are suggestive of Crohn's disease only in H. pylori-negative specimens.

  10. Arterite de Takayasu e doença de Crohn: uma associação incomum Takayasu's arteritis and Crohn's disease: an unusual association

    Directory of Open Access Journals (Sweden)

    Clóvis Konopka

    2009-12-01

    Full Text Available A arterite de Takayasu e a doença de Crohn são doenças inflamatórias com etiologia desconhecida. Raramente ocorrem de modo concomitante em um mesmo indivíduo, havendo menos de 30 casos relatados na literatura. Este trabalho descreve essa associação em uma paciente de 36 anos de idade portadora de doença de Crohn, que apresentou redução dos pulsos no membro superior esquerdo e pressão arterial de 60/40 mmHg. A angiotomografia evidenciou estenose segmentar de artéria subclávia esquerda e espessamento parietal circunferencial da aorta na transição toracoabdominal entre T10 e L1, estabelecendo o diagnóstico de arterite de Takayasu. Ambas as patologias são mediadas imunologicamente e apresentam granulomas e vasculite granulomatosa, o que contribui para reforçar a hipótese de uma origem imunológica comum no seu desenvolvimento. Acreditamos que este seja o primeiro caso relatado na literatura brasileira da presença concomitante destas duas enfermidades.Takayasu's arteritis and Crohn's disease are chronic inflammatory diseases with unknown etiology. They rarely occur together in the same individual, with less than 30 cases reported in the literature. This case report describes this association in a 36-year-old woman with Crohn’s disease and weak pulses in her left arm with blood pressure of 60/40 mmHg. Angiotomography showed segmental stenosis in the left subclavian artery and circumferential thickening of the aortic wall between T10 and L1, establishing the diagnosis of Takayasu's arteritis. Both are organ-specific and immune-mediated diseases and exhibit granulomas and granulomatous vasculitis, which contribute to reinforce the hypothesis of a common immunologic origin. We believe that this is the first case of concomitant presence of these two diseases reported in the Brazilian literature.

  11. Clinical status, quality of life, and work productivity in Crohn's disease patients after one year of treatment with adalimumab.

    Science.gov (United States)

    Saro, Cristina; Ceballos, Daniel; Muñoz, Fernando; de la Coba, Cristóbal; Aguilar, María Dolores; Lázaro, Pablo; García-Sánchez, Valle; Hernández, Mariola; Barrio, Jesús; de Francisco, Ruth; Fernández, Luis I; Barreiro-de Acosta, Manuel

    2017-02-01

    Clinical trials have shown the efficacy of adalimumab in Crohn's disease, but the outcome in regular practice remains unknown. The aim of the study was to examine clinical status, quality of life, and work productivity of Crohn's disease patients receiving adalimumab for one year in the context of usual clinical practice. This was a prospective, observational study with a one-year follow-up. After baseline, Crohn's disease patients were evaluated at 1, 3, 6, 9, and 12 months after starting treatment with adalimumab. Outcome variables included: clinical status (measured with CDAI), quality of life (measured with EuroQoL-5D and IBDQ), and work productivity (measured with WPAI questionnaire). These outcome variables were compared using the Student's t test or Wilcoxon test for paired comparison data according to the data distribution. Statistical significance was set at two-sided p work productivity impact decreased from 53% to 24% (p quality of life and work productivity.

  12. Birth outcome in women with ulcerative colitis and Crohn's disease, and pharmacoepidemiological aspects of anti-inflammatory drug therapy

    DEFF Research Database (Denmark)

    Nørgård, Bente Mertz

    2011-01-01

    , including patients with ulcerative colitis and Crohn's disease. The third part (and the latest publications) includes birth outcome in women with Crohn's disease; and the methods of cohort establishment in these studies are developed and improved due to the knowledge gathered from conducting the earlier...... prescription Database, the Danish National Hospital Discharge Registry, the Danish Medical Birth Registry, and review of selected medical records. After exposure to sulfasalazine during pregnancy our data suggest. No significantly increased overall relative risk of congenital abnormalities and no significantly...... National Hospital Discharge Registry, the nationwide Danish Prescription Database and the Danish Medical Birth Registry. Furthermore, birth outcomes are examined in Crohn's disease women with disease activity during pregnancy, based on data from review of hospital records, the Danish National Hospital...

  13. Predicting and explaining inflammation in Crohn's disease patients using predictive analytics methods and electronic medical record data.

    Science.gov (United States)

    Reddy, Bhargava K; Delen, Dursun; Agrawal, Rupesh K

    2018-01-01

    Crohn's disease is among the chronic inflammatory bowel diseases that impact the gastrointestinal tract. Understanding and predicting the severity of inflammation in real-time settings is critical to disease management. Extant literature has primarily focused on studies that are conducted in clinical trial settings to investigate the impact of a drug treatment on the remission status of the disease. This research proposes an analytics methodology where three different types of prediction models are developed to predict and to explain the severity of inflammation in patients diagnosed with Crohn's disease. The results show that machine-learning-based analytic methods such as gradient boosting machines can predict the inflammation severity with a very high accuracy (area under the curve = 92.82%), followed by regularized regression and logistic regression. According to the findings, a combination of baseline laboratory parameters, patient demographic characteristics, and disease location are among the strongest predictors of inflammation severity in Crohn's disease patients.

  14. 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, C; 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...... as a delta score, i.e. the difference in score between a patient and the matched control. RESULTS: In 21 of 23 questions the median delta score was zero, indicating no difference between patient and control. The median total delta score was 0.4 in favour of healthy controls (P

  15. Retreatment and maintenance therapy with infliximab in fistulizing Crohn' disease Retratamiento y tratamiento de mantenimiento con infliximab en la enfermedad de Crohn fistulizante

    Directory of Open Access Journals (Sweden)

    L. Rodrigo

    2004-08-01

    Full Text Available Objectives: infliximab has clearly demonstrated its efficacy in the short-term treatment of fistulizing Crohn' disease. We present here the results of retreatment and long-term maintenance therapy. Patients and methods: eighty one consecutive patients with active fistulizing Crohn' disease, in whom previous treatments had failed, were treated with infliximab. All patients received as the initial treatment of 5 mg/kg i.v. infusions (weeks 0, 2, and 6. Those patients who failed to respond after the initial cycle (group 1, n= 25, or those who relapsed after having responded (group 2, n=13, received retreatment with three similar doses (weeks 0,2, and 6. Those who responded to retreatment were included in a long-term maintenance programme (n=44, with repeated doses (5 mg/kg i.v. infusions every eight weeks for 1-2 years. Results: in the initial treatment 56% of the patients responded partially; this response being complete in 44%. In the retreatment, 28% of group 1 (non-responders presented a complete response, compared to 77% in group 2 (relapsers (pObjetivos: el infliximab ha demostrado su eficacia en el tratamiento a corto plazo de la enfermedad de Crohn (EC fistulosa. En este trabajo presentamos los resultados del retratamiento y del tratamiento de mantenimiento a largo plazo. Pacientes y métodos: se trataron con infliximab un total de 81 pacientes consecutivos con EC fistulosa activa, en los cuales, habían fallado tratamientos previos. Todos los pacientes recibieron como tratamiento inicial infusiones a dosis de 5 mg/kg i.v. en las semanas 0, 2 y 6. Aquellos pacientes que no respondieron después del ciclo inicial (grupo 1, n=25, o los que recayeron después de haber respondido (grupo 2, n=13, recibieron retratamiento con 3 dosis similares (semanas 0, 2 y 6. Aquellos que respondieron a la terapia de retratamiento fueron incluidos en un programa de mantenimiento a largo plazo (n=44, con dosis repetidas (infusiones con 5 mg/kg i.v. cada 8

  16. 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...... patients, 22 patients with irritable bowel syndrome (IBS), and 24 healthy donors. One-way analysis of variance, Mann-Whitney U-test, logistic regression models, and receiver operator characteristics (ROC) curve analysis was carried out to evaluate the diagnostic accuracy of the biomarkers. The ECM...

  17. Derrame pleural: uma complicação extra-intestinal da doença de Crohn Pleural effusion: an extraintestinal complication of Crohn's disease

    Directory of Open Access Journals (Sweden)

    ELIE FISS

    2002-09-01

    Full Text Available Paciente de 34 anos, portadora de doença de Crohn (DC havia oito anos, foi atendida queixando-se de dor torácica e febre, sem manifestações gastrointestinais. Testes laboratoriais mostraram atividade inflamatória (VHS = 45mm, PCR positivo. O exame físico revelou derrame pleural na base do hemitórax esquerdo, confirmado pela radiografia de tórax. A análise do líquido pleural mostrou 100% de linfócitos, com BAAR negativo. A biópsia pleural evidenciou granuloma não caseoso. Foi instituída terapia para tuberculose, sem sucesso, com regressão dos sintomas apenas após reintrodução de altas doses de corticosteróide, sugerindo atividade da DC como causa do derrame pleural.A 34-year-old patient had had Crohn's disease (CD for eight years; she was seen for complaints of thoracic pain and fever, without gastrointestinal manifestations. Initial laboratory exams were compatible with the presence of inflammatory activity (VHS = 45 mm for normal value of 20 mm and PCR+. The physical exam revealed signs of pleural effusion in the left hemithorax base, which was confirmed by thoracic RX. The pleural liquid analysis showed that the cells were 100% of lymphocytes, with negative BAAR research. The pleural biopsy evidenced non caseous granuloma. Despite the tuberculosis treatment, the patient only got better when corticotherapy was introduced in high doses, suggesting the activity of CD as the cause of the pleural effusion. This case establishes a connection between activity of CD and manifestations of lung disease.

  18. Early combined immunosuppression for the management of Crohn's disease (REACT): a cluster randomised controlled trial.

    Science.gov (United States)

    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

    2015-11-07

    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 Crohn's disease. In this open-label cluster randomised controlled trial (Randomised Evaluation of an Algorithm for Crohn's Treatment, REACT), we included community gastroenterology practices from Belgium and Canada that were willing to be assigned to either of the study groups, participate in all aspects of the study, and provide data on up to 60 patients with Crohn's disease. These practices were randomly assigned (1:1) to either ECI or conventional management. The computer-generated randomisation was minimised by country and practice size. Up to 60 consecutive adult patients were assessed within practices. Patients who were aged 18 years or older; documented to have Crohn's disease; able to speak or understand English, French, or Dutch; able to access a telephone; and able to provide written informed consent were followed up for 2 years. The primary outcome was the proportion of patients in corticosteroid-free remission (Harvey-Bradshaw Index score ≤ 4) at 12 months at the practice level. This trial is registered with ClinicalTrials.gov, number NCT01030809. This study took place between March 15, 2010, and Oct 1, 2013. Of the 60 practices screened, 41 were randomly assigned to either ECI (n=22) or conventional management (n=19). Two practices (one in each group) discontinued because of insufficient resources. 921 (85%) of the 1084 patients at ECI practices and 806 (90%) of 898 patients at conventional management practices completed 12 months follow-up and were included in an intention-to-treat analysis. The 12 month practice-level remission rates were similar at ECI and conventional management practices (66·0% [SD 14·0] and 61·9% [16·9]; adjusted difference 2·5%, 95

  19. Accounting for Pharmacokinetic Variability of Certolizumab Pegol in Patients with Crohn's Disease.

    Science.gov (United States)

    Vande Casteele, Niels; Mould, Diane R; Coarse, Jason; Hasan, Iram; Gils, Ann; Feagan, Brian; Sandborn, William J

    2017-12-01

    Certolizumab pegol is an effective biologic for patients with Crohn's disease (CD). Individual differences in certolizumab pegol apparent clearance (CL/F) affect exposure and possibly efficacy. A previously developed population pharmacokinetic (PK) model did not account for dynamic changes in clinical parameters during therapy. The aim of this study was to refine the existing PK model to capture the time-varying influence of covariates. Data collected from 2157 Crohn's disease patients in nine studies were analyzed using nonlinear mixed-effects modeling software (NONMEM). Certolizumab pegol concentration-time data were described by a one-compartment PK model with first-order absorption, and one-compartment disposition with linear, time-dependent elimination using antidrug antibody (ADAb) concentration as a continuous variable. The final dataset consisted of 12,926 analyzable records. Parameter estimates were absorption rate constant 1.83/day, CL/F 0.527 L/day, and apparent volume of distribution (V/F) 8.33 L. ADAb concentration (2.5-214 units/mL) increased the median CL/F by 142-174%. For a typical patient, body weight (46.8-100.5 kg) increased the median CL/F and V/F from 82 to 120%. Albumin (32-48 g/L) decreased and C-reactive protein (0.5-54.0 mg/L) increased the median CL/F from 123 to 85% and from 83 to 113%, respectively. Between-patient variability of CL/F was 19.6%. By incorporating time-varying covariates, this population PK model reduces between-patient variability on CL/F estimates, and the relative influence of ADAb can now be assessed. As Crohn's disease patient covariates are often time-dependent, this model is more reflective of patient drug exposure with sustained treatment.

  20. [Low-intensity, evidence-based cognitive-behavioural therapy of a patient with Crohn's disease].

    Science.gov (United States)

    Antal-Uram, Dóra; Harsányi, László; Perczel-Forintos, Dóra

    2018-03-01

    Inflammatory bowel disease (Crohn's disease and colitis ulcerosa) is a chronic, long-term condition that causes chronic inflammation in the digestive tract, and shows an increasing incidence and prevalence worldwide. Changes in disease activity over time affect psychological distress which increases the risk of exacerbations. Beside somatic symptoms (such as abdominal pain, diarrhoea and weight loss), psychiatric comorbidity (in particular major depression, anxiety, social phobia) is common in patients with Crohn's disease. This case study illustrates the management and stabilization of a 21-year-old adult male patient with active Crohn's disease and with severe psychiatric comorbidity. The patient was diagnosed with avoidant personality disorder and dysruptive mood dysregulation disorder based on the results of psychodiagnostics (SCID-II structured clinical interview, MMPI personality inventory and disease-specific clinical questionnaires such as Beck Depression Inventory, Beck Hopelessness Scale, Social Cognition Questionnaire, Anger Expression Scale, Cognitive Emotion Regulation Questionnaire, Rosenberg Self-Esteem Scale). The main aim of psychotherapy is to increase the adherence to pharmacotherapy, to promote psychosocial functioning, to improve well-being and to enhance adaptive coping strategies. Low-intensity cognitive-behavioural psychotherapy was used which included psychoeducation, motivational interview, behavioural activation, patient diary, cognitive restructuring, problem-solving training, and family consulting. Twenty-five sessions were held weekly in outpatient form and 3 sessions of crisis intervention after the surgery at the hospital. The efficacy of the treatment was measured by self-reported questionnaires at baseline and at two follow-up sessions which corroborated a very significant decrease in the severity of depression, hopelessness, while emotional regulation and self-esteem became more adaptive. The remission of the above

  1. Application of the Vienna Classificaton for Crohn's Disease to a Single Clinician Database of 877 Patients

    Directory of Open Access Journals (Sweden)

    Hugh James Freeman

    2001-01-01

    Full Text Available An international working party at the World Congress of Gastroenterology held in Vienna, Austria from September 6 to 11, 1998 defined a classification for Crohn's disease based on patient age at diagnosis (eg, less than 40 years of age, 40 years of age or older, disease location (eg, terminal ileum, colon, ileocolon or upper gastrointestinal tract and behaviour (eg, stricturing, penetrating. Disease location in the upper gastrointestinal tract was defined by disease being present proximal to the terminal ileum, regardless of terminal ileal or colon involvement. A 20-year, single clinician database of 877 patients from a university campus hospital was used, and comprised 492 women (56.1% and 385 men (43.9%. Of these patients, 740 (84.4% were diagnosed before age 40 years and 137 (15.6% were diagnosed by 40 years of age or older. Disease was located in the terminal ileum alone in 222 patients (25.3%, colon alone in 238 patients (27.2% and ileocolon in 304 patients (34.6%. Another 113 patients (13.1% had disease in the upper gastrointestinal tract, usually with disease also in the terminal ileum (23 patients, colon (12 patients or ileocolon (71 patients. Only seven of 877 patients had disease located in the upper gastrointestinal tract alone with no distal disease. Disease behaviour could be classified as nonstricturing and nonpenetrating in 256 patients (29.2%, stricturing in 294 patients (33.6% and penetrating in 327 patients (37.2%. Of the 877 patients with Crohn's disease, 837 were white, 38 were Asian and two were black. In this tertiary care setting of a single clinician practice in a Canadian teaching hospital at the University of British Columbia, Crohn's disease predominantly affects women, and young adults with a high rate of stricturing and penetrating complications.

  2. Fecal zonulin is elevated in Crohn’s disease and in cigarette smokers

    Directory of Open Access Journals (Sweden)

    Karin Malíčková

    2017-12-01

    Full Text Available Objectives: Human zonulin is a protein that increases permeability in the epithelial layer of the small intestine by reversibly modulating the intercellular tight junctions. There is not sufficient information available about zonulin's participation in inflammatory bowel diseases (IBD. The aim of this study was therefore to investigate fecal and serum zonulin in IBD patients and its relation to the disease localization, behavior and smoking status. Design and methods: Forty IBD patients and forty healthy persons were examined for fecal and serum zonulin concentrations by competitive ELISA (DRG International Inc. Values were correlated to IBD type, localization and behavior, and smoking. Results: Serum and fecal zonulin were significantly higher in patients with Crohn’s disease compared to ulcerative colitis (p = 0.038 for fecal zonulin, and p = 0.041 for serum zonulin concentrations. No association of serum or fecal zonulin was found with respect to IBD localization and behavior. The only difference was found with respect to smoking. Both the IBD cohort and healthy smokers showed significantly higher fecal zonulin levels (median 203 ng/mL compared to non-smokers (median 35.8 ng/mL, p < 0.001. Conclusions: Fecal and serum zonulin levels are elevated in patients with active Crohn’s disease but not with ulcerative colitis. High fecal zonulin levels in smokers irrespective of IBD point to the significant and undesirable up-regulation of gut permeability in cigarette smokers. Keywords: Zonulin, Inflammatory bowel disease, Crohn's disease, Ulcerative colitis, Smoking

  3. Diagnostic and therapeutic impact of MR enterography in Crohn's disease

    Energy Technology Data Exchange (ETDEWEB)

    Hafeez, R. [Department of Surgery, University College London Hospitals, NW1 2BU (United Kingdom); Punwani, S. [Centre for Medical Imaging, University College London (United Kingdom); Department of Specialist X-Ray, University College London Hospitals, NW1 2BU (United Kingdom); Boulos, P. [Department of Surgery, University College London Hospitals, NW1 2BU (United Kingdom); Bloom, S.; McCartney, S. [Department of Gastroenterology, University College London Hospitals, NW1 2BU (United Kingdom); Halligan, S. [Centre for Medical Imaging, University College London (United Kingdom); Department of Specialist X-Ray, University College London Hospitals, NW1 2BU (United Kingdom); Taylor, S.A., E-mail: csytaylor@yahoo.co.uk [Centre for Medical Imaging, University College London (United Kingdom); Department of Specialist X-Ray, University College London Hospitals, NW1 2BU (United Kingdom)

    2011-12-15

    Aim: To assess the impact of magnetic resonance enterography (MRE) on clinician diagnostic confidence and therapeutic strategy in patients under investigation for small bowel Crohn's disease. Material and methods: Gastroenterologists completed a proforma before and following MRE in 51 patients (mean age 35 years, 26 female) under investigation for small bowel Crohn's disease, indicating percentage confidence for presence/absence of small bowel involvement. In suspected disease, diagnostic confidence (using a scoring system from 1 = no to 6 = yes) was scored for subcategories: extent >30 cm (DE), terminal ileum (lTI), jejunal (JD), colonic disease (CoD), strictures (ST), activity (AD), extraluminal complications (EL), and surgical need (NS). Therapeutic strategy was recorded. Patients were divided into three groups: 1 = suspected disease, MRE normal (n = 15); 2 = suspected disease, MRE abnormal (n = 30); 3 = no suspected disease, MRE normal (n = 6). Binomial exact and paired t-tests were use to compare confidence pre and post-MRE. Results: Mean percentage confidence for the presence/absence of small bowel disease increased from 62 to 84% (p = 0.003), 87 to 98% (p = 0.0001), and 83 to 98% (p = 0.005) after MRE for groups 1, 2, and 3, respectively. In suspected disease, confidence changed significantly for all of the subcategories (p < 0.001) except EL in group 1. The percentage of patients with a confidence change ranged from 40% (CoD) to 87% (lTI; group 1) and from 7% (EL) to 93% (DE; group 2). Therapeutic strategy changed in 31/51 (61%, 95% CI 47-74%), 14 with a reduction in planned therapy and 17 with an increase. Conclusion: MRE had a positive diagnostic impact in patients under investigation for small bowel Crohn's disease and this influenced therapeutic strategy in 61% of the patients.

  4. A Crohn's disease variant in Atg16l1 enhances its degradation by caspase 3

    Science.gov (United States)

    Murthy, Aditya; Li, Yun; Peng, Ivan; Reichelt, Mike; Katakam, Anand Kumar; Noubade, Rajkumar; Roose-Girma, Merone; Devoss, Jason; Diehl, Lauri; Graham, Robert R.; van Lookeren Campagne, Menno

    2014-02-01

    Crohn's disease is a debilitating inflammatory bowel disease (IBD) that can involve the entire digestive tract. A single-nucleotide polymorphism (SNP) encoding a missense variant in the autophagy gene ATG16L1 (rs2241880, Thr300Ala) is strongly associated with the incidence of Crohn's disease. Numerous studies have demonstrated the effect of ATG16L1 deletion or deficiency; however, the molecular consequences of the Thr300Ala (T300A) variant remains unknown. Here we show that amino acids 296-299 constitute a caspase cleavage motif in ATG16L1 and that the T300A variant (T316A in mice) significantly increases ATG16L1 sensitization to caspase-3-mediated processing. We observed that death-receptor activation or starvation-induced metabolic stress in human and murine macrophages increased degradation of the T300A or T316A variants of ATG16L1, respectively, resulting in diminished autophagy. Knock-in mice harbouring the T316A variant showed defective clearance of the ileal pathogen Yersinia enterocolitica and an elevated inflammatory cytokine response. In turn, deletion of the caspase-3-encoding gene, Casp3, or elimination of the caspase cleavage site by site-directed mutagenesis rescued starvation-induced autophagy and pathogen clearance, respectively. These findings demonstrate that caspase 3 activation in the presence of a common risk allele leads to accelerated degradation of ATG16L1, placing cellular stress, apoptotic stimuli and impaired autophagy in a unified pathway that predisposes to Crohn's disease.

  5. Impact of pretreatment variables on the outcome of {sup 131}I therapy with a standardized dose of 150 Gray in Graves` disease; Einfluss praetherapeutischer Variablen auf die Wirkung einer standardisierten {sup 131}J-Therapie mit 150 Gray beim Morbus Basedow

    Energy Technology Data Exchange (ETDEWEB)

    Pfeilschifter, J. [Heidelberg Univ., Radiologische Klinik (Germany). Abt. fuer Nuklearmedizin; Elser, H. [Medizinische Universitaetsklinik und Poliklinik Heidelberg (Germany). Abt. fuer Innere Medizin I; Haufe, S. [Medizinische Universitaetsklinik und Poliklinik Heidelberg (Germany). Abt. fuer Innere Medizin I; Ziegler, R. [Heidelberg Univ., Radiologische Klinik (Germany). Abt. fuer Nuklearmedizin; Georgi, P. [Medizinische Universitaetsklinik und Poliklinik Heidelberg (Germany). Abt. fuer Innere Medizin I

    1997-04-01

    Aim: We examined the impact of several pretreatment variables on thyroid size and function in 61 patients with Graves` disease one year after a standardized [131]I treatment with 150 Gray. Methods: FT3, FT4, and TSH serum concentrations were determined before and 1.5, 3, 6, and 12 months after therapy. Thyroid size was measured by ultrasound and scintigraphy before and one year after therapy. Results: One year after therapy, 30% of the patients had latent or manifest hyperthyroidism, 24% were euthyroid, and 46% had developed latent or manifest hypothyroidism. Age and initial thyroid volume were major predictors of posttherapeutical thyroid function. Thus, persistent hyperthyroidism was observed in 70% of the patients age 50 years and older with a thyroid size of more than 50 ml. With few exception, thyroid size markedly decreased after therapy. Initial thyroid size and age were also major predictors of posttherapeutical thyroid volume. Thyroid size normalized in all patients younger than 50 years of age, independent from initial thyroid size. Conclusion: Radioiodine treatment with 150 Gray causes a considerable decrease in thyroid size in most patients with Graves` disease. Age and initial thyroid volume are important determinants of thyroid function and size after therapy and should be considered in dose calculation. (orig.) [Deutsch] Ziel: Bei 61 Patienten mit einem Morbus Basedow haben wir den Einfluss praetherapeutischer Variablen auf die Funktion und das Volumen der Schilddruese ein Jahr nach einer {sup 131}J-Therapie mit 150 Gray untersucht. Methoden: FT3, FT4, und TSH wurden vor Therapie und eineinhalb, 3, 6 und 12 Monate nach Therapie gemessen. Das Schilddruesenvolumen wurde vor Therapie und ein Jahr nach Therapie sonographisch und szintigraphisch bestimmt. Ergebnisse: Ein Jahr nach Therapie waren 30% der Patienten latent oder manifest hyperthyreot, 24% euthyreot, und 46% latent oder manifest hypothyreot. Lebensalter und Ausgangsvolumen der Schilddruese

  6. Discontinuation of infliximab therapy in patients with Crohn's disease in sustained complete remission (the STOP IT study)

    DEFF Research Database (Denmark)

    Buhl, Sine Schnoor; Steenholdt, Casper; Brynskov, Jørn

    2014-01-01

    INTRODUCTION: Infliximab (IFX), a monoclonal chimeric antibody against tumour necrosis factor (TNF) α, is effective for induction and maintenance of remission in moderate to severe Crohn's disease. Discontinuation of IFX maintenance therapy in patients in remission should be considered in order......, biochemical and endoscopic remission (ie, Crohn's Disease Activity Index (CDAI) score therapy. The primary end point...... a patient exhibits sustained remission. Study results will be published in an English language scientific medical journal. The study is approved by the Danish Medicines Agency (EudraCT-number: 2012-002702-51) and the Regional Ethics Committee of Region Hovedstaden Denmark (Approval-number: H-4...

  7. Magnitude of Increased Infliximab Clearance Imposed by Anti-infliximab Antibodies in Crohn's Disease Is Determined by Their Concentration

    DEFF Research Database (Denmark)

    Edlund, Helena; Steenholdt, Casper; Ainsworth, Mark A

    2017-01-01

    in IFX clearance imposed by anti-IFX Abs has generally been evaluated using a binary classification, i.e., positive or negative. This analysis aimed to investigate if anti-IFX Ab concentrations provide a more adequate prediction of alterations in clearance. Data originated from a clinical trial on Crohn......'s disease patients with IFX treatment failure. The trial was not originally designed for pharmacokinetic analysis. Therefore, published pharmacokinetic models were utilized as priors to enable covariate investigation. The impact of anti-IFX Abs on clearance was assessed using different mathematical...

  8. Alpha-defensin DEFA1A3 gene copy number elevation in Danish Crohn's disease patients

    DEFF Research Database (Denmark)

    Jespersgaard, Cathrine; Fode, Peder; Dybdahl, Marianne

    2011-01-01

    BACKGROUND AND PURPOSE OF STUDY: Extensive copy number variation is observed for the DEFA1A3 gene encoding alpha-defensins 1-3. The objective of this study was to determine the involvement of alpha-defensins in colonic tissue from Crohn's disease (CD) patients and the possible genetic association...... of DEFA1A3 with CD. METHODS: Two-hundred and forty ethnic Danish CD patients were included in the study. Reverse transcriptase PCR assays determined DEFA1A3 expression in colonic tissue from a subset of patients. Immunohistochemical analysis identified alpha-defensin peptides in colonic tissue. Copy...

  9. Medical risk factors for small-bowel adenocarcinoma with focus on Crohn's disease

    DEFF Research Database (Denmark)

    Kærlev, Linda; Teglbjaerg, P.S.; Sabroe, Svend

    2001-01-01

    the 3-year period preceding the SBA diagnosis. Previous gallstone surgery, which may be a sign of severe gallstone disease, was not associated with SBA. Liver cirrhosis, hepatitis or medical treatments with radioactive substances or corticosteroid tablets were not associated with this disease. Cases...... with SBA had an increased prevalence of anaemia; OR 15.3 (2.5-92.1). An association between low educational level and SBA was found; OR 1.75 (1.0-3.0). CONCLUSION: This study supports Crohn disease and coeliac disease being strong but rare risk factors for SBA. Previous gallstones were unrelated to SBA...

  10. Crohn's disease complicated by Epstein-Barr virus-driven haemophagocytic lymphohistiocytosis successfully treated with rituximab.

    Science.gov (United States)

    Thompson, Grace; Pepperell, Dominic; Lawrence, Ian; McGettigan, Benjamin David

    2017-02-22

    We report a case of Epstein-Barr virus (EBV)-driven haemophagocytic lymphohistiocytosis (HLH) in a man with Crohn's disease treated with 6-mercaptopurine and adalimumab therapy who was successfully treated with rituximab therapy alone. This is the first published case in an adult patient with EBV-driven HLH in the setting of thiopurine use and inflammatory bowel disease to be successfully treated with rituximab therapy alone. Here, we will discuss putative immunological mechanisms which may contribute to this potentially life-threatening complication. 2017 BMJ Publishing Group Ltd.

  11. Quantifying the inflammatory activity in Crohn's disease using CE dynamic MRI

    International Nuclear Information System (INIS)

    Pauls, S.; Schmidt, S.A.; Brambs, H.J.; Gabelmann, A.; Kratzer, W.; Mittrach, C.; Adler, G.; Rieber, A.

    2003-01-01

    Purpose: Evaluation of dynamic contrast enhanced MRI in patients with Crohn's disease to assess local inflammatory activity. Material and Methods: Prospective study of 13 patients with histologically proven Crohn's disease. Axial and coronal slices were acquired by a 1.5 T MR (Magnetom Vision, Siemens, Germany): T1 flash 2 D (TR 72.5 ms, TE 4.1 ms), T2 (TR 2730 ms, TE 138 ms), turbo-flash sequences T1 (TR 94.2 ms, TE 4.1 ms) post contrast media fat saturated (Magnevist circledR , 0.2 ml/kg, flow 4 ml/s). In area of maximal thickening of terminal ileal wall, axial dynamic T1 sequences (TR 11 ms, TE 4.2 ms) were acquired every 1.5 s post contrast media application for a total duration of 1 min. Contrast uptake was subjectively measured by semiquantitative score and computed assisted ROI evaluation. MR parameters were correlated with CDAI (Crohn's disease activity index) and SAI (severe activity index). Results: Contrast uptake in the intestinal wall occurred after 18.5 s (range: 3.0-28.0), contrast upslope until plateau phase lasted for 16.1 s (range: 8.0-50.0). Maximum contrast enhancement into the bowel wall was 266% (105-450%) of baseline. After maximum contrast uptake, we observed a plateau phase in all cases for the total duration of measurement. A significant correlation existed for maximum contrast uptake to CDAI (r = 0.591; p = 0.033), for beginning of contrast upslope to the time until plateau phase (r = 0.822; p = 0.001), and for the time until plateau phase to CDAI (r = 0.562; p = 0.046). CDAI was on average 108, median 106; SAI was on average 114, median 115. SAI correlated significantly to CDAI (r = 0.874). Maximum contrast uptake, beginning of contrast upslope, and time until plateau phase were independent to creeping fat, local lymphadenitis, laboratory parameters, temperature, body mass index, heart frequency and systolic blood pressure. Conclusion: Dynamic MRI enables to quantify local inflammatory activity of bowel wall in patients with Crohn

  12. Timing of ileocolonic resection for symptomatic Crohn's disease--the patient's view.

    OpenAIRE

    Scott, N A; Hughes, L E

    1994-01-01

    Eighty patients were asked if they would have preferred their ileocolonic resection and anastomosis for Crohn's disease, to have been carried out sooner, later or at the same time as it was done. Seventy of the patients replied (88%). No patient would have preferred their operation to have been later, while 74% thought it should have been earlier. A preferred operation time was given for 69 resections, between 0 months--that is, at the same time--and 15 years earlier. The median preferred ope...

  13. Two distinct metacommunities characterize the gut microbiota in Crohn's disease patients

    DEFF Research Database (Denmark)

    He, Qing; Gao, Yuan; Jie, Zhuye

    2017-01-01

    The inflammatory intestinal disorder Crohn's disease (CD) has become a health challenge worldwide. The gut microbiota closely interacts with the host immune system, but its functional impact in CD is unclear. Except for studies on a small number of CD patients, analyses of the gut microbiota in CD......). Based on signature taxa, CD microbiotas clustered into two distinct metacommunities indicating individual variability in CD microbiome structure. Metacommunity-specific functional shifts in CD showed enrichment in producers of the pro-inflammatory hexa-acylated lipopolysaccharide variant and a reduction...

  14. 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......, the AIEC-prototype strain LF82 was evaluated for its ability to adhere to ileal and colonic biopsies from CD and healthy controls (HC). Moreover, the efficacy of the non-pathogenic E. coli Nissle 1917 (ECN) in averting LF82 adhesion to ileal mucosa was assessed. Similar numbers of LF82 adhered to biopsies...

  15. Stricturoplasty-a bowel-sparing option for long segment small bowel Crohn's disease.

    Science.gov (United States)

    Limmer, Alexandra M; Koh, Hoey C; Gilmore, Andrew

    2017-08-01

    Stricturoplasty is a surgical option for management of severe stricturing Crohn's disease of the small bowel. It avoids the need for small bowel resection and the associated metabolic complications. This report contrasts the indications and technical aspects of two different stricturoplasty techniques. Case 1 describes an extensive Michelassi (side-to-side isoperistaltic) stricturoplasty performed for a 100 cm segment of diseased small bowel in a 45-year-old patient. Case 2 describes the performance of 12 Heineke-Mikulicz stricturoplasties in a 23-year-old patient with multiple short fibrotic strictures.

  16. Challenging Ulcerative Vulvar Conditions: Hidradenitis Suppurativa, Crohn Disease, and Aphthous Ulcers.

    Science.gov (United States)

    Stewart, Kristen M A

    2017-09-01

    This article discusses the clinical evaluation and approach to patients with 3 complex ulcerative vulvar conditions: hidradenitis suppurativa, metastatic Crohn disease of the vulva, and aphthous ulcers. These conditions are particularly challenging to medical providers because, although each is known to present with nonspecific examination findings that vary in morphology, the predominance of the diagnosis is based on clinical examination and exclusion of a wide variety of other conditions. Care of patients with these conditions is further complicated by the lack of therapeutic data and the significant impact these conditions have on quality of life. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Medical Therapies for Stricturing Crohn's Disease: Efficacy and Cross-Sectional Imaging Predictors of Therapeutic Failure.

    Science.gov (United States)

    Campos, Cécile; Perrey, Antoine; Lambert, Céline; Pereira, Bruno; Goutte, Marion; Dubois, Anne; Goutorbe, Felix; Dapoigny, Michel; Bommelaer, Gilles; Hordonneau, Constance; Buisson, Anthony

    2017-06-01

    Medical therapy efficacy remains controversial in stricturing Crohn's disease. Cross-sectional imaging, especially magnetic resonance imaging, has been suggested as very helpful to guide therapeutic decision making. To assess efficacy and predictors of therapeutic failure in patients receiving medical treatments for stricturing Crohn's disease. In this retrospective study, therapeutic failure was defined as symptomatic stricture leading to surgical or endoscopic therapeutics, hospitalization, treatment discontinuation or additional therapy and short-term clinical response as clinical improvement assessed by two physicians. The 55 cross-sectional imaging examinations (33 magnetic resonance imaging and 22 CT scan) before starting medical therapy were analyzed independently by two radiologists. Results were expressed as hazard ratio (HR) or odds ratio (OR) with 95% confidence intervals (95% CI). Among 84 patients, therapeutic failure rate within 60 months was 66.6%. In multivariate analysis, Crohn's disease diagnosis after 40 years old (HR 3.9, 95% CI [1.37-11.2], p = 0.011), small stricture luminal diameter (HR 1.34, 95% CI [1.01-1.80], p = 0.046), increased stricture wall thickness (HR 1.23, 95% CI [1.04-1.46], p = 0.013) and fistula with abscess (HR 5.63, 95% CI [1.64-19.35], p = 0.006) were associated with therapeutic failure, while anti-TNF combotherapy (HR 0.17, 95% CI [0.40-0.71], p = 0.015) prevented it. Considering 108 therapeutic sequences, the short-term clinical response rate was 65.7%. In multivariate analysis, male gender (OR 0.15, 95% CI [0.03-0.64], p = 0.011), fistula with abscess (OR 0.09, 95% CI [0.01-0.77], p = 0.028) and comb sign (OR 0.23, 95% CI [0.005-0.97], p = 0.047) were associated with short-term clinical failure. Anti-TNF combotherapy seemed to prevent therapeutic failure, and cross-sectional imaging should be systematically performed to help medical management in stricturing Crohn's disease.

  18. Concanavalin A-binding cholesterol crystallization inhibiting and promoting activity in bile from patients with Crohn's disease compared to patients with ulcerative colitis.

    Science.gov (United States)

    Keulemans, Y C; Mok, K S; Slors, J F; Brink, M A; Gouma, D J; Tytgat, G N; Groen, A K

    1999-10-01

    Crohn's disease is a risk factor for gallstone formation. In contrast, patients with ulcerative colitis have an incidence of gallstone formation comparable to the general population. The reason for this difference is not known. The aim of this study was to elucidate the factors controlling cholesterol crystallization in gallbladder bile of Crohn's disease and ulcerative colitis patients. Gallbladder bile was obtained by aspiration during bowel resections (26 Crohn's disease patients, 20 ulcerative colitis patients). Biliary lipid composition, crystal detection time and the effect of extraction of the concanavalin A-binding fraction on crystal formation were determined. Cholesterol crystals were present in seven of the 26 bile samples of Crohn's disease-patients and one of the 20 ulcerative colitis patients. Four of the bile samples of Crohn's disease patients were fast nucleating. None of the 20 ulcerative colitis patients had fast nucleating bile. Lipid composition, total lipid concentration and CSI were not significantly different between the two groups. In Crohn's disease patients extraction of concanavalin A-binding fraction decreased crystallization in 10 bile samples but accelerated crystallization in one bile sample. In eight bile samples from ulcerative colitis patients crystallization increased after concanavalin A-binding fraction extraction. Compared to ulcerative colitis patients, gallbladder bile of Crohn's disease patients showed increased cholesterol crystallization despite comparable lipid composition and cholesterol saturation index. This difference is caused by increased cholesterol crystallization-promoting activity. Bile from ulcerative colitis patients contains a Con A-binding factor which inhibits cholesterol crystallization.

  19. Continuous elemental enteral alimentation in the treatment of children and adolescents with Crohn's disease.

    Science.gov (United States)

    Morin, C L; Roulet, M; Roy, C C; Weber, A; Lapointe, N

    1982-01-01

    Ten pediatric patients, aged 8.5-19 years, with active symptomatic Crohn's disease, received a three-week period of continuous elemental enteral alimentation with no other form of treatment. All patients in this study were selected according to the following criteria, which were applied consecutively: (1) newly diagnosed patients with no previous treatment for Crohn's disease, (2) disease activity index over 200, and (3) no complication requiring surgery. All patients experienced a clinical remission and improved their immunologic and nutritional status during the elemental enteral alimentation. The mean disease activity index for the whole group was 307.0 +/- 23.6 (range: 203 to 413) before and 69.2 +/- 11.4 (range: 15 to 114) after the feeding period. Significant increases in body weight, triceps skinfold, mid-arm circumference, serum transferrin and mean percentage of T lymphocytes were also observed. Following cessation of enteral alimentation, a small declining dose of prednisone was used during a one-year follow-up period. Eight of the ten patients were still in clinical remission three months after the feeding period and their nutritional status had continued to improve during that period of time.

  20. Continuous elemental enteral alimentation in children with Crohn's disease and growth failure.

    Science.gov (United States)

    Morin, C L; Roulet, M; Roy, C C; Weber, A

    1980-12-01

    Four children aged (11.7-13.5 yr) with protracted growth retardation related to Crohn's disease, received a 6-wk period of continuous elemental enteral alimentation with no other form of treatment. Despite drug therapy the yearly height and weight gain velocities of these children (1.7 +/- 0.3 cm and -0.8 +/- 1.4 kg, respectively) had been abnormal during the previous 2 yr. All patients experienced a complete remission of symptoms, improved nutritional status, and significant height (1.8 +/- 0.3 cm) and weight (3.8 +/- 0.5 kg) gains during the 67 wk of treatment. After cessation of elemental enteral alimentation, 3 of the 4 patients continued to grow, and over a period of 4.5 mo from the beginning of this form of nutritional therapy, they gained an average of 5.0 +/- 1.6 kg and 3.5 +/- 0.3 cm. The disease became active thereafter, and the 3 children resumed their previously abnormal growth patterns during the ensuing year. The 4th patient had surgery 2 mo after elemental enteral alimentation and experienced a subsequent second spurt of growth and pubertal changes. This study suggests that a relatively short course of elemental enteral alimentation leads to a temporary resumption of growth in children with severe growth failure and Crohn's disease. The possibility that repeated courses of elemental enteral alimentation might be beneficial needs to be explored.

  1. Reversal of growth arrest in adolescents with Crohn's disease after parenteral alimentation.

    Science.gov (United States)

    Layden, T; Rosenberg, F; Nemchausky, G; Elson, C; Rosenberg, I

    1976-06-01

    Growth arrest and delayed onset of puberty often complicate childhood onset Crohn's disease of the small bowel (granulomatous enteritis). Nutritional deficits arising from inadequate dietary intake, malabsorption, and increased caloric needs may contribute to growth retardation. To assess whether a sustained high caloric and nitrogen intake could reestablish growth, 4 children with extensive Crohn's disease of the small bowel were studied before and after parenteral alimentation which was instituted for symtomatic disease control. Weight gain, positive nitrogen balance, and improved nutritional status were achieved during parenteral alimentation in each patient. In 2 patients weight gain was sustained using oral nutritional supplements, and a substantial increase in linear skeletal growth continued in the ensuing months. One patient entered puberty within 4 months of parenteral alimentation and another had the onset of menarche and the development of secondary sex characteristics 4 months after parenteral alimentation and resection of diseased bowel. Growth may be reestablished in some growth-arrested children if intake is sufficient to establish a sustained positive caloric and nitrogen balance. Nutritional requirements imposed by the demands of growth and active disease and often compounded by the catabolic effects of corticosteroids may be excessive; growth may occur only if these needs are met orally and/or parenterally.

  2. High-output stoma after small-bowel resections for Crohn's disease.

    Science.gov (United States)

    Tsao, Stephen K K; Baker, Melanie; Nightingale, Jeremy M D

    2005-12-01

    A 56-year-old Caucasian woman with a history of Crohn's disease and multiple bowel resections resulting in a loop jejunostomy was referred to our Nutritional Unit from a neighboring district general hospital for further management. She was first seen in October 2001, and initial assessment indicated that she was malnourished with fluid depletion, evidenced by the high volume of stomal fluid produced. There had been no sudden change in her medication, her Crohn's disease was quiescent and there was no evidence of any intra-abdominal sepsis. Despite a high calorific intake through her diet, she continued to lose weight. Serum urea and electrolytes; magnesium; C-reactive protein; full blood count; urinary spot sodium; anthropometric measurements. High-output stoma with malabsorption as a consequence of repeated small-bowel surgery. The patient was treated with oral hypotonic fluid restriction (0.5 l/day), 2 l of oral glucose-saline solution per day, high-dose oral antimotility agents (loperamide and codeine phosphate), a proton-pump inhibitor (omeprazole) and oral magnesium replacement. A year later, the patient's loop jejunostomy was closed and an end ileostomy fashioned, bringing an additional 35 cm of small bowel into continuity; macronutrient absorption improved but her problem of dehydration was only slightly reduced. She was stabilized on a twice-weekly subcutaneous magnesium and saline infusion and daily oral 1alpha-hydroxycholecalciferol.

  3. Histoplasma meets Crohn's disease: a rare case of new-onset ascites.

    Science.gov (United States)

    Bosshardt, Charles Robert; Gnann, John; Lodhia, Nilesh

    2018-04-17

    A 53-year-old man with Crohn's disease treated with adalimumab was hospitalised with abdominal pain, fatigue, fever and chills. CT scan of the abdomen showed chronic thickening of the terminal ileum and cecum and new-onset ascites. Further studies revealed weakly positive urine and serum histoplasma antigen. Laparoscopy revealed metastatic caking of the omentum and abdominal wall; peritoneal biopsy demonstrated organisms morphologically consistent with Histoplasma capsulatum No dissemination outside of the peritoneal cavity was evident. The patient completed 2 weeks of liposomal amphotericin B followed by oral itraconazole for 1 year. Adalimumab therapy was held for 10 weeks, then restarted. Presenting symptoms resolved following initiation of antifungal therapy. Follow-up MRI of his abdomen demonstrated resolution of ascites. To our knowledge, this is the first reported case of histoplasmosis presenting as peritonitis in a patient with Crohn's disease receiving antitumour necrosis factor-alpha (TNF-α) therapy. Many clinicians are aware that patients receiving anti-TNF-α therapy are at increased risk for histoplasmosis, but may fail to consider the diagnosis in the absence of lung involvement. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  4. Intestinal Behçet and Crohn's disease: two sides of the same coin.

    Science.gov (United States)

    Valenti, Simona; Gallizzi, Romina; De Vivo, Dominique; Romano, Claudio

    2017-04-20

    Behçet's disease (BD) and Crohn's disease (CD) are chronic immune-mediated, inflammatory disorders affecting many different systems (joints, skin, eyes, gastrointestinal and biliary tracts). Both disorders have fluctuating courses and when gastrointestinal symptoms are prevalent, differential diagnosis can be difficult. BD involves the gastrointestinal tract in 10-15% of cases with localized lesions in the ileocecal region. The clinical picture is heterogeneous with various clusters of disease expression. CD is a chronic inflammatory disorder, which can affect any part of the intestinal tract, as well as extra-intestinal tissue. Factors that contribute towards the pathogenesis of both disease include the host's genetic profile, and immune system, and environmental factors such as the gut microbiota. The aim of this manuscript is to provide a narrative review of clinical features of BD and CD, highlighting the importance of differential diagnosis and therapeutic approach, especially in the presence of gastrointestinal involvement. A comprehensive search of published literature using the Pubmed ( http://www.ncbi.nlm.nih.gov/pubmed/ ) database was carried out to identify all articles published in English from 1999 to October 2016, using 4 key terms: "Behçet Disease", "Intestinal Behçet's Disease", "Crohn's Disease" and" Inflammatory Bowel Disease".

  5. A changing trend in the management of patients with newly diagnosed Crohn's disease.

    LENUS (Irish Health Repository)

    Qasim, A

    2012-02-01

    BACKGROUND: Epidemiologic shift with rising incidence of Crohn\\'s disease (CD) has been reported in recent studies. AIMS: To determine disease behaviour and therapeutic interventions undertaken in newly diagnosed patients with CD. METHODS: Patients diagnosed with CD between January 2006 and June 2008 were included. Disease type, location, degree of involvement and type of therapeutic interventions were recorded. RESULTS: A total of 78 patients were included. Colonic, ileo-colonic, terminal ileal and isolated small bowel disease were present in 37, 27, 9 and 5 patients, respectively. Disease phenotype was inflammatory, stenosing and fistulising in 42, 30 and 6 patients, respectively. Surgery was required in 22 patients, including right hemicolectomy (n = 8), subtotal colectomy (n = 4), segmental colonic resection (n = 2), segmental small bowel resection (n = 2), appendectomy (n = 2) and perianal surgery (n = 4). Fourteen patients underwent surgery at the time of diagnosis. Laparoscopic surgery was performed in 14 patients. CONCLUSIONS: A significant proportion of newly diagnosed patients with CD underwent surgical intervention on their first admission to hospital. This may signify a changing trend in the management approach.

  6. Contrast-enhanced ultrasonography for the determination of Crohn's disease activity - preliminary experience.

    Science.gov (United States)

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

    2014-01-01

    Contrast-enhanced ultrasound (CEUS) is a recent non-invasive modality, which may partially replace currently used techniques (endoscopy, CT enterography and MR enterography) in the diagnostics and assessment of Crohn's disease (CD). The aim of the study was to analyze early experience in the use of CEUS for the measurement of activity and staging of CD. Eleven patients previously diagnosed with CD were included in the study. They underwent contrast-enhanced ultrasonography (SonoVue, Bracco), low-dose CT enterography (LDCTE), assessment of laboratory markers of inflammation and clinical CD activity index (CDAI). Contrast enhancement was evaluated using a semi-quantitative method and a quantitative method that included measurement of peak enhancement (PE), enhancement curve rise time (RT) and wash-in-rate (WiR). Ileal wall thickening was observed in all patients. Semi-quantitative method was used to observe CD activity in CEUS in 10 cases that perfectly matched LDCTE findings. There was a moderate positive correlation between PE and CDAI (r=0.65, p<0.001). There was no significant relationship between perfusion parameters and laboratory markers of inflammation. CEUS is a promising modality for non-invasive assessment of pathologic ileal vascularization in the course of Crohn's disease. Intensity of enhancement in CEUS reflects activity of the disease detected in LDCTE and correlates with CDAI.

  7. Pathogenic aspects and therapeutic avenues of intestinal fibrosis in Crohn's disease.

    Science.gov (United States)

    Zorzi, Francesca; Calabrese, Emma; Monteleone, Giovanni

    2015-12-01

    In Crohn's disease, one of the two major forms of inflammatory bowel diseases in human beings, persistent and chronic inflammation promotes fibrotic processes thereby facilitating formation of strictures, the most common indication for surgical intervention in this disorder. The pathogenesis of Crohn's disease-associated fibrosis is not fully understood, but variants of genes involved in the recognition of microbial components/products [e.g. CARD15 (caspase-activating recruitment domain 15) and ATG16L1 (autophagy-related 16-like 1)] are associated with this phenotype, and experimental evidence suggests that intestinal fibrosis results from an altered balance between deposition of ECM (extracellular matrix) and degradation of ECM by proteases. Studies have also contributed to identify the main phenotypic and functional alterations of cells involved in the fibrogenic process, as well as molecules that stimulate such cells to produce elevated amounts of collagen and other ECM-related proteins. In the present review, we assess the current knowledge about cellular and molecular mediators of intestinal fibrosis and describe results of recent studies aimed at testing the preventive/therapeutic effect of compounds in experimental models of intestinal fibrosis. © 2015 Authors; published by Portland Press Limited.

  8. Assessing pediatric ileocolonic Crohn's disease activity based on global MR enterography scores

    Energy Technology Data Exchange (ETDEWEB)

    Pomerri, Fabio; Zuliani, Monica; Giorgi, Benedetta; Muzzio, Pier Carlo [University of Padova, Department of Medicine-DIMED, Padova (Italy); Al Bunni, Faise [Rovigo Hospital, Radiology Unit, S. Maria della Misericordia, Rovigo (Italy); Guariso, Graziella; Gasparetto, Marco; Cananzi, Mara [University of Padova, Department of Women and Child Health, Padova (Italy)

    2017-03-15

    This study was aimed at correlating a magnetic resonance index of activity (MaRIA) and a magnetic resonance enterography global score (MEGS) with activity indexes in a paediatric population with Crohn's disease (CD). This retrospective study included 32 paediatric patients (median age 14.5 years, 18 male) with proven CD who underwent magnetic resonance enterography (MRE). A correlation analysis was performed on the MRE-based scores, the simplified endoscopic score for CD (SES-CD), the paediatric Crohn's disease activity index (PCDAI), and C-reactive protein (CRP) levels. Based on PCDAI, comparison of both global MaRIA and MEGS was made between patients with mild and moderate/severe disease activity. Global MaRIA correlated with SES-CD (r = 0.70, p = 0.001) and PCDAI (r = 0.42, p = 0.016). MEGS correlated with PCDAI (r = 0.46, p = 0.007) and CRP levels (r = 0.35, p = 0.046). MEGS differed significantly (p = 0.027) between patients grouped by clinical disease severity. MRE-based global scores correlated with clinical indexes of CD activity. Therefore, they represent a potential useful tool to predict CD activity and severity, as well as a possible promising alternative to endoscopy, to monitor paediatric patients with CD during their follow-up. (orig.)

  9. The effect of elemental diet on intestinal permeability and inflammation in Crohn's disease

    International Nuclear Information System (INIS)

    Teahon, K.; Smethurst, P.; Pearson, M.; Levi, A.J.; Bjarnason, I.

    1991-01-01

    This study examines whether treatment of acute Crohn's disease with an elemental diet improves intestinal integrity and inflammation as assessed by a 51Cr-labeled ethylenediaminetetraacetatic acid (EDTA) permeability test and the fecal excretion of 111In-labeled autologous leukocytes, respectively. Thirty-four patients with active Crohn's disease completed a 4-week treatment course with an elemental diet. Active disease was characterized by increased intestinal permeability [24-hour urine excretion of orally administered 51Cr-EDTA, 6.4% ± 0.6% (mean ± SE); normal, less than 3.0%] and by high fecal excretion of 111In-labeled leukocytes (14.2% ± 1.1%; normal, less than 1.0%). Twenty-seven (80%) went into clinical remission, usually within a week of starting treatment. After 4 weeks of treatment, there was a significant decrease in both the urine excretion of 51Cr-EDTA (to 3.4% ± 0.5%; P less than 0.01) and the fecal excretion of 111In (to 5.7% ± 1.0%; P less than 0.001), indicating that such treatment is not just symptomatic. A framework for the mechanism by which elemental diet works, centering around the importance of the integrity of the intestinal barrier function, is proposed, and also appears to provide a logical explanation for some relapses of the disease

  10. Molecular reclassification of Crohn's disease: a cautionary note on population stratification.

    Directory of Open Access Journals (Sweden)

    Bärbel Maus

    Full Text Available Complex human diseases commonly differ in their phenotypic characteristics, e.g., Crohn's disease (CD patients are heterogeneous with regard to disease location and disease extent. The genetic susceptibility to Crohn's disease is widely acknowledged and has been demonstrated by identification of over 100 CD associated genetic loci. However, relating CD subphenotypes to disease susceptible loci has proven to be a difficult task. In this paper we discuss the use of cluster analysis on genetic markers to identify genetic-based subgroups while taking into account possible confounding by population stratification. We show that it is highly relevant to consider the confounding nature of population stratification in order to avoid that detected clusters are strongly related to population groups instead of disease-specific groups. Therefore, we explain the use of principal components to correct for population stratification while clustering affected individuals into genetic-based subgroups. The principal components are obtained using 30 ancestry informative markers (AIM, and the first two PCs are determined to discriminate between continental origins of the affected individuals. Genotypes on 51 CD associated single nucleotide polymorphisms (SNPs are used to perform latent class analysis, hierarchical and Partitioning Around Medoids (PAM cluster analysis within a sample of affected individuals with and without the use of principal components to adjust for population stratification. It is seen that without correction for population stratification clusters seem to be influenced by population stratification while with correction clusters are unrelated to continental origin of individuals.

  11. Molecular reclassification of Crohn's disease: a cautionary note on population stratification.

    Science.gov (United States)

    Maus, Bärbel; Jung, Camille; Mahachie John, Jestinah M; Hugot, Jean-Pierre; Génin, Emmanuelle; Van Steen, Kristel

    2013-01-01

    Complex human diseases commonly differ in their phenotypic characteristics, e.g., Crohn's disease (CD) patients are heterogeneous with regard to disease location and disease extent. The genetic susceptibility to Crohn's disease is widely acknowledged and has been demonstrated by identification of over 100 CD associated genetic loci. However, relating CD subphenotypes to disease susceptible loci has proven to be a difficult task. In this paper we discuss the use of cluster analysis on genetic markers to identify genetic-based subgroups while taking into account possible confounding by population stratification. We show that it is highly relevant to consider the confounding nature of population stratification in order to avoid that detected clusters are strongly related to population groups instead of disease-specific groups. Therefore, we explain the use of principal components to correct for population stratification while clustering affected individuals into genetic-based subgroups. The principal components are obtained using 30 ancestry informative markers (AIM), and the first two PCs are determined to discriminate between continental origins of the affected individuals. Genotypes on 51 CD associated single nucleotide polymorphisms (SNPs) are used to perform latent class analysis, hierarchical and Partitioning Around Medoids (PAM) cluster analysis within a sample of affected individuals with and without the use of principal components to adjust for population stratification. It is seen that without correction for population stratification clusters seem to be influenced by population stratification while with correction clusters are unrelated to continental origin of individuals.

  12. [Cutaneous involvement in chronic inflammatory bowel disease : Crohn's disease and ulcerative colitis].

    Science.gov (United States)

    Richter, L; Rappersberger, K

    2016-12-01

    Over recent decades, both the incidence and prevalence of chronic inflammatory bowel disease have continued to rise in industrialized countries; the disease is frequently associated with extracutaneous involvement and comorbidity. The purpose of this work was to investigate the frequency and specificity of mucocutaneous manifestations in Crohn's disease (CD) and ulcerative colitis (UC). An extensive search in peer-reviewed journals via PubMed was performed; presented is a summary and analysis of various studies and data, including data of patients treated at our department. CD and UC are frequently associated with mucocutaneous symptoms; however, primary/specific disease-associations are exclusively seen in CD patients. These include peri-anal and -stomal fistulas and ulcerations, "metastatic" Crohn's disease as well as oral granulomatous disease. Moreover, in both CD and UC, there occur several other inflammatory skin conditions such as erythema nodosum, pyoderma gangrenosum, hidradenitis suppurativa, chronic oral aphthous disease, Sweet syndrome, pyostomatitis vegetans, and bowel-associated dermatosis-arthritis syndrome. Malnutrition syndromes (zinc and vitamin deficiencies) are only rarely observed. On skin and oral/genital mucous membranes various different inflammatory manifestations may be observed during the course of CD or UC. However, most data about a direct pathogenic relationship of the gastrointestinal and dermatologic disorders are quite heterogeneous or even contradictory. Nevertheless, knowledge of these conditions and their possible association with CD and UC could be crucial for early diagnosis and initiation of an appropriate therapy and thus be essential to prevent secondary tissue damage.

  13. Fecal zonulin is elevated in Crohn's disease and in cigarette smokers.

    Science.gov (United States)

    Malíčková, Karin; Francová, Irena; Lukáš, Milan; Kolář, Martin; Králíková, Eva; Bortlík, Martin; Ďuricová, Dana; Štěpánková, Lenka; Zvolská, Kamila; Pánková, Alexandra; Zima, Tomáš

    2017-12-01

    Human zonulin is a protein that increases permeability in the epithelial layer of the small intestine by reversibly modulating the intercellular tight junctions. There is not sufficient information available about zonulin's participation in inflammatory bowel diseases (IBD). The aim of this study was therefore to investigate fecal and serum zonulin in IBD patients and its relation to the disease localization, behavior and smoking status. Forty IBD patients and forty healthy persons were examined for fecal and serum zonulin concentrations by competitive ELISA (DRG International Inc). Values were correlated to IBD type, localization and behavior, and smoking. Serum and fecal zonulin were significantly higher in patients with Crohn's disease compared to ulcerative colitis (p = 0.038 for fecal zonulin, and p = 0.041 for serum zonulin concentrations). No association of serum or fecal zonulin was found with respect to IBD localization and behavior. The only difference was found with respect to smoking. Both the IBD cohort and healthy smokers showed significantly higher fecal zonulin levels (median 203 ng/mL) compared to non-smokers (median 35.8 ng/mL), p zonulin levels are elevated in patients with active Crohn's disease but not with ulcerative colitis. High fecal zonulin levels in smokers irrespective of IBD point to the significant and undesirable up-regulation of gut permeability in cigarette smokers.

  14. Comparison of remicade to curcumin for the treatment of Crohn's disease: A systematic review.

    Science.gov (United States)

    Schneider, Allaire; Hossain, Ivy; VanderMolen, Julia; Nicol, Kara

    2017-08-01

    The aim of this study was to review the literature to assess if there is evidence to support the use of Curcumin as a safe complementary therapy in treating Crohn's Disease (CD) in conjunction with Remicade. Systematic searches were performed by three researchers using electronic databases (ProQuest Medical Library, CINAHL Complete, and PUBMED) to locate and identify articles to meet a predetermined set of inclusion criteria. Specifically full text, peer-reviewed articles published after 2007 were included if they studied human participants 18 years or older. Tumor necrosis factor-alpha (TNF-a) and Interleukin-1 (IL-1) levels increase in CD patients. Remicade reduces TNF-a in adults with CD. The issues are eventual loss of response (LOR) once IL-1 increases, and severe risks such as malignancy. CD patients using Curcumin saw a 55 point mean reduction in the Crohn's Disease Activity Index, reducing IL-1 and Crp. Plus it reduced TNF-a and PPMTase which improved colorectal cancer outcomes. LOR of Remicade occurs when IL-1 increases, and it can cause malignancy. Research shows Curcumin reduces IL-1 and improves cancer outcomes. Future research, using both Remicade and Curcumin, would have to be done, but preliminary data would suggest using both would reduce LOR. Curcumin, even by itself, was found to be a cheap and safe way to reduce CD symptoms and inflammatory markers. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Preoperative Nutritional Optimization for Crohn's Disease Patients Can Improve Surgical Outcome.

    Science.gov (United States)

    Dreznik, Yael; Horesh, Nir; Gutman, Mordechai; Gravetz, Aviad; Amiel, Imri; Jacobi, Harel; Zmora, Oded; Rosin, Danny

    2017-11-01

    Preoperative preparation of patients with Crohn's disease is challenging and there are no specific guidelines regarding nutritional support. The aim of this study was to assess whether preoperative nutritional support influenced the postoperative outcome. A retrospective, cohort study including all Crohn's disease patients who underwent abdominal surgery between 2008 and 2014 was conducted. Patients' characteristics and clinical and surgical data were recorded and analyzed. Eighty-seven patients were included in the study. Thirty-seven patients (42.5%) received preoperative nutritional support (mean albumin level 3.14 vs. 3.5 mg/dL in the non-optimized group; p nutritional status prior to surgery. Preoperative albumin level, after adequate nutritional preparation, was similar between the 2 groups. The 2 groups differ neither in demographic and surgical data, overall post-op complication (p = 0.85), Clavien-Dindo score (p = 0.42), and length of stay (p = 0.1). Readmission rate was higher in the non-optimized group (p = 0.047). Nutritional support can minimize postoperative complications in patients with low albumin levels. Nutritional status should be optimized in order to avoid hazardous complications. © 2017 S. Karger AG, Basel.

  16. Ultrasound and MRI predictors of surgical bowel resection in pediatric Crohn disease

    International Nuclear Information System (INIS)

    Rosenbaum, Daniel G.; Conrad, Maire A.; Kelsen, Judith R.; Biko, David M.; Anupindi, Sudha A.; Ruchelli, Eduardo D.

    2017-01-01

    Imaging predictors for surgery in children with Crohn disease are lacking. To identify imaging features of the terminal ileum on short-interval bowel ultrasound (US) and MR enterography (MRE) in children with Crohn disease requiring surgical bowel resection and those managed by medical therapy alone. This retrospective study evaluated patients 18 years and younger with Crohn disease undergoing short-interval bowel US and MRE (within 2 months of one another), as well as subsequent ileocecectomy or endoscopy within 3 months of imaging. Appearance of the terminal ileum on both modalities was compared between surgical patients and those managed with medical therapy, with the following parameters assessed: bowel wall thickness, mural stratification, vascularity, fibrofatty proliferation, abscess, fistula and stricture on bowel US; bowel wall thickness, T2 ratio, enhancement pattern, mesenteric edema, fibrofatty proliferation, abscess, fistula and stricture on MRE. A two-sided t-test was used to compare means, a Mann-Whitney U analysis was used for non-parametric parameter scores, and a chi-square or two-sided Fisher exact test compared categorical variables. Imaging findings in surgical patients were correlated with location-matched histopathological scores of inflammation and fibrosis using a scoring system adapted from the Simple Endoscopic Score for Crohn Disease, and a Spearman rank correlation coefficient was used to compare inflammation and fibrosis on histopathology. Twenty-two surgical patients (mean age: 16.5 years; male/female: 13/9) and 20 nonsurgical patients (mean age: 14.8; M/F: 8/12) were included in the final analysis. On US, the surgical group demonstrated significantly increased mean bowel wall thickness (6.1 mm vs. 4.7 mm for the nonsurgical group; P = 0.01), loss of mural stratification (odds ratio [OR] = 6.3; 95% confidence interval [CI]: 1.4-28.4; P = 0.02) and increased fibrofatty proliferation (P = 0.04). On MRE, the surgical group showed

  17. Ultrasound and MRI predictors of surgical bowel resection in pediatric Crohn disease

    Energy Technology Data Exchange (ETDEWEB)

    Rosenbaum, Daniel G. [NewYork-Presbyterian Hospital/Weill Cornell Medicine, Division of Pediatric Radiology, New York, NY (United States); Conrad, Maire A.; Kelsen, Judith R. [The Children' s Hospital of Philadelphia, Division of Gastroenterology, Hepatology and Nutrition, Philadelphia, PA (United States); Biko, David M.; Anupindi, Sudha A. [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Ruchelli, Eduardo D. [The Children' s Hospital of Philadelphia, Division of Anatomic Pathology, Philadelphia, PA (United States)

    2017-01-15

    Imaging predictors for surgery in children with Crohn disease are lacking. To identify imaging features of the terminal ileum on short-interval bowel ultrasound (US) and MR enterography (MRE) in children with Crohn disease requiring surgical bowel resection and those managed by medical therapy alone. This retrospective study evaluated patients 18 years and younger with Crohn disease undergoing short-interval bowel US and MRE (within 2 months of one another), as well as subsequent ileocecectomy or endoscopy within 3 months of imaging. Appearance of the terminal ileum on both modalities was compared between surgical patients and those managed with medical therapy, with the following parameters assessed: bowel wall thickness, mural stratification, vascularity, fibrofatty proliferation, abscess, fistula and stricture on bowel US; bowel wall thickness, T2 ratio, enhancement pattern, mesenteric edema, fibrofatty proliferation, abscess, fistula and stricture on MRE. A two-sided t-test was used to compare means, a Mann-Whitney U analysis was used for non-parametric parameter scores, and a chi-square or two-sided Fisher exact test compared categorical variables. Imaging findings in surgical patients were correlated with location-matched histopathological scores of inflammation and fibrosis using a scoring system adapted from the Simple Endoscopic Score for Crohn Disease, and a Spearman rank correlation coefficient was used to compare inflammation and fibrosis on histopathology. Twenty-two surgical patients (mean age: 16.5 years; male/female: 13/9) and 20 nonsurgical patients (mean age: 14.8; M/F: 8/12) were included in the final analysis. On US, the surgical group demonstrated significantly increased mean bowel wall thickness (6.1 mm vs. 4.7 mm for the nonsurgical group; P = 0.01), loss of mural stratification (odds ratio [OR] = 6.3; 95% confidence interval [CI]: 1.4-28.4; P = 0.02) and increased fibrofatty proliferation (P = 0.04). On MRE, the surgical group showed

  18. Ultrasound and MRI predictors of surgical bowel resection in pediatric Crohn disease.

    Science.gov (United States)

    Rosenbaum, Daniel G; Conrad, Maire A; Biko, David M; Ruchelli, Eduardo D; Kelsen, Judith R; Anupindi, Sudha A

    2017-01-01

    Imaging predictors for surgery in children with Crohn disease are lacking. To identify imaging features of the terminal ileum on short-interval bowel ultrasound (US) and MR enterography (MRE) in children with Crohn disease requiring surgical bowel resection and those managed by medical therapy alone. This retrospective study evaluated patients 18 years and younger with Crohn disease undergoing short-interval bowel US and MRE (within 2 months of one another), as well as subsequent ileocecectomy or endoscopy within 3 months of imaging. Appearance of the terminal ileum on both modalities was compared between surgical patients and those managed with medical therapy, with the following parameters assessed: bowel wall thickness, mural stratification, vascularity, fibrofatty proliferation, abscess, fistula and stricture on bowel US; bowel wall thickness, T2 ratio, enhancement pattern, mesenteric edema, fibrofatty proliferation, abscess, fistula and stricture on MRE. A two-sided t-test was used to compare means, a Mann-Whitney U analysis was used for non-parametric parameter scores, and a chi-square or two-sided Fisher exact test compared categorical variables. Imaging findings in surgical patients were correlated with location-matched histopathological scores of inflammation and fibrosis using a scoring system adapted from the Simple Endoscopic Score for Crohn Disease, and a Spearman rank correlation coefficient was used to compare inflammation and fibrosis on histopathology. Twenty-two surgical patients (mean age: 16.5 years; male/female: 13/9) and 20 nonsurgical patients (mean age: 14.8; M/F: 8/12) were included in the final analysis. On US, the surgical group demonstrated significantly increased mean bowel wall thickness (6.1 mm vs. 4.7 mm for the nonsurgical group; P = 0.01), loss of mural stratification (odds ratio [OR] = 6.3; 95% confidence interval [CI]: 1.4-28.4; P = 0.02) and increased fibrofatty proliferation (P = 0.04). On MRE, the

  19. Intestinal APCs of the endogenous nanomineral pathway fail to express PD-L1 in Crohn's disease.

    Science.gov (United States)

    Robertson, Jack; Haas, Carolin T; Pele, Laetitia C; Monie, Tom P; Charalambos, Charles; Parkes, Miles; Hewitt, Rachel E; Powell, Jonathan J

    2016-05-26

    Crohn's disease is a chronic inflammatory condition most commonly affecting the ileum and colon. The aetiology of Crohn's disease is complex and may include defects in peptidoglycan recognition, and/or failures in the establishment of intestinal tolerance. We have recently described a novel constitutive endogenous delivery system for the translocation of nanomineral-antigen-peptidoglycan (NAP) conjugates to antigen presenting cells (APCs) in intestinal lymphoid patches. In mice NAP conjugate delivery to APCs results in high surface expression of the immuno-modulatory molecule programmed death receptor ligand 1 (PD-L1). Here we report that NAP conjugate positive APCs in human ileal tissues from individuals with ulcerative colitis and intestinal carcinomas, also have high expression of PD-L1. However, NAP-conjugate positive APCs in intestinal tissue from patients with Crohn's disease show selective failure in PD-L1 expression. Therefore, in Crohn's disease intestinal antigen taken up by lymphoid patch APCs will be presented without PD-L1 induced tolerogenic signalling, perhaps initiating disease.

  20. Genetic polymorphism in ATG16L1 gene influences the response to adalimumab in Crohn's disease patients

    NARCIS (Netherlands)

    Koder, Silvo; Repnik, Katja; Ferkolj, Ivan; Pernat, Cvetka; Skok, Pavel; Weersma, Rinse K.; Potocnik, Uros

    2015-01-01

    Aim: To see if SNPs could help predict response to biological therapy using adalimumab (ADA) in Crohn's disease (CD). Materials & methods: IBDQ index and CRP levels were used to monitor therapy response. We genotyped 31 CD-associated genes in 102 Slovenian CD patients. Results: The strongest

  1. Adalimumab dose escalation and dose de-escalation success rate and predictors in a large national cohort of Crohn's patients

    NARCIS (Netherlands)

    Baert, Filip; Glorieus, Elien; Reenaers, Cathérine; D'Haens, Geert; Peeters, Harald; Franchimont, Dennis; Dewit, Olivier; Caenepeel, Philippe; Louis, Edouard; van Assche, Gert; D'Heygere, F.; George, C.; van Hootegem, P.; Ilegems, S.; Fontaine, F.; Colard, A.; Schoofs, N.; Belaiche, J.; Louis, E.; Reenaers, C.; van Kemseke, C.; Coche, J. C.; Dewit, O.; Rahier, J. F.; de Reuck, M.; Baert, F.; Decaestecker, J.; de Wulf, D.; Amininejad, L.; Franchimont, D.; van Gossum, A.; Du Ville, L.; Hendrickx, K.; Lepoutre, L.; Vandervoort, J.; van der Spek, P.; Sprengers, D.; van de Mierop, F.; Potvin, P.; Bontems, P.; Moreels, T.; van Outryve, M.; Mana, F.; de Looze, D.; de Vos, M.; Peeters, H.; Ferrante, M.; Rutgeerts, P.; van Assche, G.; Vermeire, S.

    2013-01-01

    Adalimumab is efficacious in inducing and maintaining remission in Crohn's disease but dose escalation is needed in 30-40% after 1 year. Attempts for dose de-escalation have not been studied. This study aimed to assess the need for, predictors, and outcome of dose escalation and de-escalation in a

  2. An Atypical Eating Disorder with Crohn's Disease in a Fifteen-Year-Old Male: A Case Study.

    Science.gov (United States)

    Holaday, Margot; And Others

    1994-01-01

    Discusses how 6 months after psychological intervention for an eating disorder, a 15-year-old male was diagnosed with Crohn's disease, a chronic inflammatory bowel disease. Addresses need for additional training for those from traditional school and counseling psychology programs. Advocates a team approach and consultations. (RJM)

  3. Differences in outcomes over time with exclusive enteral nutrition compared to steroids in children with mild to moderate Crohn's Disease

    DEFF Research Database (Denmark)

    Cohen-Dolev, Noa; Sladek, Malgorata; Hussey, Seamus

    2018-01-01

    Background: Exclusive enteral nutrition (EEN) and corticosteroids (CS) both induce similar rates of remission in mild to moderate pediatric Crohn's disease (CD), but differ with regard to mucosal healing. Our goal was to evaluate if EEN at diagnosis was superior to CS for improving long term outc...

  4. T cell-mediated increased osteoclast formation from peripheral blood as a mechanism for crohn's disease-associated bone loss

    NARCIS (Netherlands)

    Oostlander, A.E.; Everts, V.; Schoenmaker, T.; Bravenboer, N.; van Vliet, S.J.; van Bodegraven, A.A.; Lips, P.; de Vries, T.J.

    2012-01-01

    The pathophysiology of osteoporosis in patients with Crohn's disease (CD) is still not completely elucidated. In this study, we evaluated osteoclastogenesis from peripheral blood cells of CD patients and studied the role of lymphocytes and inflammatory cytokines in this process. Peripheral blood

  5. Vitamin D deficiency in Crohn's disease and healthy controls: a prospective case-control study in the Netherlands

    NARCIS (Netherlands)

    de Bruyn, Jessica R.; van Heeckeren, Rosanne; Ponsioen, Cyriel Y.; van den Brink, Gijs R.; Löwenberg, Mark; Bredenoord, Albert J.; Frijstein, Gerard; D'Haens, Geert R.

    2014-01-01

    Vitamin D deficiency has been observed in a wide range of medical conditions including Crohn's disease (CD). We aimed to assess whether CD patients have lower vitamin D levels than healthy controls, and to determine risk factors for vitamin D deficiency. 25(OH)D was measured by chemiluminescent

  6. Direct bacterial killing in vitro by recombinant Nod2 is compromised by Crohn's disease-associated mutations.

    Directory of Open Access Journals (Sweden)

    Laurent-Herve Perez

    2010-06-01

    Full Text Available A homeostatic relationship with the intestinal microflora is increasingly appreciated as essential for human health and wellbeing. Mutations in the leucine-rich repeat (LRR domain of Nod2, a bacterial recognition protein, are associated with development of the inflammatory bowel disorder, Crohn's disease. We investigated the molecular mechanisms underlying disruption of intestinal symbiosis in patients carrying Nod2 mutations.In this study, using purified recombinant LRR domains, we demonstrate that Nod2 is a direct antimicrobial agent and this activity is generally deficient in proteins carrying Crohn's-associated mutations. Wild-type, but not Crohn's-associated, Nod2 LRR domains directly interacted with bacteria in vitro, altered their metabolism and disrupted the integrity of the plasma membrane. Antibiotic activity was also expressed by the LRR domains of Nod1 and other pattern recognition receptors suggesting that the LRR domain is a conserved anti-microbial motif supporting innate cellular immunity.The lack of anti-bacterial activity demonstrated with Crohn's-associated Nod2 mutations in vitro, supports the hypothesis that a deficiency in direct bacterial killing contributes to the association of Nod2 polymorphisms with the disease.

  7. Tofacitinib for induction and maintenance therapy of Crohn's disease: results of two phase IIb randomised placebo-controlled trials

    NARCIS (Netherlands)

    Panés, Julian; Sandborn, William J.; Schreiber, Stefan; Sands, Bruce E.; Vermeire, Séverine; D'Haens, Geert; Panaccione, Remo; Higgins, Peter D. R.; Colombel, Jean-Frederic; Feagan, Brian G.; Chan, Gary; Moscariello, Michele; Wang, Wenjin; Niezychowski, Wojciech; Marren, Amy; Healey, Paul; Maller, Eric

    2017-01-01

    Tofacitinib is an oral, small-molecule Janus kinase inhibitor that is being investigated for IBD. We evaluated the efficacy and safety of tofacitinib for induction and maintenance treatment in patients with moderate-to-severe Crohn's disease (CD). We conducted two randomised, double-blind,

  8. Genome-wide meta-analysis increases to 71 the number of confirmed Crohn's disease susceptibility loci

    NARCIS (Netherlands)

    Franke, Andre; McGovern, Dermot P. B.; Barrett, Jeffrey C.; Wang, Kai; Radford-Smith, Graham L.; Ahmad, Tariq; Lees, Charlie W.; Balschun, Tobias; Lee, James; Roberts, Rebecca; Anderson, Carl A.; Bis, Joshua C.; Bumpstead, Suzanne; Ellinghaus, David; Festen, Eleonora M.; Georges, Michel; Green, Todd; Haritunians, Talin; Jostins, Luke; Latiano, Anna; Mathew, Christopher G.; Montgomery, Grant W.; Prescott, Natalie J.; Raychaudhuri, Soumya; Rotter, Jerome I.; Schumm, Philip; Sharma, Yashoda; Simms, Lisa A.; Taylor, Kent D.; Whiteman, David; Wijmenga, Cisca; Baldassano, Robert N.; Barclay, Murray; Bayless, Theodore M.; Brand, Stephan; Buening, Carsten; Cohen, Albert; Colombel, Jean-Frederick; Cottone, Mario; Stronati, Laura; Denson, Ted; De Vos, Martine; D'Inca, Renata; Dubinsky, Marla; Edwards, Cathryn; Florin, Tim; Franchimont, Denis; Gearry, Richard; Glas, Juergen; Van Gossum, Andre; Guthery, Stephen L.; Halfvarson, Jonas; Verspaget, Hein W.; Hugot, Jean-Pierre; Karban, Amir; Laukens, Debby; Lawrance, Ian; Lemann, Marc; Levine, Arie; Libioulle, Cecile; Louis, Edouard; Mowat, Craig; Newman, William; Panes, Julian; Phillips, Anne; Proctor, Deborah D.; Regueiro, Miguel; Russell, Richard; Rutgeerts, Paul; Sanderson, Jeremy; Sans, Miquel; Seibold, Frank; Steinhart, A. Hillary; Stokkers, Pieter C. F.; Torkvist, Leif; Kullak-Ublick, Gerd; Wilson, David; Walters, Thomas; Targan, Stephan R.; Brant, Steven R.; Rioux, John D.; D'Amato, Mauro; Weersma, Rinse K.; Kugathasan, Subra; Griffiths, Anne M.; Mansfield, John C.; Vermeire, Severine; Duerr, Richard H.; Silverberg, Mark S.; Satsangi, Jack; Schreiber, Stefan; Cho, Judy H.; Annese, Vito; Hakonarson, Hakon; Daly, Mark J.; Parkes, Miles

    2010-01-01

    We undertook a meta-analysis of six Crohn's disease genome-wide association studies (GWAS) comprising 6,333 affected individuals (cases) and 15,056 controls and followed up the top association signals in 15,694 cases, 14,026 controls and 414 parent-offspring trios. We identified 30 new

  9. LPS-Stimulated Whole Blood Cytokine Production Is Not Related to Disease Behavior in Patients with Quiescent Crohn's Disease

    NARCIS (Netherlands)

    Broekman, M.M.T.J.; Roelofs, H.M.; Hoentjen, F.; Wiegertjes, R.; Stoel, N.; Joosten, L.A.B.; Jong, D.J. de; Wanten, G.J.A.

    2015-01-01

    INTRODUCTION: Crohn's disease (CD) is a chronic inflammatory disease in which cytokines play a pivotal role in the induction and maintenance of inflammation. Innate cytokine production is genetically determined and varies largely between individuals; this might impact the severity of inflammation.

  10. Clinical outcome of Crohn's disease according to the Vienna classification: disease location is a useful predictor of disease course

    NARCIS (Netherlands)

    Oostenbrug, Liekele E.; van Dullemen, Hendrik M.; te Meerman, Gerard J.; Jansen, Peter L. M.; Kleibeuker, Jan H.

    2006-01-01

    OBJECTIVES: Crohn's disease (CD) is a complex genetic disease with multiple clinical patterns. Clinical classifications may help to identify subgroups of patients that have a distinct pattern of disease, and they are also a prerequisite for the conduction of genetic and therapeutic studies. The aim

  11. Association Between Variants of PRDM1 and NDP52 and Crohn's Disease, Based on Exome Sequencing and Functional Studies

    NARCIS (Netherlands)

    Ellinghaus, David; Zhang, Hu; Zeissig, Sebastian; Lipinski, Simone; Till, Andreas; Jiang, Tao; Stade, Bjoern; Bromberg, Yana; Ellinghaus, Eva; Keller, Andreas; Rivas, Manuel A.; Skieceviciene, Jurgita; Doncheva, Nadezhda T.; Liu, Xiao; Liu, Qing; Jiang, Fuman; Forster, Michael; Mayr, Gabriele; Albrecht, Mario; Haesler, Robert; Boehm, Bernhard O.; Goodall, Jane; Berzuini, Carlo R.; Lee, James; Andersen, Vibeke; Vogel, Ulla; Kupcinskas, Limas; Kayser, Manfred; Krawczak, Michael; Nikolaus, Susanna; Weersma, Rinse K.; Ponsioen, Cyriel Y.; Sans, Miquel; Wijmenga, Cisca; Strachan, David P.; McAardle, Wendy L.; Vermeire, Severine; Rutgeerts, Paul; Sanderson, Jeremy D.; Mathew, Christopher G.; Vatn, Morten H.; Wang, Jun; Noethen, Markus M.; Duerr, Richard H.; Buening, Carsten; Brand, Stephan; Glas, Juergen; Winkelmann, Juliane; Illig, Thomas; Latiano, Anna; Annese, Vito; Halfvarson, Jonas; D'Amato, Mauro; Daly, Mark J.; Nothnagel, Michael; Karlsen, Tom H.; Subramani, Suresh; Rosenstiel, Philip; Schreiber, Stefan; Parkes, Miles; Franke, Andre

    BACKGROUND & AIMS: Genome-wide association studies (GWAS) have identified 140 Crohn's disease (CD) susceptibility loci. For most loci, the variants that cause disease are not known and the genes affected by these variants have not been identified. We aimed to identify variants that cause CD through

  12. Association Between Variants of PRDM1 and NDP52 and Crohn's Disease, Based on Exome Sequencing and Functional Studies

    NARCIS (Netherlands)

    Ellinghaus, David; Zhang, Hu; Zeissig, Sebastian; Lipinski, Simone; Till, Andreas; Jiang, Tao; Stade, Björn; Bromberg, Yana; Ellinghaus, Eva; Keller, Andreas; Rivas, Manuel A.; Skieceviciene, Jurgita; Doncheva, Nadezhda T.; Liu, Xiao; Liu, Qing; Jiang, Fuman; Forster, Michael; Mayr, Gabriele; Albrecht, Mario; Häsler, Robert; Boehm, Bernhard O.; Goodall, Jane; Berzuini, Carlo R.; Lee, James; Andersen, Vibeke; Vogel, Ulla; Kupcinskas, Limas; Kayser, Manfred; Krawczak, Michael; Nikolaus, Susanna; Weersma, Rinse K.; Ponsioen, Cyriel Y.; Sans, Miquel; Wijmenga, Cisca; Strachan, David P.; McArdle, Wendy L.; Vermeire, Séverine; Rutgeerts, Paul; Sanderson, Jeremy D.; Mathew, Christopher G.; Vatn, Morten H.; Wang, Jun; Nöthen, Markus M.; Duerr, Richard H.; Büning, Carsten; Brand, Stephan; Glas, Jürgen; Winkelmann, Juliane; Illig, Thomas; Latiano, Anna; Annese, Vito; Halfvarson, Jonas; D'Amato, Mauro; Daly, Mark J.; Nothnagel, Michael; Karlsen, Tom H.; Subramani, Suresh; Rosenstiel, Philip; Schreiber, Stefan; Parkes, Miles; Franke, Andre

    2013-01-01

    Genome-wide association studies (GWAS) have identified 140 Crohn's disease (CD) susceptibility loci. For most loci, the variants that cause disease are not known and the genes affected by these variants have not been identified. We aimed to identify variants that cause CD through detailed

  13. Clinical outcome of Crohn's disease according to the Vienna classification : disease location is a useful predictor of disease course

    NARCIS (Netherlands)

    Oostenbrug, Liekele E.; van Dullemen, Hendrik M.; te Meerman, Gerard J.; Jansen, Peter L. M.; Kleibeuker, Jan H.

    Objectives Crohn's disease (CD) is a complex genetic disease with multiple clinical patterns. Clinical classifications may help to identify subgroups of patients that have a distinct pattern of disease, and they are also a prerequisite for the conduction of genetic and therapeutic studies. The aim

  14. Safety and Feasibility of Using the Second-Generation Pillcam Colon Capsule to Assess Active Colonic Crohn's Disease

    NARCIS (Netherlands)

    D'Haens, Geert; Löwenberg, Mark; Samaan, Mark A.; Franchimont, Denis; Ponsioen, Cyriel; van den Brink, Gijs R.; Fockens, Paul; Bossuyt, Peter; Amininejad, Leila; Rajamannar, Gopalan; Lensink, Elsemieke M.; van Gossum, Andre M.

    2015-01-01

    The second-generation Pillcam Colon Capsule Endoscope (PCCE-2; Given Imaging Ltd, Yoqneam, Israel) is an ingestible capsule for visualization of the colon. We performed a multicenter pilot study to assess its safety and feasibility in evaluating the severity of Crohn's disease (CD). In a prospective

  15. Acute terminal ileitis, yersiniosis, and Crohn's disease: a long-term follow-up study of the relationships

    DEFF Research Database (Denmark)

    Jess, T; Jess, Per

    2001-01-01

    University Hospital during the period 1976-1998 were diagnosed as having ATI while undergoing surgery for suspected acute appendicitis. The patients were followed up, and both Yersinia titers and the development of Crohn's disease were registered. Results: Forty-four patients (83%) were tested for Yersinia...

  16. Doubling the infliximab dose versus halving the infusion intervals in Crohn's disease patients with loss of response

    DEFF Research Database (Denmark)

    Katz, Lior; Gisbert, Javier P; Manoogian, Beth

    2012-01-01

    Intensifying infliximab therapy is often practiced in Crohn's disease (CD) patients losing response to the drug but there are no data if halving the interval is superior to doubling the dose. We aimed to assess the efficacy of infliximab dose intensification by interval-halving compared with dose...

  17. Increased production of granulocyte-macrophage colony-stimulating factor in Crohn's disease--a possible target for infliximab treatment

    DEFF Research Database (Denmark)

    Agnholt, Jørgen; Kelsen, Jens; Brandsborg, Birgitte

    2004-01-01

    The presence of neutrophils among epithelial cells is one of the major features of the inflammation in Crohn's disease, and has been used to indicate disease activity. The survival of neutrophils outside the blood vessels is limited and their longevity is influenced by granulocyte-macrophage colo...

  18. Altered healing following mucogingival surgery in a patient with Crohn's disease: a literature review and case report.

    Science.gov (United States)

    Andersen, Kari M; Selvig, Knut A; Leknes, Knut N

    2003-04-01

    Crohn's disease is a chronic inflammatory bowel disease characterized by uncertainty in etiology and pathogenesis occasionally with manifestations in oral mucous membranes. This report reviews the literature on Crohn's disease and presents a patient with Crohn's disease on continuous anti-inflammatory and immunosuppressive medication who showed adverse healing response following surgical treatment of gingival recession type defects. A 28-year-old male in generally good health apart from his bowel disease requested treatment of multiple maxillary gingival recessions due to esthetic concerns and root sensitivity. Following oral hygiene instruction, 3 coronally advanced flap procedures were performed in the maxillary anterior region to cover the defects. In 2 of the surgical areas, the exposed root surfaces were treated by ethylenediaminetetraacetic acid (EDTA) in combination with enamel matrix derivative (EMD) before coronally positioning the buccal flap. Postoperatively, chlorhexidine gluconate was used for oral hygiene control. The first surgical procedure, performed as a coronally advanced flap, showed delayed and altered healing. Two weeks postoperatively, the flapped tissue remained intensely red and swollen. In the following 2 surgical sites where EDTA and EMD were applied the healing was uneventful. Differences in immediate tissue response, however, did not influence the 3-month treatment outcome with respect to root coverage. Patients with Crohn's disease on recommended systemic medications may show a delayed and altered wound healing indicating that periodontal surgery must be closely monitored. Treatment planning should take into account the potential wound healing promoting effects of enamel matrix derivative as well as adverse healing effects of chlorhexidine gluconate administration.

  19. Faecal microbiota transplantation for recurring Clostridium difficile infection in a patient with Crohn's disease and ileorectal anastomosis

    DEFF Research Database (Denmark)

    Oppfeldt, Asser Mathiassen; Dahlerup, Jens F; Christensen, Lisbet A

    2016-01-01

    disease (IBD) who are on immunomodulating therapies is controversial. In particular, patients who have undergone colectomy may have different treatment responses to FMT. In this case report, we describe the successful use of FMT in a female patient aged 19 years with Crohn's disease who underwent...

  20. A single center experience of methotrexate in the treatment of Crohn's disease and ulcerative colitis: a case for subcutaneous administration.

    Science.gov (United States)

    Nathan, Debbie M; Iser, John H; Gibson, Peter R

    2008-06-01

    Methotrexate (MTX) is used as a second-line immuno-modulator in patients with inflammatory bowel disease when purine analogs are not tolerated or lack efficacy. High-level evidence indicates efficacy for intramuscular administration in Crohn's disease, but there are few reports of experience with subcutaneous delivery. This study aimed to evaluate the response to and tolerance of MTX where subcutaneous administration was the preferred option. The records of all patients treated with MTX were evaluated with regard to the dose, duration, response, and tolerance to MTX. Remission was defined as improvement in symptoms with no corticosteroid requirement for 3 months or ability to wean off steroids. MTX was initiated in 45 patients with Crohn's disease and 23 ulcerative colitis (median age, 46 years; range, 20-80 years; 54% men) because of intolerance (69%) or resistance (31%) to purine analogues. MTX was initiated in 74% of patients in doses of 25 mg (33) or 20 mg (17), administered by subcutaneous self-injection in 90% of subjects. Remission was achieved in 24 of 45 (53%) with Crohn's disease and 11 of 23 (48%) with ulcerative colitis. An additional four (9%) patients with Crohn's disease and three patients (13%) with ulcerative colitis demonstrated symptomatic improvement and/or ability to decrease corticosteroid dose. While nine patients ceased therapy and nine successfully reduced their doses due to intolerance, three of four patients had no adverse effects. Subcutaneous delivery was well accepted. Subcutaneously administered MTX exhibits apparent efficacy, acceptance, tolerance, and safety in patients with Crohn's disease or ulcerative colitis who are steroid-dependent and where purine analogs have been ineffective or intolerable.

  1. Pilotní studie ročního režimu pohybové aktivity gymnaziálních studentek [Variability of year-round physical activity in high school girls – pilot study

    Directory of Open Access Journals (Sweden)

    Marek Pelcl

    2008-03-01

    Full Text Available 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 decline of physical activity. To infl uence physical activity behavior in children and youth, it is necessary to determine factors aff ecting physical activity which are related to seasonal, monthly or weekly period. Therefore, the purpose of this study is to collect one year pedometer self-monitoring data to fi nd out the year-round variability of physical activity in high school girls. Nine volunteering girls from a high school participated in this study. Girls were asked to wear pedometer at their waist during each day of one year and record steps per day and daily behavior. We obtained 2118 person-day, each girl recorded 303 days. The days with lowest number of steps were Saturday and Sunday. The highest number of steps was obtained on days with regular physical education lesson – Wednesday. The month with the lowest average number steps/day was February and the average number steps/day was the highest in June. Although this study has several limitations (e.g. low sample size, the variability in year-round physical activity has been found across days and autumn, winter, and spring months.

  2. Attitudes of Crohn's Disease Patients: Infodemiology Case Study and Sentiment Analysis of Facebook and Twitter Posts.

    Science.gov (United States)

    Roccetti, Marco; Marfia, Gustavo; Salomoni, Paola; Prandi, Catia; Zagari, Rocco Maurizio; Gningaye Kengni, Faustine Linda; Bazzoli, Franco; Montagnani, Marco

    2017-08-09

    Data concerning patients originates from a variety of sources on social media. The aim of this study was to show how methodologies borrowed from different areas including computer science, econometrics, statistics, data mining, and sociology may be used to analyze Facebook data to investigate the patients' perspectives on a given medical prescription. To shed light on patients' behavior and concerns, we focused on Crohn's disease, a chronic inflammatory bowel disease, and the specific therapy with the biological drug Infliximab. To gain information from the basin of big data, we analyzed Facebook posts in the time frame from October 2011 to August 2015. We selected posts from patients affected by Crohn's disease who were experiencing or had previously been treated with the monoclonal antibody drug Infliximab. The selected posts underwent further characterization and sentiment analysis. Finally, an ethnographic review was carried out by experts from different scientific research fields (eg, computer science vs gastroenterology) and by a software system running a sentiment analysis tool. The patient feeling toward the Infliximab treatment was classified as positive, neutral, or negative, and the results from computer science, gastroenterologist, and software tool were compared using the square weighted Cohen's kappa coefficient method. The first automatic selection process returned 56,000 Facebook posts, 261 of which exhibited a patient opinion concerning Infliximab. The ethnographic analysis of these 261 selected posts gave similar results, with an interrater agreement between the computer science and gastroenterology experts amounting to 87.3% (228/261), a substantial agreement according to the square weighted Cohen's kappa coefficient method (w2K=0.6470). A positive, neutral, and negative feeling was attributed to 36%, 27%, and 37% of posts by the computer science expert and 38%, 30%, and 32% by the gastroenterologist, respectively. Only a slight agreement was

  3. Tuberculose ileocecal isolada simulando neoplasia maligna e doença de Crohn Isolated ileocecal tuberculosis simulating malignant neoplasia and Crohn's disease

    Directory of Open Access Journals (Sweden)

    S.H. BROMBERG

    2001-06-01

    Full Text Available OBJETIVO: No Brasil, a tuberculose ileocecal isolada, na ausência de tuberculose pulmonar ativa ou cicatrizada, é rara, sendo freqüentemente confundida com neoplasia e a doença de Crohn. MÉTODOS: Os autores apresentam oito doentes com essas características, tratados por cirurgia, em período de 20 anos. A dor abdominal na fossa ilíaca direita foi o principal sintoma (100%, seguido da presença de perda de peso (62,5%, febre, náuseas e vômitos e fadiga em 50% dos doentes. Sete enfermos (87,5% apresentaram massa palpável na fossa ilíaca direita. A duração média dos sintomas foi de 14,7 meses, variando de 5 a 36 meses. Todas as lesões foram detectadas pelo enema opaco e mimetizavam aspecto neoplásico. A colonoscopia foi realizada em três doentes, evidenciando lesões sub-oclusivas da região íleo-cecal em dois; as biópsias foram sugestivas de tuberculose, não sendo possível diferenciá-las da doença de Crohn. RESULTADOS: Seis enfermos com diagnóstico presuntivo de neoplasia foram submetidos a cirurgia eletiva, realizando-se neles a colectomia direita clássica. Os outros dois, com suspeita de tuberculose, foram operados na vigência de obstrução intestinal, sendo submetidos a ressecção limitada (ileocecectomia. O estudo anatomopatológico estabeleceu o diagnóstico final pelo encontro de necrose caseosa e de bacilos álcool ácido-resistentes no intestino ou nos linfonodos. A evolução pós-operatória foi satisfatória, com pequena morbidade resolvida clinicamente. Posteriormente, todos os doentes receberam o esquema tríplice por 12 meses, variando a droga de acordo com a época do tratamento. CONCLUSÃO: Apesar de rara, a tuberculose hipertrófica ileocecal isolada freqüentemente é confundida com neoplasias e com a doença de Crohn, devendo ser lembrada no diagnóstico diferencial das lesões localizadas no quadrante inferior direito do abdome.BACKGROUND: Isolated ileocecal involvement by tuberculosis in the absence

  4. Asia Pacific Consensus Statements on Crohn's disease. Part 1: Definition, diagnosis, and epidemiology: (Asia Pacific Crohn's Disease Consensus--Part 1).

    Science.gov (United States)

    Ooi, Choon Jin; Makharia, Govind K; Hilmi, Ida; Gibson, Peter R; Fock, Kwong Ming; Ahuja, Vineet; Ling, Khoon Lin; Lim, Wee Chian; Thia, Kelvin T; Wei, Shu-chen; Leung, Wai Keung; Koh, Poh Koon; Gearry, Richard B; Goh, Khean Lee; Ouyang, Qin; Sollano, Jose; Manatsathit, Sathaporn; de Silva, H Janaka; Rerknimitr, Rungsun; Pisespongsa, Pises; Abu Hassan, Muhamad Radzi; Sung, Joseph; Hibi, Toshifumi; Boey, Christopher C M; Moran, Neil; Leong, Rupert W L

    2016-01-01

    Inflammatory bowel disease (IBD) was previously thought to be rare in Asia, but emerging data indicate rising incidence and prevalence of IBD in the region. The Asia Pacific Working Group on Inflammatory Bowel Disease was established in Cebu, Philippines, at the Asia Pacific Digestive Week conference in 2006 under the auspices of the Asian Pacific Association of Gastroenterology with the goal of developing best management practices, coordinating research, and raising awareness of IBD in the region. The consensus group previously published recommendations for the diagnosis and management of ulcerative colitis with specific relevance to the Asia-Pacific region. The present consensus statements were developed following a similar process to address the epidemiology, diagnosis, and management of Crohn's disease. The goals of these statements are to pool the pertinent literature specifically highlighting relevant data and conditions in the Asia-Pacific region relating to the economy, health systems, background infectious diseases, differential diagnoses, and treatment availability. It does not intend to be all comprehensive and future revisions are likely to be required in this ever-changing field. © 2015 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

  5. Beneficial effect of treatment with a monoclonal anti-tumor necrosis factor-alpha antibody on markers of coagulation and fibrinolysis in patients with active Crohn's disease

    NARCIS (Netherlands)

    Hommes, DW; van Dullemen, HM; Levi, M; Van der Ende, A; Woody, J; Tytgat, GNJ; van Deventer, SJH

    1997-01-01

    Crohn's disease has frequently been associated with coagulation abnormalities, causing intravascular deposition of fibrin and local infarction which can subsequently compromise the gut mucosa. Also, arterial and venous thromboembolic complications of larger vessels appear to be associated with

  6. Screening prior to biological therapy in Crohn's disease: adherence to guidelines and prevalence of infections. Results from a multicentre retrospective study

    NARCIS (Netherlands)

    van der Have, Mike; Belderbos, Tim D. G.; Fidder, Herma H.; Leenders, Max; Dijkstra, Gerard; Peters, Charlotte P.; Eshuis, Emma J.; Ponsioen, Cyriel Y.; Siersema, Peter D.; van Oijen, Martijn G. H.; Oldenburg, Bas

    2014-01-01

    Screening for opportunistic infections prior to starting biological therapy in patients with inflammatory bowel disease is recommended. To assess adherence to screening for opportunistic infections prior to starting biological therapy in Crohn's disease patients and its yield. A multicentre

  7. Screening prior to biological therapy in Crohn's disease : Adherence to guidelines and prevalence of infections. Results from a multicentre retrospective study

    NARCIS (Netherlands)

    van der Have, Mike; Belderbos, Tim D. G.; Fidder, Herma H.; Leenders, Max; Dijkstra, Gerard; Peters, Charlotte P.; Eshuis, Emma J.; Ponsioen, Cyriel Y.; Siersema, Peter D.; van Oijen, Martijn G. H.; Oldenburg, Bas

    2014-01-01

    Background: Screening for opportunistic infections prior to starting biological therapy in patients with inflammatory bowel disease is recommended. Aims: To assess adherence to screening for opportunistic infections prior to starting biological therapy in Crohn's disease patients and its yield.

  8. Multimodal treatment of perianal fistulas in Crohn's disease: seton versus anti-TNF versus advancement plasty (PISA): study protocol for a randomized controlled trial.

    LENUS (Irish Health Repository)

    de Groof, E Joline

    2015-08-20

    Currently there is no guideline for the treatment of patients with Crohn\\'s disease and high perianal fistulas. Most patients receive anti-TNF medication, but no long-term results of this expensive medication have been described, nor has its efficiency been compared to surgical strategies. With this study, we hope to provide treatment consensus for daily clinical practice with reduction in costs.

  9. Systematic review: Use of ultrasonography, computed tomography and magnetic resonance imaging for the diagnosis, assessment of activity and abdominal complications of Crohn's disease

    OpenAIRE

    Panes , Julian; Bouzas , Rosa; García-Sánchez , Valle; Chaparro , María; Pérez-Gisbert , Javier; Martínez De Guereñu , Blanca; Mendoza , Juan Luis; Paredes , José María; Quiroga , Sergi; Ripollés , Tomás; Rimola , Jordi

    2011-01-01

    Abstract Backgroud: Cross-sectional imaging techniques, including ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI), are increasingly used for evaluation of Crohn?s disease (CD). Aim: To perform an assessment of the diagnostic accuracy of cross-sectional imaging techniques for diagnosis of CD, evaluation of disease extension and activity, and diagnosis of complications, and to provide recommendations for their optimal use. Methods: Relevant ...

  10. Tumor necrosis factor-alpha binding capacity and anti-infliximab antibodies measured by fluid-phase radioimmunoassays as predictors of clinical efficacy of infliximab in Crohn's disease

    DEFF Research Database (Denmark)

    Ainsworth, Mark A; Bendtzen, Klaus; Brynskov, Jørn

    2007-01-01

    To investigate if the combined assessment of anti-infliximab antibodies (Ab) and the degree of TNF-alpha binding capacity (TNF-alpha-BC) afforded by infliximab may predict the response to infliximab treatment in patients with Crohn's disease (CD).......To investigate if the combined assessment of anti-infliximab antibodies (Ab) and the degree of TNF-alpha binding capacity (TNF-alpha-BC) afforded by infliximab may predict the response to infliximab treatment in patients with Crohn's disease (CD)....

  11. Aspectos psicopatológicos en la enfermedad de Crohn y en la colitis ulcerosa

    Directory of Open Access Journals (Sweden)

    Stefano Vinaccia

    2007-06-01

    Full Text Available son trastornos crónicos que inflaman y destruyen el tejido intestinal de forma periódica y recurrente. Las EII se clasifican en dos tipos: enfermedad de Crohn (EC y colitis ulcerosa (CU. La etiología tanto de la EC como de la CU es poco conocida y el curso está influido por múltiples factores de tipo biopsicosocial. Al respecto, diversas investigaciones están aportando evidencia de la implicación de factores psicológicos en el curso de las EII, tales como el estrés psicosocial, las estrategias de afrontamiento, las características de personalidad, los síntomas psicopatológicos y el apoyo social

  12. Aspectos psicopatológicos en la enfermedad de Crohn y en la colitis ulcerosa

    Directory of Open Access Journals (Sweden)

    Sergio Tobón

    2010-07-01

    Full Text Available Las enfermedades inflamatorias del intestino (EII son trastornos crónicos que inflaman y destruyen el tejido intestinal de forma periódica y recurrente. Las EII se clasifican en dos tipos: enfermedad de Crohn (EC y colitis ulcerosa (CU. La etiología tanto de la EC como de la CU es poco conocida y el curso está influido por múltiples factores de tipo biopsicosocial. Al respecto, diversas investigaciones están aportando evidencia de la implicación de factores psicológicos en el curso de las EII, tales como el estrés psicosocial, las estrategias de afrontamiento, las características de personalidad, los síntomas psicopatológicos y el apoyo social.

  13. 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...... in patients treated with immunosuppressive drugs. Following vaccination, the patient fell ill with influenza-like illness. Elevated transaminase levels and YF viremia were detected. Despite being immunocompromised, the patient did not develop more severe adverse effects. Neutralising antibodies to YF virus...... were detected on day 14 following vaccination and remained protective at least 10 months after vaccination. Limited data is available on outcomes of YFV in patients receiving immunosuppressive therapy, including biologics, and we report this case as a reminder of vigilance of vaccine recommendations...

  14. Influence of preoperative parenteral alimentation on postoperative growth in adolescent Crohn's disease.

    Science.gov (United States)

    Lake, A M; Kim, S; Mathis, R K; Walker, W A

    1985-04-01

    The postoperative growth rates achieved in eight early pubertal adolescent males with Crohn's disease undergoing surgery for obstructive complications is reported as a function of the use of 1 month's preoperative central venous alimentation. All patients had ileal strictures with ileocolitis, bone ages less than 13, Tanner stages 1 or 2, and growth velocities below the 3rd percentile for age. During a 3-year follow-up, those receiving preoperative venous alimentation demonstrated greater oral caloric intake (significant for 1 year) and greater postoperative growth velocity (significant for 2 years) in comparison to those patients who did not receive preoperative venous alimentation. There was no significant difference between the two groups of patients in postoperative weight gain, sexual development, and 3-year disease control.

  15. Association of Crohn’s Disease and Celiac Disease: Causal link or only coincidence?

    Directory of Open Access Journals (Sweden)

    Tolga Duzenli

    2016-12-01

    Full Text Available Crohn’s disease (CD is a chronic inflammatory bowel disease that affects any part of the gastrointestinal tract, most commonly terminal ileum and proximal colon; and Celiac Disease (CeD is immuno-mediated systemic disease caused by gluten and similar prolamins in genetically susceptible individuals. Concomitant occurrence of CD and CeD is rare and there are limited literature data regarding the association of CeD to CD. Although, recent findings propose shared mechanisms, genetics and functional pathways. Herein, we report a case that has co-occurrence of CD and CeD and rewiew the literature of the association between these two diseases. [Dis Mol Med 2016; 4(4.000: 77-80

  16. Metabonomics of human fecal extracts characterize ulcerative colitis, Crohn's disease and healthy individuals

    DEFF Research Database (Denmark)

    Bjerrum, Jacob Tveiten; Wang, Yulan; Hao, Fuhua

    2015-01-01

    This study employs spectroscopy-based metabolic profiling of fecal extracts from healthy subjects and patients with active or inactive ulcerative colitis (UC) and Crohn's disease (CD) to substantiate the potential use of spectroscopy as a non-invasive diagnostic tool and to characterize the fecal......-projection to latent structure-discriminant analysis using SIMCA-P + 12 and MATLAB. Significant differences were found in the metabolic profiles making it possible to differentiate between active IBD and controls and between UC and CD. The metabolites holding differential power primarily belonged to a range of amino...... acids, microbiota-related short chain fatty acids, and lactate suggestive of an inflammation-driven malabsorption and dysbiosis of the normal bacterial ecology. However, removal of patients with intestinal surgery and anti-TNF-α antibody treatment eliminated the discriminative power regarding UC versus...

  17. Effects of five different alcoholic drinks on patients with Crohn's disease

    DEFF Research Database (Denmark)

    Hey, H.; Schmedes, A.; Nielsen, A.A.

    2007-01-01

    OBJECTIVE: Many patients with Crohn's disease (CD) complain of abdominal discomfort after alcohol intake. The aim of the present study was to investigate the effect of ethanol and sugar content in five different alcoholic drinks on abdominal discomfort in patients with CD. MATERIAL AND METHODS......: In a crossover study, two weeks apart, 12 healthy individuals and 20 patients with CD in remission consumed randomly red wine, white wine, Smirnoff Ice, Elephant Beer and pure ethanol. Blood samples were obtained for determination of serum ethanol and plasma glucose at 0, 30, 60, 90, 120 and 180 min. A self......-reported pain symptom score was used. RESULTS: There was no difference between CD patients and healthy individuals in the area under the curve (AUC) for the ethanol concentration after intake of the five different drinks. The plasma AUC for glucose in the CD patients after intake of Smirnoff Ice and Elephant...

  18. The radiological and endoscopie appearances of Crohn's disease of the upper gastro-intenstinal tract

    International Nuclear Information System (INIS)

    Kurtz, B.; Steinhardt, H.J.; Malchow, H.; Tuebingen Univ.

    1982-01-01

    Involvement of the upper gastrointestinal tract (oesophagus, stomach, duodenum, jejunum) accounted for 13% of endoscopically proven Crohn's disease in patients at the University Clinic, Tuebingen between 1973 and 1980. The basis for the diagnosis was the presence of epitheloid granulomas. The diagnosis was suspected in 26% of patients in endoscopic appearances alone. In these two groups, the appearances were similar, consisting of atypical or linear ulcers, cobble-stone lesions, chronic erosions, aphthous ulcers, stenoses, coarsening of the mucosa and areas of engorgement and granularity. Most patients were also examined radiologically. The radiological findings correspond with the endoscopic observations. Using a double contrast technique, mucosal changes could be demonstrated which, up to now, were only seen by endoscopy. If these findings are observed either radiologically or endoscopically, it is essential to examine the distal portions of the gut. (orig.) [de

  19. Mucinous adenocarcinoma arising from recurrent perianal fistula in patient with Crohn's disease: case report

    Directory of Open Access Journals (Sweden)

    Suelene Suassuna Silvestre de Alencar

    2014-07-01

    Full Text Available Introduction: Anal carcinoma is a rare variant of epithelial tumors of the anal canal. When associated with chronic and active anal fistulas, usually this is an aggressive cancer that has difficult diagnosis and poor prognosis. Anal fistulas are a common manifestation of Crohn's disease (CD. This study aims to report a case of mucinous adenocarcinoma originating from recurrent perianal fistula in patients with CD. Case report: A man of 43 years, with melanoderma, complaining of perianal tumors, anal pain and mucopurulent secretion, the patient was diagnosed with fistulae. Colonoscopy revealed a chronic inflammatory process associated with villous polypoid lesion in the colonic and rectal mucosa. In a new episode, where it was diagnosed, chronic colitis of rectum and sigmoid was being prescribed sulfasalazine with improvement. There were relapses and the patient underwent repeated fistulectomias. After investigation, CD was diagnosed. Computed tomography (CT of abdomen and pelvis showed multiple perineal and gluteal collections, and the patient underwent abdominoperineal resection of the rectum. Anatomopathological exam showed invasive mucinous adenocarcinoma. A new CT showed residual growth of the lesion. The patient was referred to the oncology referral service, where chemotherapy and radiotherapy were planned. The patient developed unfavorably, and his death occurred two months after treatment. Resumo: Introdução: Carcinoma anal é uma rara variante de tumores epiteliais do canal anal. Quando associado a fístulas anais crônicas e ativas, geralmente é um câncer agressivo que possui difícil diagnóstico e mau prognóstico. Fístulas anais são uma manifestação comum da doença de Crohn (DC. Este estudo tem como objetivo relatar um caso de adenocarcinoma mucinoso originado de fístula perianal recidivante em paciente com DC. Relato de caso: Homem de 43 anos, com melanoderma e queixas de tumorações na região perianal, dor anal e secre

  20. 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

    the included material: CD smokers (n = 28) or never-smokers (n = 14) as compared to fifteen healthy controls (8 smokers and 7 never-smokers). RNA was isolated and gene expression assessed with Affymetrix GeneChip Human Genome U133 Plus 2.0. Data were analyzed by principal component analysis (PCA), Wilcoxon......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...... smokers). AIM: To identify any difference in gene expression of the descending colonic mucosa between smoking and never-smoking CD patients (and controls) by determining genetic expression profiles from microarray analysis. METHODS: Fifty-seven specimens were obtained by routine colonoscopy from...

  1. Differing Relationship of Psycho-Social Variables with Active Ulcerative Colitis or Crohn's Disease.

    Science.gov (United States)

    Sarid, Orly; Slonim-Nevo, Vered; Schwartz, Doron; Friger, Michael; Sergienko, Ruslan; Pereg, Avihu; Vardi, Hillel; Chernin, Elena; Singer, Terri; Greenberg, Dan; Odes, Shmuel

    2018-03-09

    How psycho-social variables affect the degree of disease activity in patients with ulcerative colitis (UC) or Crohn's disease (CD) is incompletely understood. Therefore, we measured and compared the impact of psycho-social variables on the active disease state in UC and CD. One hundred and twenty-two UC and 305 CD patients with active disease completed questionnaires detailing their psychological symptoms, threatening experiences, disease-coping strategies, satisfaction with life, quality of life, and demographics. UC and CD patients were aged (mean, SD) 38.6 ± 14.0 and 45.2 ± 15.1 years, respectively. The psychological symptom index (median, IQR) was greater in UC 1.24 (0.8) than CD 0.9 (0.8), p psycho-social variables on the active disease state differs between UC and CD, thus indicating a need for specifically tailored psychotherapies.

  2. Crohn's disease of the colon: ultrastructural changes in submuscular interstitial cells of Cajal

    DEFF Research Database (Denmark)

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

    2011-01-01

    of the submuscular plexus were often empty and dilated. Fibroblast-like cells selectively encased macrophages and mast cells. The cytological changes in ICC-SMP in CD are thus similar to changes seen in ulcerative colitis and may be of pathophysiological significance with regard to the motility and sensory......Interstitial cells of Cajal (ICC) at the submuscular border of the human colon (ICC-SMP) are the proposed pacemaker cells of the musculature. In patients with Crohn's disease (CD) of the colon, ICC-SMP showed characteristic cytological changes from controls. The changes comprised secondary...... lysosomes in connection with lipid droplets and cytoplasmic vacuoles or multiple empty, confluent and often outbulging vacuoles merging with cisterns of granular endoplasmic reticulum and clusters of glycogen granules. These changes were most pronounced in patients with macroscopical mucosal inflammation...

  3. Incidence and prevalence of Crohn's disease in the county of Copenhagen, 1962-87

    DEFF Research Database (Denmark)

    Munkholm, P; Langholz, E; Nielsen, O H

    1992-01-01

    The incidence of Crohn's disease increased sixfold from 1962 to 1987 in the county of Copenhagen. The mean annual incidence for 1979-87 was 4.1 per 10(5) inhabitants. The increase was found equally in both sexes, with an approximately 40% higher incidence in women. The maximal incidence was found...... in the 15- to 24-year age group, being 12.8 per 10(5) per year for women and 6.0 per 10(5) per year for men, as mean of the period 1979-87. The prevalence at the end of the study was 54 per 10(5) inhabitants, 46 per 10(5) in men and 63 per 10(5) in women. The clinical appearance of the disease at the time...

  4. Rifaximin-extended intestinal release induces remission in patients with moderately active Crohn's disease.

    Science.gov (United States)

    Prantera, Cosimo; Lochs, Herbert; Grimaldi, Maria; Danese, Silvio; Scribano, Maria Lia; Gionchetti, Paolo

    2012-03-01

    Bacteria might be involved in the development and persistence of inflammation in patients with Crohn's disease (CD), and antibiotics could be used in therapy. We performed a clinical phase 2 trial to determine whether a gastroresistant formulation of rifaximin (extended intestinal release [EIR]) induced remission in patients with moderately active CD. We performed a multicenter, randomized, double-blind trial of the efficacy and safety of 400, 800, and 1200 mg rifaximin-EIR, given twice daily to 402 patients with moderately active CD for 12 weeks. Data from patients given rifaximin-EIR were compared with those from individuals given placebo, and collected during a 12-week follow-up period. The primary end point was remission (Crohn's Disease Activity Index <150) at the end of the treatment period. At the end of the 12-week treatment period, 62% of patients who received the 800-mg dosage of rifaximin-EIR (61 of 98) were in remission, compared with 43% of patients who received placebo (43 of 101) (P = .005). A difference was maintained throughout the 12-week follow-up period (45% [40 of 89] vs 29% [28 of 98]; P = .02). Remission was achieved by 54% (56 of 104) and 47% (47 of 99) of the patients given the 400-mg and 1200-mg dosages of rifaximin-EIR, respectively; these rates did not differ from those of placebo. Patients given the 400-mg and 800-mg dosages of rifaximin-EIR had low rates of withdrawal from the study because of adverse events; rates were significantly higher among patients given the 1200-mg dosage (16% [16 of 99]). Administration of 800 mg rifaximin-EIR twice daily for 12 weeks induced remission with few adverse events in patients with moderately active CD. Copyright © 2012 AGA Institute. Published by Elsevier Inc. All rights reserved.

  5. Mucosal CCR1 gene expression as a marker of molecular activity in Crohn's disease: preliminary data.

    Science.gov (United States)

    Dobre, Maria; Mănuc, Teodora Ecaterina; Milanesi, Elena; Pleşea, Iancu Emil; Ţieranu, Eugen Nicolae; Popa, Caterina; Mănuc, Mircea; Preda, Carmen Monica; Ţieranu, Ioana; Diculescu, Mihai Mircea; Ionescu, Elena Mirela; Becheanu, Gabriel

    2017-01-01

    A series of mechanisms of immune response, inflammation and apoptosis have been demonstrated to contribute to the appearance and evolution of Crohn's disease (CD) through the overexpression of several cytokines and chemokines in a susceptible host. The aim of this study was to identify the differences in gene expression profiles analyzing a panel of candidate genes in the mucosa from patients with active CD (CD-A), patients in remission (CD-R), and normal controls. Nine individuals were enrolled in the study: six CD patients (three with active lesions, three with mucosal healing) and three controls without inflammatory bowel disease (IBD) seen on endoscopy. All the individuals underwent mucosal biopsy during colonoscopy. Gene expression levels of 84 genes previously associated with CD were evaluated by polymerase chain reaction (PCR) array. Ten genes out of 84 were found significantly differentially expressed in CD-A (CCL11, CCL25, DEFA5, GCG, IL17A, LCN2, REG1A, STAT3, MUC1, CCR1) and eight genes in CD-R (CASP1, IL23A, STAT1, STAT3, TNF, CCR1, CCL5, and HSP90B1) when compared to controls. A quantitative gene expression analysis revealed that CCR1 gene was more expressed in CD-A than in CD-R. Our data suggest that CCR1 gene may be a putative marker of molecular activity of Crohn's disease. Following these preliminary data, a confirmation in larger cohort studies could represent a useful method in order to identify new therapeutic targets.

  6. Safety of infliximab in Crohn's disease: a large single-center experience.

    Science.gov (United States)

    Hamzaoglu, H; Cooper, J; Alsahli, M; Falchuk, K R; Peppercorn, M A; Farrell, R J

    2010-12-01

    The aim of this study was to evaluate the short- and long-term safety experience of infliximab treatment in patients with Crohn's disease (CD) in clinical practice. The medical records of 297 consecutive patients with CD treated with infliximab at the Beth Israel Deaconess Medical Center were reviewed for demographic features and adverse events. The 297 patients received a total of 1794 infusions. Patients received a median of four infusions and had a median follow-up of 14.3 months. Forty-four patients (15%) experienced a serious adverse event, requiring the infusion to be stopped in 33 patients (11%). Acute infusion reactions occurred in 18 patients (6%) including respiratory problems in 10 patients (3%) and an anaphylactoid reaction in 1 patient (0.3%). Serum sickness-like disease occurred in one patient (0.3%) and three patients (1%) developed drug-induced lupus. One patient developed a probable new demyelination disorder. Eight patients (2.7%), all of whom were on concurrent immunosuppressants, developed a serious infection, one resulting in fatal sepsis. Six patients (2%) developed malignancies including two lymphomas and two skin cancers. A total of four (1.3%) deaths were observed (median age 72.5 years); two due to gastrointestinal bleeding, one due to sepsis, and one due to malignancy. While short- and long-term infliximab therapy was generally well tolerated, serious adverse events occurred in 15% of patients including drug-induced lupus, fatal sepsis, and malignancy. Concomitant immunosuppressants were significantly associated with infections and deaths, particularly among elderly patients. Copyright © 2010 Crohn's & Colitis Foundation of America, Inc.

  7. Intravenous hydrocortisone premedication reduces antibodies to infliximab in Crohn's disease: a randomized controlled trial.

    Science.gov (United States)

    Farrell, Richard J; Alsahli, Mazen; Jeen, Yoon-Tae; Falchuk, Kenneth R; Peppercorn, Mark A; Michetti, Pierre

    2003-04-01

    We assessed the relationship between antibodies to infliximab (ATI) and the loss of response postinfliximab, infusion reactions and, in a randomized trial, investigated whether intravenous hydrocortisone premedication can reduce ATI. Initially, we prospectively evaluated clinical response, adverse events, and ATI levels in 53 consecutive patients with Crohn's disease who received 199 infliximab (5 mg/kg) infusions. Subsequently, 80 patients with Crohn's disease were randomized to intravenous hydrocortisone 200 mg or placebo immediately before their first and subsequent infliximab infusions. The primary endpoint was reduction in median ATI levels at week 16. Analysis was by intention to treat. Nineteen of our initial 53 patients (36%) developed ATI, including all 7 patients with serious infusion reactions (median ATI level, 19.6 microg/mL). Eleven of 15 patients (73%) who lost their initial response were ATI positive compared with none of 21 continuous responders, (8.9 vs. 0.7 microg/mL, P < 0.0001). Administering a second infusion within 8 weeks of the first (OR, 0.13; 95% CI, 0.03-0.5; P = 0.0007) or concurrent immunosuppressants (OR, 0.19; 95% CI, 0.04-1.03; P = 0.007) significantly reduced ATI formation. In the placebo-controlled trial, ATI levels were lower at week 16 among hydrocortisone-treated patients (1.6 vs. 3.4 microg/mL, P = 0.02), and 26% of hydrocortisone-treated patients developed ATI compared with 42% of placebo-treated patients, P = 0.06. Loss of initial response and infusion reactions post-infliximab is strongly related to ATI formation and level. Administering a second infusion within 8 weeks of the first and concurrent immunosuppressant therapy significantly reduce ATI formation. Intravenous hydrocortisone premedication significantly reduces ATI levels but does not eliminate ATI formation or infusion reactions.

  8. Optimizing management of Crohn's disease within a project management framework: results of a pilot study.

    Science.gov (United States)

    Keefer, Laurie; Doerfler, Bethany; Artz, Caroline

    2012-02-01

    Psychotherapy for Crohn's disease (CD) has focused on patients with psychological distress. Another approach to optimize management of CD is to target patients who do not exhibit psychological distress but engage in behaviors that undermine treatment efficacy / increase risk for flare. We sought to determine the feasibility/acceptability and estimate the effects of a program framed around Project Management (PM) principles on CD outcomes. Twenty-eight adults with quiescent CD without a history of psychiatric disorder were randomized to PM (n = 16) or treatment as usual (TAU; n = 12). Baseline and follow-up measures were Inflammatory Bowel Disease Questionnaire (IBDQ), Medication Adherence Scale (MAS), Perceived Stress Questionnaire (PSQ), and IBD Self-Efficacy Scale (IBD-SES). There were significant group × time effects favoring PM on IBDQ-Total Score (F(1) = 15.2, P = 0.001), IBDQ-Bowel (F(1) = 6.5, P = 0.02), and IBDQ-Systemic (F(1) = 9.3, P = 0.007) but not IBDQ-Emotional (F(1) = 1.9, P = ns) or IBDQ-Social (F(1) = 2.4, P = ns). There was a significant interaction effect favoring PM with respect to PSQ (F(1) = 8.4, P = 0.01) and IBD-SES (F(1) = 12.2, P = 0.003). There was no immediate change in MAS (F(1) = 4.3, P = ns). Moderate effect sizes (d > 0.30) were observed for IBDQ total score (d = 0.45), IBDQ bowel health (d = 0.45), and systemic health (d = 0.37). Effect sizes for PSQ (d = 0.13) and IBDSES (d = 0.17) were smaller. Behavioral programs that appeal to patients who may not seek psychotherapy for negative health behaviors may improve quality of life and potentially disease course and outcomes. Copyright © 2011 Crohn's & Colitis Foundation of America, Inc.

  9. The Impact of Ostomy on Quality of Life and Functional Status of Crohn's Disease Patients.

    Science.gov (United States)

    Abdalla, Maisa I; Sandler, Robert S; Kappelman, Michael D; Martin, Christopher F; Chen, Wenli; Anton, Kristen; Long, Millie D

    2016-11-01

    The potential need for an ostomy is a main concern for patients with inflammatory bowel disease. We performed this study to evaluate the impact of a long-term ostomy (≥6 mo duration) on the functional status and specific patient-reported outcomes in a population of patients with Crohn's disease (CD). We performed a cross-sectional analysis within the Crohn's and Colitis Foundation of America Partners cohort. Bivariate analyses and logistic regression models were used to investigate associations between ostomy and various demographic, disease factors, and patient-reported outcomes for health-related quality of life. A total of 402 CD patients with ostomy for a minimum duration of 6 months were compared with 4331 CD patients with no ostomy. Patients with ostomy were more likely to be in clinical remission compared with those without ostomy, 48.5% versus 31.3%, respectively. Having an ostomy did not impact the overall health-related quality of life and was not associated with anxiety, depression, sleep disturbances, or reduced sexual interest and satisfaction. However, the presence of ostomy was associated with reduced social role satisfaction in both patients with controlled and active disease. Additionally, in the subset of patients who did not achieve clinical remission, those with ostomy experienced greater pain interference (odds ratio, 1.63; 95% confidence interval, 1.12-2.35) and fatigue (odds ratio, 1.66; 95% confidence interval, 1.15-2.39). Ostomy is well tolerated in CD patients, particularly when clinical remission is achieved.

  10. Concomitant Use of Immunomodulators Affects the Durability of Infliximab Therapy in Children With Crohn's Disease.

    Science.gov (United States)

    Grossi, Victoria; Lerer, Trudy; Griffiths, Anne; LeLeiko, Neal; Cabrera, Jose; Otley, Anthony; Rick, James; Mack, David; Bousvaros, Athos; Rosh, Joel; Grossman, Andrew; Saeed, Shehzaad; Kay, Marsha; Boyle, Brendan; Oliva-Hemker, Maria; Keljo, David; Pfefferkorn, Marian; Faubion, William; Kappelman, Michael D; Sudel, Boris; Markowitz, James; Hyams, Jeffrey S

    2015-10-01

    It is important to determine the effects of immunomodulators on the ability of children to remain on infliximab therapy for Crohn's disease (durability of therapy), given the potential benefits and risks of concomitant therapy-especially with thiopurines in male patients. We investigated how immunomodulatory treatment affects the durability of infliximab therapy. We collected data from the Pediatric Inflammatory Bowel Disease Collaborative Research Group Registry, from January 2002 through August 2014, on 502 children with Crohn's disease who participated in a prospective multicenter study. Data were collected from patients who received at least a 3-dose induction regimen of infliximab, and their concomitant use of immunomodulators: no thiopurine or methotrexate treatment, treatment for 6 months or less during infliximab therapy, or treatment for more than 6 months during infliximab therapy. The probabilities (± standard error) that children remained on infliximab therapy for 1 year, 3 years, and 5 years after the treatment began were 0.84 ± 0.02, 0.69 ± 0.03, and 0.60 ± 0.03, respectively. Age, sex, and disease extent or location did not affect the durability of infliximab therapy. Greater length of concomitant use of immunomodulators was associated with increased time of infliximab therapy. The probability that patients with more than 6 months of immunomodulator use remained on infliximab therapy for 5 years was 0.70 ± 0.04, compared with 0.48 ± 0.08 for patients who did not receive immunomodulators and 0.55 ± 0.06 for patients who received immunomodulators for 6 months or less (P immunomodulators for 6 months or more after starting infliximab, the overall durability of infliximab therapy was greater among patients receiving methotrexate than thiopurine (P immunomodulator for more than 6 months after starting infliximab therapy increases the chances that patients will remain on infliximab. In boys, methotrexate appears to increase the durability of

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

    Directory of Open Access Journals (Sweden)

    Albers Lisette

    2011-01-01

    Full Text Available Abstract 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 especially perianal Crohn's disease. Methods This is a retrospective cohort study which was performed in a tertiary level referral hospital in the Netherlands. From the IBD database, female patients aged 18-80 years in 2004 were selected. Data analysis took place in the years 2005 and 2006. Eventually, 114 women with at least one pregnancy after the diagnosis of Crohn's disease were eligible for the study. Differences between groups were analyzed using Wilcoxon Mann Whitney tests and Chi-square analysis with 2 × 2 or 2 × 3 contingency tables. Two-tailed values were used and p values Results 21/114 women (18% had active luminal disease prior to pregnancy, with significantly more pregnancy related complications compared to women with inactive luminal disease (Odds ratio 2.8; 95% CI 1.0 - 7.4. Caesarean section rate was relatively high (37/114, 32%, especially in patients with perianal disease prior to pregnancy compared to women without perianal disease (Odds ratio 4.6; 95% CI 1.8 - 11.4. Disease progression after childbirth was more frequent in patients with active luminal disease prior to pregnancy compared to inactive luminal disease (Odds ratio 9.7; 95% CI 2.1 - 44.3. Progression of perianal disease seems less frequent after vaginal delivery compared with caesarean section, in both women with prior perianal disease (18% vs. 31%, NS and without prior perianal disease (5% vs 14%, NS. There were no more fistula-related complications after childbirth in women with an episiotomy or second degree tear. Conclusion A relatively high rate of caesarean sections was observed in women with Crohn's disease, especially in women with perianal disease

  12. Crohn disease

    Science.gov (United States)

    ... Other stressful events in your life, such as moving, a job loss, or the loss of a loved one can worsen digestive problems. Ask your provider for tips on how to manage your stress . MEDICINES You can take medicine to treat very ...

  13. Crohn's Disease

    Science.gov (United States)

    ... Definition & Facts Symptoms & Causes Diagnosis Treatment Eating, Diet, & Nutrition Clinical Trials Acid Reflux (GER & GERD) in Children & Teens Definition & Facts Symptoms & Causes Diagnosis Treatment Eating, Diet, & Nutrition Clinical Trials Acid Reflux (GER & GERD) in Infants Definition & ...

  14. Crohn's Disease

    Science.gov (United States)

    ... headsets so that the child can watch a movie while the scan is being performed. Thus, the ... the possible charges you will incur. Web page review process: This Web page is reviewed regularly by ...

  15. 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.

    Directory of Open Access Journals (Sweden)

    Joachim Høg Mortensen

    Full Text Available 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 patients, 22 patients with irritable bowel syndrome (IBS, and 24 healthy donors. One-way analysis of variance, Mann-Whitney U-test, logistic regression models, and receiver operator characteristics (ROC curve analysis was carried out to evaluate the diagnostic accuracy of the biomarkers.The ECM 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. Furthermore, BGM and EL-NE biomarkers were highly associated with colon inflammation in CD patients.ECM fragments of tissue remodelling in IBD affect UC and CD differently, and may aid in differentiating IBD from IBS (EL-NE, BGM, Pro-C5, and UC from CD patients (BGM, VICM. Formation of type V collagen is related to the level of inflammation in CD and may reflect disease activity in CD.

  16. Crohn's disease intestinal CD4+ T cells have impaired interleukin-10 productionwhich is not restored by probiotic bacteria

    DEFF Research Database (Denmark)

    Hvas, Christian L; Kelsen, Jens; Agnholt, Jørgen

    2007-01-01

    OBJECTIVE: Crohn's disease (CD) has been associated with low mucosal interleukin (IL)-10 production, but the mechanism behind this deficiency remains unclear. The aim of this study was to investigate IL-10 and interferon (IFN)-gamma production in intestinal CD4+ T cells from CD patients and healthy...... volunteers (HV) and to examine how this was affected by bacterial products and the presence or absence of autologous dendritic cells. MATERIAL AND METHODS: We cultured intestinal CD4+ T cells from CD patients (n=9) and HV (n=6) and differentiated dendritic cells from their peripheral monocytes. Intestinal T...... this imbalance in CD, but tended to do so in HV. When there were no dendritic cells, CD intestinal T cells responded to autologous bacteria with an increased IFN-gamma production (2.3+/-1.3 ng/ml) compared with HV intestinal T cells (0.3+/-0.2 ng/ml). CONCLUSIONS: Crohn's disease intestinal CD4+ T cells display...

  17. Accurate cut-offs for predicting endoscopic activity and mucosal healing in Crohn's disease with fecal calprotectin

    Directory of Open Access Journals (Sweden)

    Juan María Vázquez-Morón

    Full Text Available Background: Fecal biomarkers, especially fecal calprotectin, are useful for predicting endoscopic activity in Crohn's disease; however, the cut-off point remains unclear. The aim of this paper was to analyze whether faecal calprotectin and M2 pyruvate kinase are good tools for generating highly accurate scores for the prediction of the state of endoscopic activity and mucosal healing. Methods: The simple endoscopic score for Crohn's disease and the Crohn's disease activity index was calculated for 71 patients diagnosed with Crohn's. Fecal calprotectin and M2-PK were measured by the enzyme-linked immunosorbent assay test. Results: A fecal calprotectin cut-off concentration of ≥ 170 µg/g (sensitivity 77.6%, specificity 95.5% and likelihood ratio +17.06 predicts a high probability of endoscopic activity, and a fecal calprotectin cut-off of ≤ 71 µg/g (sensitivity 95.9%, specificity 52.3% and likelihood ratio -0.08 predicts a high probability of mucosal healing. Three clinical groups were identified according to the data obtained: endoscopic activity (calprotectin ≥ 170, mucosal healing (calprotectin ≤ 71 and uncertainty (71 > calprotectin < 170, with significant differences in endoscopic values (F = 26.407, p < 0.01. Clinical activity or remission modified the probabilities of presenting endoscopic activity (100% vs 89% or mucosal healing (75% vs 87% in the diagnostic scores generated. M2-PK was insufficiently accurate to determine scores. Conclusions: The highly accurate scores for fecal calprotectin provide a useful tool for interpreting the probabilities of presenting endoscopic activity or mucosal healing, and are valuable in the specific clinical context.

  18. Prediagnostic Serum Vitamin D Levels and the Risk of Crohn's Disease and Ulcerative Colitis in European Populations

    DEFF Research Database (Denmark)

    Opstelten, Jorrit L; Chan, Simon S M; Hart, Andrew R

    2018-01-01

    Background: A low vitamin D status has been put forward as a potential risk factor for the development of inflammatory bowel disease (IBD). This study investigated the association between prediagnostic circulating vitamin D concentrations and dietary intakes of vitamin D, and the risk of Crohn...... with the development of CD or UC. This does not suggest a major role for vitamin D deficiency in the etiology of IBD, although larger studies are needed to confirm these findings....

  19. Stress, coping and support needs of patients with ulcerative colitis or Crohn's disease: a qualitative descriptive study.

    Science.gov (United States)

    Larsson, Kjerstin; Lööf, Lars; Nordin, Karin

    2017-03-01

    To examine disease-related stress, coping strategies and the need for information and support in patients with inflammatory bowel disease (ulcerative colitis or Crohn's disease). Psychological stress is an important factor in ulcerative colitis and Crohn's disease, and therefore, coping strategies and support needs should be considered in routine clinical practice. This is a qualitative study using a descriptive interview-based approach. Fifteen patients with ulcerative colitis (n = 7) or Crohn's disease (n = 8) were interviewed. The interviews were analysed with content analysis. The informants largely focused on disease-related stress (e.g. access to a toilet, symptoms and worries) and relations to other people (various reactions from others and social situations). Behavioural strategies (i.e. taking actions and the need for making plans, prepare and adapt), social strategies (seeking help and information and sharing feelings about the disease with others) and emotional strategies (distraction, positive attitude and acceptance) were adopted to cope with the stress associated with the disease. The need for information and support concerned instrumental support (disease-related information) and emotional support (to talk about disease management). Faecal urgency and the fear of losing bowel control are important stressors for patients with inflammatory bowel disease. The patients handle this problem using various coping strategies depending on the type of stressful events. Both instrumental and emotional support were requested which primarily occurred at the time of diagnosis and disease flare-ups. Patients with ulcerative colitis or Crohn's disease ask for information and psychosocial support that are tailored to their individual needs and at different stages in the disease trajectory to improve everyday life and strengthen self-management strategies. © 2016 John Wiley & Sons Ltd.

  20. Vedolizumab: a review of its use in adult patients with moderately to severely active ulcerative colitis or Crohn's disease.

    Science.gov (United States)

    Garnock-Jones, K P

    2015-02-01

    Vedolizumab (Entyvio™) is a humanized monoclonal antibody α4β7 integrin-receptor antagonist indicated for the treatment of adult patients with moderately to severely active ulcerative colitis or Crohn's disease. This article reviews the pharmacological properties of intravenous infusions of vedolizumab and its clinical efficacy in adult patients with these diseases. In phase III clinical trials, patients with ulcerative colitis had significantly higher rates of clinical response and clinical remission when treated with vedolizumab than when receiving placebo at both 6 and 52 weeks. However, outcomes with vedolizumab in patients with Crohn's disease were mixed. In a study that evaluated both clinical remission rate and CDAI-100 response rate as primary endpoints, only the clinical remission rate at 6 weeks was significantly higher with vedolizumab than placebo. In another trial, there was no significant between-group difference in the clinical remission rate in TNF-antagonist failure patients at 6 weeks (primary endpoint), although there was a significant difference at 10 weeks. In the Crohn's disease study that included maintenance treatment, vedolizumab was significantly more effective at 52 weeks than placebo in both endpoints (clinical remission was the only primary endpoint in the maintenance study). Vedolizumab was generally well tolerated in these trials. As vedolizumab is a specific α4β7 integrin antagonist, with gut-specific effects, it is unlikely to be associated with the development of progressive multifocal leukoencephalopathy, a risk observed with the less selective α4β7/α4β1 integrin antagonist natalizumab. Vedolizumab is a useful addition to the treatment options available for patients with moderately to severely active ulcerative colitis and Crohn's disease.

  1. Is there a benefit from the concomitant use of immunosupression with anti-TNF in Crohn's disease; heads or tails?

    Science.gov (United States)

    Lakatos, Peter Laszlo

    2009-09-01

    Over the last some years the increasing knowledge on the pathogenesis of Crohn's disease led to the development of a number of biological agents targeting specific molecules involved in gut inflammation, first of all TNF-alpha and its receptors. Infliximab, adalimumab and certolizumab have been successful in inducing and maintaining remission in Crohn's disease at both short and long term. This was recently confirmed by a Cochrane meta-analysis and also open label extension follow-up and cohort studies. Emerging new data however indicate that combination therapy with infliximab-azathioprine appears to have added benefit in inducing steroid-free remission and mucosal healing than either infliximab or azathioprine alone in azathioprine-naïve patients with early disease. Similarly the combination of steroids induction and infliximab was efficacious in luminal Crohn's disease. In contrast, there seems to be no synergism between methotrexate and infliximab. It is also less clear whether it is beneficial to use short or long-term infliximab-azathioprine combination in patients who previously failed therapy with azathioprine. In contrast, combination may potentially be associated with increased risk for infection and cancer. In case control-studies, especially the combination of steroids and anti-TNF and older age increased the risk for infectious complications, while scattered case reports point to the potentially increased risk of a rare form of non-Hodgkin's lymphoma (Hepatosplenic T cell lymphoma) with the use of azathioprine-anti-TNF combination. The aim of this review is to summarize the benefits and risks for the use combination therapy with TNF-alpha inhibitors in the treatment of Crohn's disease.

  2. Adalimumab for maintenance therapy for one year in Crohn's disease: results of a Latin American single-center observational study.

    Science.gov (United States)

    Kotze, Paulo Gustavo; Abou-Rejaile, Vinícius Rezende; Uiema, Luciana Aparecida; Olandoski, Marcia; Sartor, Maria Cristina; Miranda, Eron Fábio; Kotze, Lorete Maria da Silva; Saad-Hossne, Rogério

    2014-01-01

    Adalimumab is a fully-human antibody that inhibits TNF alpha, with a significant efficacy for long-term maintenance of remission. Studies with this agent in Latin American Crohn's disease patients are scarce. The objective of this study was to outline clinical remission rates after 12 months of adalimumab therapy for Crohn's disease patients. Retrospective, single-center, observational study of a Brazilian case series of Crohn's disease patients under adalimumab therapy. Variables analyzed: demographic data, Montreal classification, concomitant medication, remission rates after 1, 4, 6 and 12 months. Remission was defined as Harvey-Bradshaw Index ≤ 4, and non-responder-imputation and last-observation-carried-forward analysis were used. The influence of infliximab on remission rates was analyzed by Fischer and Chi-square tests (Panalysis. After 12 months, remission on patients with previous infliximab occurred in 69.23% as compared to 94.59% in infliximab-naïve patients (P = 0.033). Adalimumab was effective in maintaining clinical remission after 12 months of therapy, with an adequate safety profile, and was also more effective in infliximab naïve patients.

  3. Perspectives of IBD China: Is Crohn's and Colitis Foundation Model a Solution to Health Care Issues for the Country?

    Science.gov (United States)

    Chen, Yan

    2018-04-21

    The success of the Crohn's and Colitis Foundation of America (CCFA), now Crohn's and Colitis Foundation (CCF) has established a role model for developing countries with an increasing incidence of inflammatory bowel disease (IBD), including China. While there are shared etiopathogenetic pathways and clinical features in IBD between Eastern and Western countries, patients with IBD as well as health care professionals in China are facing distinctive challenges, including the fragmented and inconsistent health insurance, social support system, and three-tiered health care service. Financial burden remains to be a tremendous obstacle to the management of IBD. In addition, poor rapport between patients and clinicians, and the lack of properly trained IBD specialists makes a noticeable gap in the management of IBD between China and Western countries. The China Crohn's &Colitis Foundation (CCCF), closely following the successful model of CCF, was established under the same doctrine, and served as a non-profit, volunteer-driven organization dedicated to improving quality of life of patients in by IBD through education and training.

  4. Detection of Crohn's disease: Comparison of CT and MR enterography without anti-peristaltic agents performed on the same day

    International Nuclear Information System (INIS)

    Grand, David J.; Beland, Michael D.; Machan, Jason T.; Mayo-Smith, William W.

    2012-01-01

    Objective: To directly compare CT enterography (CTE) and MR enterography (MRE) without antiperistaltic agents. Materials/methods: 26 patients referred for CTE underwent CTE immediately followed by MRE without use of an anti-peristaltic agent. Each study was evaluated on a 10 point scale for exam quality, level of diagnostic confidence, and presence of Crohn's disease. Kappa analysis was performed to determine the degree of agreement between the CTE and MRE of each patient. Results: 25 patients completed the MRE. The quality of the CTEs was judged as excellent by both readers (reader 1 = average 9.5/10, reader 2 = average 9.1/10). The quality of the MREs was ranked lower than the CTEs by both readers (reader 1 = average 8.9/10, reader 2 = average 7.2/10), which was statistically significant (p < 0.05). The level of confidence in interpretation was not significantly different between CTE and MRE for reader 1 or 2 (p = 0.3). There was substantial agreement between readers for the presence or absence of Crohn's disease on both CTE (kappa = 0.75) and MRE (kappa = 0.67). Conclusion: MR enterography without anti-peristaltic agents results in high diagnostic confidence and excellent agreement for the presence of Crohn's disease.

  5. Location and activity of ulcerative and Crohn's colitis by 111In leukocyte scan. A prospective comparison study

    International Nuclear Information System (INIS)

    Stein, D.T.; Gray, G.M.; Gregory, P.B.; Anderson, M.; Goodwin, D.A.; McDougall, I.R.

    1983-01-01

    A prospective blinded study comparing the 111 In leukocyte scan to barium enema, colonoscopy, or surgery or a combination of these, was carried out in 15 patients (10 with active ulcerative colitis and 5 with active Crohn's colitis). Correlation of disease location to colonic regions between indium scan and other diagnostic studies was excellent in 11 instances, good in 2, and poor in 3. In 2 of the 3 studies where major disagreement occurred, the comparative barium enema was performed greater than 2 mo after the indium scan. Disease activity, estimated by the intensity of radionuclide uptake, was compared to clinical disease activity assessed by the Crohn's Disease Activity Index for both forms of colitis. The relative degree of inflammation estimated by the indium scan correlated well with the independent clinical assessment (correlation coefficient . 0.81). The indium 111 leukocyte scan appears to be an accurate, noninvasive method for assessing the extent and the severity of the inflammation in patients with acute ulcerative or Crohn's colitis

  6. Intestinal permeability to (/sup 51/Cr)EDTA in children with Crohn's disease and celiac disease

    Energy Technology Data Exchange (ETDEWEB)

    Turck, D.; Ythier, H.; Maquet, E.; Deveaux, M.; Marchandise, X.; Farriaux, J.P.; Fontaine, G.

    1987-07-01

    (/sup 51/Cr)EDTA was used as a probe molecule to assess intestinal permeability in 7 healthy control adults, 11 control children, 17 children with Crohn's disease, and 6 children with untreated celiac disease. After subjects fasted overnight, 75 kBq/kg (= 2 microCi/kg) /sup 51/Cr-labeled EDTA was given by mouth; 24-h urinary excretion of (/sup 51/Cr)EDTA was measured and expressed as a percentage of the total oral dose. Mean and SD were as follows: control adults 1.47 +/- 0.62, control children 1.59 +/- 0.55, and patients with Crohn's disease or celiac disease 5.35 +/- 1.94. The difference between control children and patients was statistically significant (p less than 0.001). These results show that intestinal permeability to (/sup 51/Cr)EDTA is increased among children with active or inactive Crohn's disease affecting small bowel only or small bowel and colon, and with untreated celiac disease. The (/sup 51/Cr)EDTA permeability test could facilitate the decision to perform more extensive investigations in children suspected of small bowel disease who have atypical or poor clinical and biological symptomatology.

  7. Photobiologisch aktive Beschichtungsmasse und ihre Verwendung

    OpenAIRE

    Danz, R.; Elling, B.; Buechtemann, A.

    2005-01-01

    DE 19935179 A UPAB: 20010515 NOVELTY - A photobiologically active coating mass containing (a) a visible light-transparent polymeric binder and (b) an active substance which is electronically excitable by visible light and produces singlet oxygen and/or organic radicals is new. ACTIVITY - Antibacterial; virucide. USE - The coating mass is useful in plant protection, food, medical and textile technology, sanitation and environmental protection. In particular, it can be used for the coating of p...

  8. Marketingové aktivity ve sportu

    OpenAIRE

    Janoušková, Veronika

    2009-01-01

    Bachelor document presents marketing activities which are use in sport departments. Theoretic part presents marketing, marketing mix and marketing mix in sport. Practical part is about marketing mix in the czech football club Bohemians 1905, a.s. I evaluate their tools in marketing mix and try to find out some new solutions and give them some new introductions.

  9. Aktive og passive valg i pensionsopsparingen

    DEFF Research Database (Denmark)

    Nielsen, Torben Heien

    2017-01-01

    This paper reviews two papers from my own research. I show that the effect of pension policies are highly dependent on which type of decision maker the policy targets. Specifically, the effectiveness of the policy is stronger if it affects passive choice. Such policies, e.g., employer pensions......, are extremely effective in increasing total individual savings. Tax deductions on the other hand are ineffective. The reason is that an estimated 85 % of the population are passive savers, who do not respond to changes in policies. Consequently, an increased labor market pension rate will also make their total...

  10. Poslechové aktivity v praxi

    OpenAIRE

    Tetourová, Markéta

    2015-01-01

    The content of this Diploma Thesis is dedicated to the listening activities in Music lessons at primary schools. The Diploma Thesis summarizes the history of listening activities in Music lessons. It deals with the position of Musical education in Framework Educational Programme. The Diploma Thesis comprises the overview of all the most frequently used music textbooks for primary schools. The textbooks are sorted according to the publisher. The Diploma Thesis examines whether the music textbo...

  11. Prediction of complicated disease course for children newly diagnosed with Crohn's disease: a multicentre inception cohort study.

    Science.gov (United States)

    Kugathasan, Subra; Denson, Lee A; Walters, Thomas D; Kim, Mi-Ok; Marigorta, Urko M; Schirmer, Melanie; Mondal, Kajari; Liu, Chunyan; Griffiths, Anne; Noe, Joshua D; Crandall, Wallace V; Snapper, Scott; Rabizadeh, Shervin; Rosh, Joel R; Shapiro, Jason M; Guthery, Stephen; Mack, David R; Kellermayer, Richard; Kappelman, Michael D; Steiner, Steven; Moulton, Dedrick E; Keljo, David; Cohen, Stanley; Oliva-Hemker, Maria; Heyman, Melvin B; Otley, Anthony R; Baker, Susan S; Evans, Jonathan S; Kirschner, Barbara S; Patel, Ashish S; Ziring, David; Trapnell, Bruce C; Sylvester, Francisco A; Stephens, Michael C; Baldassano, Robert N; Markowitz, James F; Cho, Judy; Xavier, Ramnik J; Huttenhower, Curtis; Aronow, Bruce J; Gibson, Greg; Hyams, Jeffrey S; Dubinsky, Marla C

    2017-04-29

    Stricturing and penetrating complications account for substantial morbidity and health-care costs in paediatric and adult onset Crohn's disease. Validated models to predict risk for complications are not available, and the effect of treatment on risk is unknown. We did a prospective inception cohort study of paediatric patients with newly diagnosed Crohn's disease at 28 sites in the USA and Canada. Genotypes, antimicrobial serologies, ileal gene expression, and ileal, rectal, and faecal microbiota were assessed. A competing-risk model for disease complications was derived and validated in independent groups. Propensity-score matching tested the effect of anti-tumour necrosis factor α (TNFα) therapy exposure within 90 days of diagnosis on complication risk. Between Nov 1, 2008, and June 30, 2012, we enrolled 913 patients, 78 (9%) of whom experienced Crohn's disease complications. The validated competing-risk model included age, race, disease location, and antimicrobial serologies and provided a sensitivity of 66% (95% CI 51-82) and specificity of 63% (55-71), with a negative predictive value of 95% (94-97). Patients who received early anti-TNFα therapy were less likely to have penetrating complications (hazard ratio [HR] 0·30, 95% CI 0·10-0·89; p=0·0296) but not stricturing complication (1·13, 0·51-2·51; 0·76) than were those who did not receive early anti-TNFα therapy. Ruminococcus was implicated in stricturing complications and Veillonella in penetrating complications. Ileal genes controlling extracellular matrix production were upregulated at diagnosis, and this gene signature was associated with stricturing in the risk model (HR 1·70, 95% CI 1·12-2·57; p=0·0120). When this gene signature was included, the model's specificity improved to 71%. Our findings support the usefulness of risk stratification of paediatric patients with Crohn's disease at diagnosis, and selection of anti-TNFα therapy. Crohn's and Colitis Foundation of America, Cincinnati

  12. Accuracy of CT enterography and magnetic resonance enterography imaging to detect lesions preoperatively in patients undergoing surgery for Crohn's disease.

    Science.gov (United States)

    Seastedt, Kenneth P; Trencheva, Koiana; Michelassi, Fabrizio; Alsaleh, Doaa; Milsom, Jeffrey W; Sonoda, Toyooki; Lee, Sang W; Nandakumar, Govind

    2014-12-01

    CT enterography and magnetic resonance enterography have emerged as first-line imaging technologies for the evaluation of the gastrointestinal tract in Crohn's disease. The purpose of this work was to evaluate the accuracy of these imaging modalities to identify Crohn's disease lesions preoperatively. This was a retrospective chart review. The study was conducted at a single institution. Seventy-six patients with Crohn's disease with preoperative CT enterography and/or magnetic resonance enterography were included in the study. The number of stenoses, fistulas, and abscesses on CT enterography and/or magnetic resonance enterography before surgery were compared with operative findings. Forty patients (53%) were women, 46 (60%) underwent surgery for recurrent Crohn's disease, and 46 (57%) had previous abdominal surgery. Thirty-six (47%) had a preoperative CT enterography and 43 (57%) had a preoperative magnetic resonance enterography. CT enterography sensitivity was 75% for stenosis and 50% for fistula. MRE sensitivity was 68% for stenosis and 60% for fistula. The negative predictive values of CT enterography and magnetic resonance enterography for stenosis were very low (54% and 65%) and were 85% and 81% for fistula. CT enterography had 76% accuracy for stenosis and 79% for fistula; magnetic resonance enterography had 78% accuracy for stenosis and 85% for fistula. Both were accurate for abscess. False-negative rates for CT enterography were 50% for fistula and 25% for stenosis. False-negative rates for magnetic resonance enterography were 40% for fistula and 32% for stenosis. Unexpected intraoperative findings led to modification of the planned surgical procedure in 20 patients (26%). This study was limited by its small sample size, its retrospective nature, and that some studies were performed at outside institutions. CT enterography and magnetic resonance enterography in patients with Crohn's disease were accurate for the identification of abscesses but not for

  13. Surgery, Crohn's disease, and the biological era: has there been an impact?

    LENUS (Irish Health Repository)

    Slattery, Eoin

    2012-02-01

    INTRODUCTION: The management of Crohn\\'s disease (CD) has changed considerably over the last 20 years. Immunomodulators and biological therapies now play a role in treating patients with CD, but little is known of their influence on surgical rates. AIM: To review the surgery rates for CD in an Irish university hospital over a 20-year period and to determine whether newer therapies had an impact on surgical rates. METHOD: Seven hundred twenty-two patients attending St Vincent\\'s University Hospital, Dublin, with CD over a 20-year period (January 1986 to December 2005) were identified. The patients were divided into quartiles. Resection rates were determined in all the quartiles, at both 1 and 3 years from diagnosis. RESULTS: A decline in surgery, 3 years from diagnosis, was noted between the first quartile (72 patients, 40%) and the second quartile (58 patients, 32%; P=0.03). No significant change in surgical rates at 3 years occurred between the other 3 quartiles (32%, 30%, and 35%, respectively; P=NS). The patients who required a resection within 3 years were diagnosed at a younger age in later years. There was a similar predominance of 60% of female patients requiring surgery in all groups. The patients requiring surgery were twice as likely to be ex-smokers or current smokers in all groups. Use of infliximab, within 3 years from diagnosis, increased from 0, 0, and 16 patients (8.8%) to 40 patients (22.1%) in the last quartile. The majority of patients were treated with infliximab on an "on demand" basis. Use of infliximab earlier within the course of the disease was seen in later quartiles (ie, within 1 y of diagnosis): 0, 0, 6, and 21 patients. CONCLUSION: Despite the introduction of infliximab over the past 10 years, no demonstrable difference has been seen in the rates of patients requiring resection surgery within 3 years of diagnosis. The reasons for this are unclear, but may relate to episodic treatment, rather than regular maintenance treatment. Female

  14. Crohn's Disease: current state of biological therapy Doença de Crohn: estado atual da terapia biológica

    Directory of Open Access Journals (Sweden)

    Júlio César Monteiro Santos Júnior

    2011-12-01

    Full Text Available The inflammatory bowel diseases (IBD are defined as nonspecific chronic intestinal inflammations with possible systemic involvement. IBD have unknown etiology. The inflammatory process is complex and heterogeneous, both as to the characterization of the disease that affects the digestive tract, without an intelligible pattern of revelation and balance, and in its different systemic damages when including the extensive and severe extraintestinal symptoms. Aparently, the natural history of the disease is irregular in relation to the offending agent system and the attacked system, both in the intestinal and extraintestinal teguments. Isolated aspects showing irregularity in this balance gives us the notion that IBD, especially Crohn's disease, can be caused by the stimulation of an immune response caused by damaging agents (intestinal bacteria, but mediated by inadequate genetic factors, whose expressions determine different individual susceptibilities. These observations have been shown in genetic studies that emphasize the importance of pathological interaction between host and bacteria subsidized by a genomic region that contains genes producing proteins (NOD2 - nucleotide-binding oligomerization domain containing 2 participating in an enhanced defense response by the tissue. Increased numbers and the activation of these cells in the intestinal mucosa elevate local levels of tumor necrosis factor α (TNF-α, interleukin-1β, interferon-Γ, and cytokines of the interleukin-23-Th17 pathway. So, it can be assumed that the susceptibility, which is a result of genetic alterations, is connected to an exaggerated response in the pro-inflammatory phase because of a dysfunction in the intestinal immune system. The identification of tumor necrosis factor (TNF-α as the active element in the pro-inflammatory inadequate response gave rise to the heightened production of biological substances that could block TNF-α, at different levels, opening a large

  15. NOD2/CARD15: geographic differences in the Spanish population and clinical applications in Crohn's disease.

    Science.gov (United States)

    Barreiro-de-Acosta, M; Mendoza, J L; Lana, R; Domínguez-Muñoz, J E; Díaz-Rubio, M

    2010-05-01

    Crohn's disease (CD) is a genetically complex disease in which both genetic susceptibility and environmental factors play key roles in the development of the disorder. NOD2/CARD15 mutations are associated with CD. NOD2 encodes for a protein that is an intracellular receptor for a bacterial product (muramyl dipeptide), though the exact functional consequences of these mutations remain the subject of debate. NOD2/CARD15 mutations are associated with ileal CD, with stricturing behavior, and possibly with a more complicated course of CD. NOD2/CARD15 mutations associated with CD have demonstrated heterogeneity across ethnicities and populations throughout the world, with regional variations across Europe and Spain. However, "NOD2/CARD15 testing" is not yet ready for use in the clinical setting. One of the reasons is that we know that these genetic variants increase the risk of disease only marginally, and many healthy individuals carry the risk alleles, at present it is not recommended to screen first-degree relatives, because we do not have the ability to prevent the disease at the present time.

  16. TNF promoter polymorphisms and modulation of growth retardation and disease severity in pediatric Crohn's disease.

    Science.gov (United States)

    Levine, Arie; Shamir, Raanan; Wine, Eytan; Weiss, Batya; Karban, Amir; Shaoul, Ron R; Reif, Shimon S; Yakir, Benjamin; Friedlander, Marcello; Kaniel, Yael; Leshinsky-Silver, Esther

    2005-07-01

    Delayed growth is common in pediatric Crohn's disease (CD). Multiple factors have been shown to affect growth in this situation, the most prominent being the presence and severity of inflammation and inadequate nutritional intake. Inflammation, anorexia, and weight loss are all manifestations of circulating TNF-alpha, which is elevated in CD. The ability to secrete TNF-alpha may be affected by polymorphisms in the TNF-alpha promoter. The aim of our study was to determine whether growth retardation and disease severity in pediatric onset CD are affected by TNF promoter genotype. Genotyping for TNF-alpha and NOD2/CARD15 single nucleotide polymorphisms was performed in 87 patients with detailed growth records. Parameters including disease location and disease severity were recorded, and the effect of these polymorphisms on Z-scores for height and weight at disease onset and during follow-up were analyzed. Lower age of onset was linked to more height retardation, while the presence of colonic disease and the absence of ileal disease were more likely to predict the absence of growth retardation. The presence of two polymorphisms thought to decrease circulating TNF-alpha was associated with higher mean Z-scores for height and a trend toward less growth retardation. Two other polymorphisms were modestly associated with disease severity. Polymorphisms in the TNF-alpha promoter may independently modulate growth and disease severity in pediatric onset CD. The effect of these polymorphisms does not appear to be mediated via weight loss, and is relatively modest.

  17. Clinical experience with adalimumab in a multicenter Swiss cohort of patients with Crohn's disease.

    Science.gov (United States)

    Nichita, Cristina; Stelle, Marc; Vavricka, Stephan; El-Wafa Ali, Abdou; Ballabeni, Pierluigi; de Saussure, Philippe; Straumann, Alex; Rogler, Gerhard; Michetti, Pierre

    2010-01-01

    Controlled clinical trials have demonstrated the efficacy and safety of adalimumab in patients with moderate-to-severe Crohn's disease (CD), but there is, however, only limited long-term experience with adalimumab in daily practice. To assess the long-term effectiveness and safety of adalimumab in a multicenter cohort of practice-based patients with moderate-to-severe CD. We retrospectively reviewed the charts of CD patients who received adalimumab over a 3-year period. Disease severity was scored using the Harvey-Bradshaw index (HBI). Remission was defined as an HBI of 3 points at evaluation compared to the baseline. Univariate logistic regression analysis was used to identify the predictive variables associated with response. The charts of 55 patients were reviewed; remission and response rates observed at weeks 4-6 were 52.7 and 83.6%, respectively. Remission was maintained at weeks 12, 24 and 52 in 89.6, 72.4 and 44.7% of patients, respectively. Remission and response rates were not influenced by smoking status, disease location or duration, the first month total dose, or previous infliximab therapy. The remission rate at weeks 4-6 was significantly higher in patients intolerant of infliximab as compared to those who lost response to this drug. Adalimumab was well tolerated overall. Adalimumab can be considered a suitable option in patients with moderate-to-severe CD, demonstrating sustained long-term effectiveness. Copyright (c) 2010 S. Karger AG, Basel.

  18. Infliximab for Crohn's disease in the Swiss IBD Cohort Study: clinical management and appropriateness.

    Science.gov (United States)

    Juillerat, Pascal; Pittet, Valérie; Vader, John-Paul; Burnand, Bernard; Gonvers, Jean-Jacques; de Saussure, Philippe; Mottet, Christian; Seibold, Frank; Rogler, Gerhard; Sagmeister, Markus; Felley, Christian; Michetti, Pierre; Froehlich, Florian

    2010-11-01

    Antitumor necrosis factor a agents have significantly improved the management of Crohn's disease (CD), but not all patients benefit from this therapy. We used data from the Swiss Inflammatory Bowel Disease Cohort Study and predefined appropriateness criteria to examine the appropriateness of use of infliximab (IFX) in CD patients. EPACT II (European Panel on the Appropriateness of CD Therapy, 2007; www.epact.ch) appropriateness criteria have been developed using a formal explicit panel process combining evidence from the published literature and expert opinion. Questionnaires relating to EPACT II criteria were used at enrollment and follow-up of all Swiss Inflammatory Bowel Disease Cohort Study patients. A step-by-step analysis of all possible indications for IFX therapy in a given patient allowed identification of the most appropriate indication and final classification in a single appropriateness category (appropriate, uncertain, inappropriate). Eight hundred and twenty-one CD patients were prospectively enrolled between November 2006 and March 2009. IFX was administered to 146 patients (18%) at enrollment and was most frequently used for complex fistulizing disease and for the maintenance of remission induced by biological therapy. IFX therapy was considered appropriate in 44%, uncertain in 44%, and inappropriate in 10% of patients. In this cohort, 9 out of 10 indications for IFX therapy were clinically generally acceptable (appropriate or uncertain) according to EPACT II criteria. Uncertain indications resulted mainly from the current more liberal use of IFX in clinical practice as compared with the EPACT II criteria.

  19. Serum concentrations of trace elements in patients with Crohn's disease receiving enteral nutrition.

    Science.gov (United States)

    Johtatsu, Tomoko; Andoh, Akira; Kurihara, Mika; Iwakawa, Hiromi; Tsujikawa, Tomoyuki; Kashiwagi, Atsunori; Fujiyama, Yoshihide; Sasaki, Masaya

    2007-11-01

    We investigated the trace element status in Crohn's disease (CD) patients receiving enteral nutrition, and evaluated the effects of trace element-rich supplementation. Thirty-one patients with CD were enrolled in this study. All patients were placed on an enteral nutrition regimen with Elental(R) (Ajinomoto pharmaceutical. Ltd., Tokyo, Japan). Serum selenium, zinc and copper concentrations were determined by atomic absorption spectroscopy. Serum selenoprotein P levels were determined by an ELISA system. Average serum levels of albumin, selenium, zinc and copper were 4.1 +/- 0.4 g/dl, 11.2 +/- 2.8 microg/dl, 71.0 +/- 14.8 microg/dl, and 112.0 +/- 25.6 microg/dl, respectively. In 9 patients of 31 CD patients, serum albumin levels were lower than the lower limit of the normal range. Serum selenium, zinc and copper levels were lower than lower limits in 12 patients, 9 patients and 1 patient, respectively. Serum selenium levels significantly correlated with both serum selenoprotein P levels and glutathione peroxidase activity. Supplementation of selenium (100 microg/day) and zinc (10 mg/day) for 2 months significantly improved the trace element status in CD patients. In conclusion, serum selenium and zinc levels are lower in many CD patients on long-term enteral nutrition. In these patients, supplementation of selenium and zinc was effective in improving the trace element status.

  20. Hemophagocytic lymphohistiocytosis caused by primary Epstein-Barr virus in patient with Crohn's disease.

    Science.gov (United States)

    Virdis, Francesco; Tacci, Sara; Messina, Federico; Varcada, Massimo

    2013-11-27

    We present a case of a 19-year-old man with a 6-year history of Crohn's disease (CD), previously treated with 6-mercaptopurine, who was admitted to our department for Epstein-Barr virus (EBV) infection and subsequently developed a hemophagocytic lymphohistiocytosis (HLH). HLH is a rare disease which causes phagocytosis of all bone marrow derived cells. It can be a primary form as a autosomic recessive disease, or a secondary form associated with a variety of infections; EBV is the most common, the one with poorer prognosis. The incidence of lymphoproliferative disorders was increased in patients with inflammatory bowel disease (IBD) treated with thiopurines. Specific EBV-related clinical and virological management should be considered when treating a patient with IBD with immunosuppressive therapy. Moreover EBV infection in immunosuppressed patient can occur with more aggressive forms such as encephalitis and diffuse large B cell lymphoma. Our case confirms what is described in the literature; patients with IBD, particularly patients with CD receiving thiopurine therapy, who present 5 d of fever and cervical lymphadenopathy or previous evidence of lymphopenia should be screened for HLH.

  1. Unusual Case of Cerebral Venous Thrombosis in Patient with Crohn's Disease

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    Inha Kim

    2015-05-01

    Full Text Available The development of cerebral venous thrombosis (CVT as a secondary complication of Crohn's disease (CD seems to be rare, but it is generally accepted that the disease activity of CD contributes to the establishment of a hypercoagulable state. Here, we describe a case of CVT that developed outside the active phase of CD. A 17-year-old male visited the emergency room because of a sudden onset of right-sided weakness and right-sided hypesthesia. He had been diagnosed with CD 1 year before and was on a maintenance regimen of mesalazine and azathioprine. He did not exhibit any symptoms indicating a CD flare-up (bloody stools, abdominal pain, complications, or weight loss. A brain MRI scan revealed an acute infarction of the left frontal cortex and a cortical subarachnoid hemorrhage. Additionally, a magnetic resonance venography revealed a segmental filling defect in the superior sagittal sinus and also the non-visualizability of some bilateral cortical veins. The characteristics of the present case suggest that the risk of CVT is most likely related to CD per se rather than disease activity associated with CD.

  2. Crohn's disease and smoking: is it ever too late to quit?

    Science.gov (United States)

    Lawrance, Ian C; Murray, Kevin; Batman, Birol; Gearry, Richard B; Grafton, Rachel; Krishnaprasad, Krupa; Andrews, Jane M; Prosser, Ruth; Bampton, Peter A; Cooke, Sharon E; Mahy, Gillian; Radford-Smith, Graham; Croft, Anthony; Hanigan, Katherine

    2013-12-01

    Smoking increases CD risk. The aim was to determine if smoking cessation at, prior to, or following, CD diagnosis affects medication use, disease phenotypic progression and/or surgery. Data on CD patients with disease for ≥5 yrs were collected retrospectively including the Montreal classification, smoking history, CD-related abdominal surgeries, family history, medication use and disease behaviour at diagnosis and the time when the disease behaviour changed. 1115 patients were included across six sites (mean follow-up-16.6 yrs). More non-smokers were male (p=0.047) with A1 (p3 cigarettes/day had an increased risk of developing B2/B3 disease (p=0.012: OR 3.8 95%CI 1.27-11.17). Progression to B2/B3 disease and surgery is reduced by smoking cessation. All CD patients regardless of when they were diagnosed, or how many surgeries, should be strongly encouraged to cease smoking. Copyright © 2013 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

  3. Fecal bacteria from treatment-naive Crohn's disease patients can skew helper T cell responses.

    Science.gov (United States)

    Ma, Fei; Zhang, Yi; Xing, Junjie; Song, Xiaoling; Huang, Ling; Weng, Hao; Wu, Xiangsong; Walker, Emma; Wang, Zhongchuan

    2017-12-01

    Many studies have demonstrated that the inflamed mucosa of Crohn's disease (CD) patients presented a disturbed gut commensal community, and the shift in microbial composition and species variety is associated with disease severity. To establish a link between changes in the intestinal bacterial composition and the alteration of inflammation, we obtained fecal bacteria from CD patients and non-CD controls. The bacteria were then used to stimulate the peripheral blood mononuclear cells (PBMCs) from one non-CD individual. We found that the frequency of IFN-γ- and IL-17-expressing CD4 T cells was significantly higher after stimulation with CD bacteria than with non-CD bacteria, while the frequency of IL-4- and IL-10-expressing CD4 T cells was significantly decreased after stimulation with CD bacteria. A similar trend was observed in the level of cytokine expression and transcription expression. However, this difference was not clear-cut, as overlapping regions were observed between the two groups. With longer stimulation using CD bacteria, the skewing toward Th1/Th17 responses were further increased. This increase depended on the presence of monocytes/macrophages. Interestingly, we also found that B cells presented an inhibitory effect in CD bacteria-mediated skewing toward Th1/Th17 cells and promoted IL-10 secretion in CD bacteria-stimulated PBMCs. Together, our results demonstrated that CD bacteria could promote Th1/Th17 inflammation in a host factor-independent fashion. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Small-Bowel Capsule Endoscopy in Patients with Suspected Crohn's Disease—Diagnostic Value and Complications

    Science.gov (United States)

    Figueiredo, Pedro; Almeida, Nuno; Lopes, Sandra; Duque, Gabriela; Freire, Paulo; Lérias, Clotilde; Gouveia, Hermano; Sofia, Carlos

    2010-01-01

    Background. The aim of this work was to assess the value of capsule enteroscopy in the diagnosis of patients with suspected Crohn's Disease (CD). Methods. This was a retrospective study in a single tertiary care centre involving patients undergoing capsule enteroscopy for suspected CD. Patients taking nonsteroidal anti inflammatory drugs during the thirty preceding days or with a follow-up period of less than six months were excluded. Results. Seventy eight patients were included. The endoscopic findings included mucosal breaks in 50%, ulcerated stenosis in 5%, and villous atrophy in 4%. The diagnosis of CD was established in 31 patients. The sensitivity, specificity, positive and negative predictive value of the endoscopic findings were 93%, 80%, 77%, and 94%, respectively. Capsule retention occurred in four patients (5%). The presence of ulcerated stenosis was significantly more frequent in patients with positive inflammatory markers. The diagnostic yield of capsule enteroscopy in patients with negative ileoscopy was 56%, with a diagnostic acuity of 93%. Conclusions. Small bowel capsule endoscopy is a safe and valid technique for assessing patients with suspected CD. Capsule retention is more frequent in patients with positive inflammatory markers. Patients with negative ileoscopy and suspected CD should be submitted to capsule enteroscopy. PMID:20811612

  5. Small-Bowel Capsule Endoscopy in Patients with Suspected Crohn's Disease—Diagnostic Value and Complications

    Directory of Open Access Journals (Sweden)

    Pedro Figueiredo

    2010-01-01

    Full Text Available Background. The aim of this work was to assess the value of capsule enteroscopy in the diagnosis of patients with suspected Crohn's Disease (CD. Methods. This was a retrospective study in a single tertiary care centre involving patients undergoing capsule enteroscopy for suspected CD. Patients taking nonsteroidal anti inflammatory drugs during the thirty preceding days or with a follow-up period of less than six months were excluded. Results. Seventy eight patients were included. The endoscopic findings included mucosal breaks in 50%, ulcerated stenosis in 5%, and villous atrophy in 4%. The diagnosis of CD was established in 31 patients. The sensitivity, specificity, positive and negative predictive value of the endoscopic findings were 93%, 80%, 77%, and 94%, respectively. Capsule retention occurred in four patients (5%. The presence of ulcerated stenosis was significantly more frequent in patients with positive inflammatory markers. The diagnostic yield of capsule enteroscopy in patients with negative ileoscopy was 56%, with a diagnostic acuity of 93%. Conclusions. Small bowel capsule endoscopy is a safe and valid technique for assessing patients with suspected CD. Capsule retention is more frequent in patients with positive inflammatory markers. Patients with negative ileoscopy and suspected CD should be submitted to capsule enteroscopy.

  6. Small-bowel capsule endoscopy in patients with suspected Crohn's disease-diagnostic value and complications.

    Science.gov (United States)

    Figueiredo, Pedro; Almeida, Nuno; Lopes, Sandra; Duque, Gabriela; Freire, Paulo; Lérias, Clotilde; Gouveia, Hermano; Sofia, Carlos

    2010-01-01

    The aim of this work was to assess the value of capsule enteroscopy in the diagnosis of patients with suspected Crohn's Disease (CD). Methods. This was a retrospective study in a single tertiary care centre involving patients undergoing capsule enteroscopy for suspected CD. Patients taking nonsteroidal anti inflammatory drugs during the thirty preceding days or with a follow-up period of less than six months were excluded. Results. Seventy eight patients were included. The endoscopic findings included mucosal breaks in 50%, ulcerated stenosis in 5%, and villous atrophy in 4%. The diagnosis of CD was established in 31 patients. The sensitivity, specificity, positive and negative predictive value of the endoscopic findings were 93%, 80%, 77%, and 94%, respectively. Capsule retention occurred in four patients (5%). The presence of ulcerated stenosis was significantly more frequent in patients with positive inflammatory markers. The diagnostic yield of capsule enteroscopy in patients with negative ileoscopy was 56%, with a diagnostic acuity of 93%. Small bowel capsule endoscopy is a safe and valid technique for assessing patients with suspected CD. Capsule retention is more frequent in patients with positive inflammatory markers. Patients with negative ileoscopy and suspected CD should be submitted to capsule enteroscopy.

  7. Computed tomographic findings of abdominal complications of Crohn's disease - pictorial essay

    Energy Technology Data Exchange (ETDEWEB)

    Zissin, R. [Tel-Aviv Univ., Dept. of Diagnostic Imaging, Sapir Medical Center, Kfar Saba, Sackler Faculty of Medicine, Tel Aviv (Israel)]. E-mail: zisinrivka@clalit.org.il; Hertz, M. [Tel-Aviv Univ., Dept. of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv (Israel); Osadchy, A. [Tel-Aviv Univ., Dept. of Diagnostic Imaging, Sapir Medical Center, Kfar Saba, Sackler Faculty of Medicine, Tel Aviv (Israel); Novis, B. [Tel-Aviv Univ., Dept. of Gastroenterology, Sapir Medical Center, Kfar Saba, Sackler Faculty of Medicine, Tel Aviv (Israel); Gayer, G. [Tel-Aviv Univ., Department of Diagnostic Imaging, Assaf Harode Medical Center, Zrifin, Sackler Faculty of Medicine, Tel Aviv (Israel)

    2005-02-15

    Crohn's disease (CD) is a chronic, transmural, inflammatory disease of the gastrointestinal tract (CIT) most often affecting the terminal ileum and colon. Diarrhea, abdominal pain, anorexia, nausea, and weight loss are the most common clinical symptoms. Abdominal complications of CD, both intestinal and extraintestinal, are frequent and variable. The most common intestinal complications include ileocolitis with external or internal fistulas and abscess formation, strictures, and bowel obstruction. Less common are free perforation, intussusception, and malignancy. The extraintestinal complications include nephrolithiasis, cholelithiasis, fatty liver, portal vein gas, and thromboembolic events. Nowadays, computed tomography (CT) provides superb anatomic detail and diagnostic accuracy of various intra-abdominal pathological processes, and it thus has become an essential diagnostic tool in the evaluation and management of patients wit known CD for the assessment of bowel wall involvement, the mesenteric extent of the disease, and inn-abdominal complications. In addition, as CT is frequently performed to evaluate patients with acute abdomen, it may encounter clinically unsuspected complications in patients with CD. This article reviews the CT features of various intra-abdominal complications of CD. (author)

  8. Computed tomographic findings of abdominal complications of Crohn's disease - pictorial essay

    International Nuclear Information System (INIS)

    Zissin, R.; Hertz, M.; Osadchy, A.; Novis, B.; Gayer, G.

    2005-01-01

    Crohn's disease (CD) is a chronic, transmural, inflammatory disease of the gastrointestinal tract (CIT) most often affecting the terminal ileum and colon. Diarrhea, abdominal pain, anorexia, nausea, and weight loss are the most common clinical symptoms. Abdominal complications of CD, both intestinal and extraintestinal, are frequent and variable. The most common intestinal complications include ileocolitis with external or internal fistulas and abscess formation, strictures, and bowel obstruction. Less common are free perforation, intussusception, and malignancy. The extraintestinal complications include nephrolithiasis, cholelithiasis, fatty liver, portal vein gas, and thromboembolic events. Nowadays, computed tomography (CT) provides superb anatomic detail and diagnostic accuracy of various intra-abdominal pathological processes, and it thus has become an essential diagnostic tool in the evaluation and management of patients wit known CD for the assessment of bowel wall involvement, the mesenteric extent of the disease, and inn-abdominal complications. In addition, as CT is frequently performed to evaluate patients with acute abdomen, it may encounter clinically unsuspected complications in patients with CD. This article reviews the CT features of various intra-abdominal complications of CD. (author)

  9. Trisomy 9 syndrome: Report of a case with Crohn disease and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Wolldridge, J.; Zuncih, J. [Indiana University School of Medicine, Gary, IN (United States)

    1995-04-10

    We report on a 6-year-old boy with mosaic trisomy 9. The patient was born at 42 weeks of gestation to a 27-year-old G1 white woman. Birth weight was 2,820 g, length 52 cm, and Apgar scores were 4 and 6 at 1 and 5 min, respectively. The infant presented with apparently low-set ears, overfolded helices, epicanthal folds, prominent nasal bridge, high-arched palate, micrognathia, bilateral dislocated hips, left genu recurvatum, and cryptorchidism. Chromosome analysis showed an unusual karyotype: 47,XY,+inv(9qh+)/47,XY,+mar. The marker chromosome was thought to be a remnant of the inv (9qh+), while the father`s was 46,XY. At age 5 months, the patient developed seizures and gastroesophageal reflux. Crohn disease was diagnosed at age 2 years, although symptoms began at age 1 year. Recurrent bouts of pneumonia have occurred since the patient`s birth. Severe psychomotor retardation was also noted. Trisomy 9 syndrome was first reported in 1973. Over 30 cases have been reported since then. Of these case reports, only 5 patients were older than 1 year. Inflammatory bowel disease has been reported in association with other chromosome abnormalities, but to our knowledge, has not been reported in trisomy 9 syndrome. 39 refs., 4 figs., 2 tabs.

  10. Stress and brain functional changes in patients with Crohn's disease: A functional magnetic resonance imaging study.

    Science.gov (United States)

    Agostini, A; Ballotta, D; Righi, S; Moretti, M; Bertani, A; Scarcelli, A; Sartini, A; Ercolani, M; Nichelli, P; Campieri, M; Benuzzi, F

    2017-10-01

    In Crohn's disease (CD) patients, stress is believed to influence symptoms generation. Stress may act via central nervous system pathways to affect visceral sensitivity and motility thus exacerbating gastrointestinal symptoms. The neural substrate underpinning these mechanisms needs to be investigated in CD. We conducted an explorative functional magnetic resonance imaging (fMRI) study in order to investigate potential differences in the brain stress response in CD patients compared to controls. 17 CD patients and 17 healthy controls underwent a fMRI scan while performing a stressful task consisting in a Stroop color-word interference task designed to induce mental stress in the fMRI environment. Compared to controls, in CD patients the stress task elicited greater blood oxygen level dependent (BOLD) signals in the midcingulate cortex (MCC). The MCC integrate "high" emotional processes with afferent sensory information ascending from the gut. In light of these integrative functions, the stress-evoked MCC hyperactivity in CD patients might represent a plausible neural substrate for the association between stress and symptomatic disease. The MCC dysfunction might be involved in mechanisms of central disinhibition of nociceptive inputs leading to amplify the visceral sensitivity. Finally, the stress-evoked MCC hyperactivity might affect the regulation of intestinal motility resulting in exacerbation of disease symptoms and the autonomic and neuroendocrine regulation of inflammation resulting in enhanced inflammatory activity. © 2017 John Wiley & Sons Ltd.

  11. Magnetization transfer ratio for the assessment of perianal fistula activity in Crohn's disease

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    Pinson, C.; Dolores, M.; Cruypeninck, Y.; Koning, E.; Dacher, J.N.; Savoye-Collet, C. [Rouen University Hospital-Charles Nicolle, Department of Radiology, Rouen cedex (France); Savoye, G. [Rouen University Hospital-Charles Nicolle, Department of Gastroenterology, Rouen cedex (France)

    2017-01-15

    Assessment of perianal fistulas is important to guide management of Crohn's disease (CD). Our objectives were to analyze the feasibility of magnetization transfer (MT) imaging to assess fistulas and to evaluate its contribution in assessing disease activity. During 15 months, all patients referred for perianal fistulas in CD underwent 3T-MRI including diffusion, T2/T1-weighted gadolinium-enhanced sequences and MT sequences (one with an off-resonance saturation pulse of 800 and one with 1200 Hz). We collected Van Assche score, fistula activity signs by analyzing T2, diffusion and contrast enhancement. We calculated MT ratio (MTR) with a ROI in the largest fistula. Twenty-nine patients (mean 34.9 years, range 17-53) were included. Van Assche score was 11.7, range 4-21. In 22 patients, the fistula presented with a bright T2 and diffusion signal with contrast enhancement, and was characterized as active. Mean MTR was respectively 47.2 (range 12-68) and 34.3 (range 11-57) at 800 and 1200 Hz. MTR at 800 Hz was significantly lower in non-active (34, range 12-55) than in active fistulas (51, range 24-68) (p < 0.02). MTR is feasible for the assessment of fistulas in CD and in the future could be used to help identify active and non-active fistulas. (orig.)

  12. Training readers to improve their accuracy in grading Crohn's disease activity on MRI

    International Nuclear Information System (INIS)

    Tielbeek, Jeroen A.W.; Bipat, Shandra; Boellaard, Thierry N.; Nio, C.Y.; 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 assessed 100 cases with direct feedback per case, randomly assigned to four sets of 25 cases. The cases in set 4 were identical to the baseline set. Grading accuracy, understaging, overstaging, mean reading times and confidence scores (scale 0-10) were compared between baseline and set 4, and between the four consecutive sets with feedback. Proportions of grading accuracy, understaging and overstaging per set were compared using logistic regression analyses. Mean reading times and confidence scores were compared by t-tests. Grading accuracy increased from 66 % (95 % CI, 56-74 %) at baseline to 75 % (95 % CI, 66-81 %) in set 4 (P = 0.003). Understaging decreased from 15 % (95 % CI, 9-23 %) to 7 % (95 % CI, 3-14 %) (P < 0.001). Overstaging did not change significantly (20 % vs 19 %). Mean reading time decreased from 6 min 37 s to 4 min 35 s (P < 0.001). Mean confidence increased from 6.90 to 7.65 (P < 0.001). During training, overall grading accuracy, understaging, mean reading times and confidence scores improved gradually. Inexperienced readers need training with at least 100 cases to achieve the literature reported grading accuracy of 75 %. (orig.)

  13. The assessment of online heath videos for surgery in Crohn's Disease.

    Science.gov (United States)

    Marshall, J H; Baker, D M; Lee, M J; Jones, G L; Lobo, A J; Brown, S R

    2018-02-10

    YouTube ™ is an open-access, non-peer reviewed video-hosting site and is used as a source of publicly available healthcare information. This study aimed to assess the thematic content of the most viewed videos relating to surgery and Crohn's Disease and to explore the viewer interactions to these videos. A search of YouTube ™ was carried out using one search string. The 50 most viewed videos were identified and categorised by source, content themes and assessed for viewer interactions. Video comments were used to describe the usefulness of the video content to viewers. The majority of videos were uploaded by patients (n=21).The remainder were uploaded by individual health care professionals (n=9), hospital/speciality associations (n=18) and industry (n=2). The median number of likes for patient videos was significantly higher than hospital/speciality association videos (p=content(n=27), and more comments asking for further information (n=14). The median number of likes for 'experience of surgery' (p=content of patient sourced videos focused on surgical and disease experience, suggesting these themes are important to patients.Current patient developed videos provide limited information, as reflected by viewers requesting further information. Storytelling patient-centred videos combined with clinical evidence may be a good model for future videos. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  14. Analysis of SHIP1 expression and activity in Crohn's disease patients.

    Directory of Open Access Journals (Sweden)

    Rajesh Somasundaram

    Full Text Available SH2 domain containing inositol-5-phosphatase (SHIP1 is an important modulator of innate and adaptive immunity. In mice, loss of SHIP1 provokes severe ileitis resembling Crohn's disease (CD, as a result of deregulated immune responses, altered cytokine production and intestinal fibrosis. Recently, SHIP1 activity was shown to be correlated to the presence of a CD-associated single nucleotide polymorphism in ATG16L1. Here, we studied SHIP1 activity and expression in an adult cohort of CD patients.SHIP1 activity, protein and mRNA expression in peripheral blood mononuclear cells from CD patients in clinical remission were determined by Malachite green assay, Western blotting and qRT-PCR respectively. Genomic DNA was genotyped for ATG16L1 rs2241880.SHIP1 protein levels are profoundly diminished in a subset of patients; however, SHIP1 activity and expression are not correlated to ATG16L1 SNP status in this adult cohort.Aberrant SHIP1 activity can contribute to disease in a subset of adult CD patients, and warrants further investigation.

  15. Use of antibiotics in patients with Crohn's disease: a systematic review and meta-analysis.

    Science.gov (United States)

    Su, Jie Wen; Ma, Jing Jing; Zhang, Hong Jie

    2015-02-01

    Some studies have suggested that antibiotic treatment might be efficient for patients with active Crohn's disease (CD). However, the results are conflicting. The aim of this study was to summarize the available evidence on the efficacy of antibiotics, especially ciprofloxacin, in treating patients with CD. A literature search was conducted on the PubMed, Medline, Web of Science and Excerpta Medica Database (EMBASE) for manuscripts published until March 2014. Randomized controlled trials that mainly evaluated the efficacy of antibiotic treatment in patients with CD using clinical remission or response as the key outcome of interest were included. Intention-to-treat analyses were used to evaluate the relative risk (RR) and 95% confidence intervals (CI). In all, 15 randomized placebo-controlled clinical trials involving 1407 participants were included in the meta-analysis. A pooled analysis revealed that compared with placebo, antibiotics benefited CD patients to a certain extent (RR 1.33, 95% CI 1.17-1.51, P antibiotics was beneficial for patients with CD. Nevertheless, subgroup analyses indicated that treatment with ciprofloxacin alone was significantly efficient for CD patients with perianal fistulas. © 2014 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

  16. Anoperineal disease in Hidradenitis suppurativa: MR imaging distinction from perianal Crohn's disease

    Energy Technology Data Exchange (ETDEWEB)

    Monnier, Louise; Amara, Nedjoua; Hoeffel, Christine [Hopital Maison Blanche, Department of Radiology, Reims (France); Dohan, Anthony [Hopital Lariboisiere, Assistance Publique-Hopitaux de Paris, Department of Radiology, Paris (France); Universite Paris-Diderot, Sorbonne Paris Cite, Paris (France); Zagdanski, Anne-Marie [Saint Louis Hospital, Department of Radiology, Paris (France); Drame, Moustapha [Hopital Robert Debre, Department of Statistics, Reims (France); Soyer, Philippe [Universite Paris-Diderot, Sorbonne Paris Cite, Paris (France)

    2017-10-15

    To determine whether Hidradenitis suppurativa (HS)-related anoperineal disease can be distinguished from Crohn's disease (CD) using MRI. Pelvic MRI of 23 HS and 46 CD patients with anoperineal disease between 2007 and 2014 were independently analysed by two radiologists. For diagnosis of HS, sensitivity, specificity and positive likelihood ratios (LRs) of inflammatory features and of their anatomical distribution were calculated and compared to those of CD. In HS, fistulae were less present (P =.033) and less frequently involved the sphincters (P =.001) than in CD. Granulomas were more frequent (P =.0005). For anterior/inguinal and posterior localizations, sensitivity, specificity and LR for diagnosis of HS were 70% (49.1, 84.4), 87% (74.3, 93.9), 5.3 (2.41, 11.79) and 57% (36.8, 74.4), 93% (82.5, 97.8), 8.67 (2.74, 27.41), respectively. Combination of signs including posterior involvement, absence of rectal wall thickening and bilaterality of features yielded specificity of 100% (95% CI: 92.3-100) for HS. Although MRI presentations of anoperineal disease may overlap between CD and HS, specific diagnosis of HS is possible with a combination of three features: absence of features' predominance in perianal area, absence of rectal wall thickening and bilaterality of features. (orig.)

  17. The role of ABO blood groups in Crohn's disease and in monitoring response to infliximab treatment.

    Science.gov (United States)

    Yu, Qiao; Wang, Lingyun; Zhang, Shenghong; Feng, Ting; Li, Li; Chen, Baili; Chen, Minhu

    2016-09-01

    The variation in ABO blood groups is reported to be associated with multiple diseases. Infliximab (IFX) has been widely used in the treatment of Crohn's disease (CD). We aim to investigate the distribution of ABO blood groups in Chinese patients with CD and to explore its impact on response to IFX. Patients with CD were consecutively recruited to the study between 2007 and 2014. CD patients receiving IFX therapy were followed for at least two years. In 293 patients with CD, most patients (40.6%) had blood type O (119/293). The odds ratio (OR) of CD in blood type O patients was 1.06 (95%CI: 0.6-1.86; p=0.84) compared to all other blood types. Among those CD patients, 107 patients received IFX treatment. One year after the first course of IFX, a significant association was found between the overall ABO system and outcomes of IFX treatment (pblood type AB (OR=4.42, 95% CI: 1.04-18.76; p=0.044) were more likely to achieve mucosal healing, while CD patients with blood type A had a high risk of losing response (OR=0.38, 95% CI: 0.15-0.96; p=0.040). ABO blood groups are not associated with prevalence of CD. Patients with blood type AB had a better response to IFX while those with blood type A appeared to have a risk of losing response to IFX.

  18. Expression of neutrophil gelatinase-associated lipocalin (NGAL) in the gut in Crohn's disease.

    Science.gov (United States)

    Thorsvik, Silje; Bakke, Ingunn; van Beelen Granlund, Atle; Røyset, Elin Synnøve; Damås, Jan Kristian; Østvik, Ann Elisabet; Sandvik, Arne Kristian

    2018-06-05

    The antimicrobial glycoprotein neutrophil gelatinase-associated lipocalin (NGAL) is strongly expressed in several infectious, inflammatory and malignant disorders, among these inflammatory bowel disease (IBD). Fecal and serum NGAL is elevated during active IBD and we have recently shown that fecal NGAL is a novel biomarker for IBD with a test performance comparable to the established fecal biomarker calprotectin. This study examines expression of NGAL in the healthy gut and in Crohn's disease (CD), with emphasis on the previously unexplored small intestine. Pinch biopsies were taken from active and inactive CD in jejunum, ileum and colon and from the same sites in healthy controls. Microarray gene expression showed that the NGAL gene, LCN2, was the second most upregulated among 1820 differentially expressed genes in terminal ileum comparing active CD and controls (FC 5.86, p = 0.027). Based on immunohistochemistry and in situ hybridization findings, this upregulation most likely represented increased expression in epithelial cells. Double immunofluorescence showed NGAL expression in 49% (range 19-70) of Paneth cells (PCs) in control ileum with no change during inflammation. In healthy jejunum, the NGAL expression in PCs was weak to none but markedly increased during active CD. We further found NGAL also in metaplastic PCs in colon. Finally, we show for the first time that NGAL is expressed in enteroendocrine cells in small intestine as well as in colon.

  19. Crohn disease and ulcerative colitis in children: an update for 2014.

    Science.gov (United States)

    Lemberg, Daniel A; Day, Andrew S

    2015-03-01

    Crohn disease (CD) and ulcerative colitis (UC), the two main types of inflammatory bowel disease (IBD), have become increasingly common in Australasian children and adolescents in recent years. Furthermore, CD and UC are seen more often in younger children. These conditions are typically more extensive in children and tend to follow more severe disease courses than in adults. Although many children may present with typical symptoms (such as abdominal pain or bloody diarrhoea), others have atypical features (including oral ulceration, short stature or skin manifestations). In addition, many children with IBD will have altered growth or nutrition, which may compromise normal linear growth and pubertal development. Early identification and full assessment of children presenting with possible IBD are essential to avoid consequences of diagnostic delay and to optimise short- and long-term outcomes. Management of IBD encompasses various options and should be undertaken within a team-based, child and family-focused, multidisciplinary setting. © 2014 The Authors. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  20. Selenium, selenoprotein genes and Crohn's disease in a case-control population from Auckland, New Zealand.

    Science.gov (United States)

    Gentschew, Liljana; Bishop, Karen S; Han, Dug Yeo; Morgan, Angharad R; Fraser, Alan G; Lam, Wen Jiun; Karunasinghe, Nishi; Campbell, Bobbi; Ferguson, Lynnette R

    2012-09-01

    New Zealand has one of the highest incidence rates of Crohn's Disease (CD), whilst the serum selenium status of New Zealanders is amongst the lowest in the world. A prospective case-control study in Auckland, New Zealand considered serum selenium as a potential CD risk factor. Serum selenium levels were significantly lower in CD patients compared to controls (101.8 ± 1.02 vs. 111.1 ± 1.01 ng/mL) (p = 5.91 × 10(-8)). Recent detailed studies in the United Kingdom have suggested an optimal serum level around 122 ng/mL, making the average CD patient in New Zealand selenium deficient. Of the 29 single nucleotide polymorphisms (SNPs) tested, 13 were found to significantly interact with serum selenium on CD. After adjustment for multiple testing, a significant interaction with serum selenium on CD was found for three SNPs, namely rs17529609 and rs7901303 in the gene SEPHS1, and rs1553153 in the gene SEPSECS. These three SNPs have not been reported elsewhere as being significantly associated with selenium or CD. It is unclear as to whether lower selenium levels are a cause or an effect of the disease.

  1. Selective biologics for ulcerative colitis and Crohn's disease – clinical utility of vedolizumab

    Directory of Open Access Journals (Sweden)

    Petkau JM

    2016-03-01

    Full Text Available Jill MV Petkau, Bertus Eksteen Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada Abstract: Inflammatory bowel disease (IBD encompasses a cluster of different disease phenotypes which are broadly classified into ulcerative colitis and Crohn's disease. Disease pathogenesis is driven by abnormal host immune responses to their resident gut microbiome in genetically susceptible individuals. Clinical disease features and outcomes are heterogenous and not unexpected as over 163 genetic loci are associated with disease susceptibility, and there are great variability in environmental exposures. Despite this variability, there has been relatively few efficacious therapies for particularly moderate-to-severe IBD. Treatment has been dominated by antitumor necrosis alpha agents with significant success but equally potentially serious adverse events. Therapeutic targeting of leucocyte trafficking has emerged as a viable alternative therapy, with vedolizumab being the lead compound. This review focuses primarily on its biological function as a selective gut immunotherapy, its safety and efficacy, and its emerging role as a mainstream therapy in managing IBD. Keywords: adhesion molecule antagonist, anti-α4β7 integrin, inflammatory bowel disease, leukocyte trafficking, monoclonal antibody, selective gut immunotherapy, tumor necrosis factor alpha

  2. Red flags in children with chronic abdominal pain and Crohn's disease-a single center experience.

    Science.gov (United States)

    El-Chammas, Khalil; Majeskie, Angela; Simpson, Pippa; Sood, Manu; Miranda, Adrian

    2013-04-01

    To compare history and symptoms at initial presentation of patients with chronic abdominal pain (CAP) and Crohn's disease (CD). Red flags are used to help determine which patients with CAP are likely to have an underlying disease such as CD. However, red flags have not been validated and pediatric studies are lacking. Patients seen in the outpatient Pediatric Gastroenterology Clinic at Children's Hospital of Wisconsin between 2005 and 2008 prospectively completed a demographic, history, and symptom questionnaire. Patients with abdominal pain for at least 1 month and no evidence of organic disease were compared with patients diagnosed with CD confirmed by mucosal biopsies. Data were collected on 606 patients (128 with CD and 478 with functional gastrointestinal disorders). Patients with functional gastrointestinal disorders had more stressors (P pain were no different between groups. Anemia, hematochezia, and weight loss were most predictive of CD (cumulative sensitivity of 94%). The presence of anemia, hematochezia, and weight loss help identify patients with CAP who require further work-up and referral to a pediatric gastroenterologist. Furthermore, waking from sleep or joint pain occurred similarly between groups and should not be considered as "red flags." Copyright © 2013. Published by Mosby, Inc.

  3. Asia-Pacific consensus statements on Crohn's disease. Part 2: Management.

    Science.gov (United States)

    Ooi, Choon Jin; Makharia, Govind K; Hilmi, Ida; Gibson, Peter R; Fock, Kwong Ming; Ahuja, Vineet; Ling, Khoon Lin; Lim, Wee Chian; Thia, Kelvin T; Wei, Shu-chen; Leung, Wai Keung; Koh, Poh Koon; Gearry, Richard B; Goh, Khean Lee; Ouyang, Qin; Sollano, Jose; Manatsathit, Sathaporn; de Silva, H Janaka; Rerknimitr, Rungsun; Pisespongsa, Pises; Abu Hassan, Muhamad Radzi; Sung, Joseph; Hibi, Toshifumi; Boey, Christopher C M; Moran, Neil; Leong, Rupert W L

    2016-01-01

    The Asia Pacific Working Group on Inflammatory Bowel Disease was established in Cebu, Philippines, at the Asia Pacific Digestive Week conference in 2006 under the auspices of the Asian Pacific Association of Gastroenterology (APAGE) with the goal of developing best management practices, coordinating research and raising awareness of IBD in the region. The consensus group previously published recommendations for the diagnosis and management of ulcerative colitis (UC) with specific relevance to the Asia-Pacific region. The present consensus statements were developed following a similar process to address the epidemiology, diagnosis and management of Crohn's disease (CD). The goals of these statements are to pool the pertinent literature specifically highlighting relevant data and conditions in the Asia-Pacific region relating to the economy, health systems, background infectious diseases, differential diagnoses and treatment availability. It does not intend to be all-comprehensive and future revisions are likely to be required in this ever-changing field. © 2015 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

  4. Pediatric Crohn disease patients exhibit specific ileal transcriptome and microbiome signature.

    Science.gov (United States)

    Haberman, Yael; Tickle, Timothy L; Dexheimer, Phillip J; Kim, Mi-Ok; Tang, Dora; Karns, Rebekah; Baldassano, Robert N; Noe, Joshua D; Rosh, Joel; Markowitz, James; Heyman, Melvin B; Griffiths, Anne M; Crandall, Wallace V; Mack, David R; Baker, Susan S; Huttenhower, Curtis; Keljo, David J; Hyams, Jeffrey S; Kugathasan, Subra; Walters, Thomas D; Aronow, Bruce; Xavier, Ramnik J; Gevers, Dirk; Denson, Lee A

    2014-08-01

    Interactions between the host and gut microbial community likely contribute to Crohn disease (CD) pathogenesis; however, direct evidence for these interactions at the onset of disease is lacking. Here, we characterized the global pattern of ileal gene expression and the ileal microbial community in 359 treatment-naive pediatric patients with CD, patients with ulcerative colitis (UC), and control individuals. We identified core gene expression profiles and microbial communities in the affected CD ilea that are preserved in the unaffected ilea of patients with colon-only CD but not present in those with UC or control individuals; therefore, this signature is specific to CD and independent of clinical inflammation. An abnormal increase of antimicrobial dual oxidase (DUOX2) expression was detected in association with an expansion of Proteobacteria in both UC and CD, while expression of lipoprotein APOA1 gene was downregulated and associated with CD-specific alterations in Firmicutes. The increased DUOX2 and decreased APOA1 gene expression signature favored oxidative stress and Th1 polarization and was maximally altered in patients with more severe mucosal injury. A regression model that included APOA1 gene expression and microbial abundance more accurately predicted month 6 steroid-free remission than a model using clinical factors alone. These CD-specific host and microbe profiles identify the ileum as the primary inductive site for all forms of CD and may direct prognostic and therapeutic approaches.

  5. Inflammatory bowel disease and exercise: results of a Crohn's and Colitis UK survey.

    Science.gov (United States)

    Chan, D; Robbins, H; Rogers, S; Clark, S; Poullis, A

    2014-01-01

    Over 250 000 people in the UK are affected with inflammatory bowel disease (IBD) and approximately 10 000 new cases are diagnosed every year. These chronic bowel conditions have been shown to affect both work and recreational activity. In the general population, regular exercise has numerous benefits to health and well-being and there are additional benefits for those with IBD. However, people with IBD face significant challenges in trying to take regular exercise. With the renewed focus on sport brought about by the recent London Olympics, Crohn's and Colitis UK surveyed its members to explore their sport and fitness habits. 918 members participated in the survey, which is the largest survey of its kind, investigating the exercise habits of people with IBD. The survey showed widespread uptake of exercise in those with IBD, with a large number feeling better for it. However, it also identified a considerable number of respondents who reported a significant negative impact of IBD on their ability to take up, enjoy and derive benefit from sporting activities. Asking questions about sporting leisure activity in clinical consultations may identify those in need of help and support and possibly identify factors to be dealt with, in order to enable them to take part in these beneficial activities.

  6. Crohn's disease in a Saudi outpatient population: Is it still rare?

    International Nuclear Information System (INIS)

    AlMofarreh, Mohammad A; Al Mofleh, Ibrahim A; AlJebreen Abdulrahman M; AlTeimi, Ibrahim N

    2009-01-01

    To determine the epidemiology of Crohn's disease (CD) in an outpatient clinic and compare it with data previously reported from different centers in the Kingdom of Saudi Arabia and outside. The medical records of all patients with CD seen in the clinic in the period from January 1993 through December 2007 were reviewed. The demographic, clinical data and methods of diagnosis were retrieved. Over a period of 15 years, we saw 133 Saudi patients with CD. They were predominantly young, with a median age of 26.2 years and male preponderance (2.3:1). The final diagnosis was established within 1 week of presentation in 47% of the patients. The leading symptoms were abdominal pain (88%), diarrhea (70%), bloating (61%), rectal bleeding (50%), weight loss (33%), constipation (24%) and perianal disease (23%). The diagnosis was established by endoscopy and histopathology. Ileocecal involvement was encountered in 40% of the patients. From the current study, it is obviously possible to diagnose a large proportion of patients with CD in a gastroenterology outpatient clinic. The data revealed a strikingly increased incidence of CD in a mainly young Saudi population in the past few years. (author)

  7. Advanced imaging techniques for small bowel Crohn's disease: what does the future hold?

    Science.gov (United States)

    Pita, Inês; Magro, Fernando

    2018-01-01

    Treatment of Crohn's disease (CD) is intrinsically reliant on imaging techniques, due to the preponderance of small bowel disease and its transmural pattern of inflammation. Ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) are the most widely employed imaging methods and have excellent diagnostic accuracy in most instances. Some limitations persist, perhaps the most clinically relevant being the distinction between inflammatory and fibrotic strictures. In this regard, several methodologies have recently been tested in animal models and human patients, namely US strain elastography, shear wave elastography, contrast-enhanced US, magnetization transfer MRI and contrast dynamics in standard MRI. Technical advances in each of the imaging methods may expand their indications. The addition of oral contrast to abdominal US appears to substantially improve its diagnostic capabilities compared to standard US. Ionizing dose-reduction methods in CT can decrease concern about cumulative radiation exposure in CD patients and diffusion-weighted MRI may reduce the need for gadolinium contrast. Clinical indexes of disease activity and severity are also increasingly relying on imaging scores, such as the recently developed Lémann Index. In this review we summarize some of the recent advances in small bowel CD imaging and how they might affect clinical practice in the near future.

  8. Treatment preferences of originator versus biosimilar drugs in Crohn's disease; discrete choice experiment among gastroenterologists.

    Science.gov (United States)

    Baji, Petra; Gulácsi, László; Lovász, Barbara D; Golovics, Petra A; Brodszky, Valentin; Péntek, Márta; Rencz, Fanni; Lakatos, Péter L

    2016-01-01

    To explore preferences of gastroenterologists for biosimilar drugs in Crohn's disease. Discrete choice experiment was carried out involving 51 Hungarian gastroenterologists in May 2014. The following attributes were used to describe hypothetical choice sets: 1) type of the treatment (biosimilar/originator), 2) severity of disease, 3) availability of continuous medicine supply, 4) frequency of the efficacy check-ups. Multinomial logit model was used to differentiate between three attitude types: 1) always opting for the originator, 2) willing to consider biosimilar for biological-naïve patients only, 3) willing to consider biosimilar treatment for both types of patients. Conditional logit model was used to estimate the probabilities of choosing a given profile. Men, senior consultants, working in inflammatory bowel disease center and treating more patients were more likely willing to consider biosimilar for biological-naïve patients only. Treatment type (originator/biosimilar) was the most important determinant of choice for patients already treated with biologicals, and the availability of continuous medicine supply in case of biological-naïve patients. The probabilities of choosing the biosimilar with all the benefits offered over the originator under current reimbursement conditions are 89% versus 11% for new patients, and 44% versus 56% for patients already treated with biological. For gastroenterologist, the continuous medical supply would be one of the major benefits of biosimilars. However, benefits offered in the scenarios do not compensate for the change from the originator to the biosimilar treatment of patients already treated with biologicals.

  9. Loss-of-function CARD8 mutation causes NLRP3 inflammasome activation and Crohn's disease.

    Science.gov (United States)

    Mao, Liming; Kitani, Atsushi; Similuk, Morgan; Oler, Andrew J; Albenberg, Lindsey; Kelsen, Judith; Aktay, Atiye; Quezado, Martha; Yao, Michael; Montgomery-Recht, Kim; Fuss, Ivan J; Strober, Warren

    2018-05-01

    In these studies, we evaluated the contribution of the NLRP3 inflammasome to Crohn's disease (CD) in a kindred containing individuals having a missense mutation in CARD8, a protein known to inhibit this inflammasome. Whole exome sequencing and PCR studies identified the affected individuals as having a V44I mutation in a single allele of the T60 isoform of CARD8. The serum levels of IL-1β in the affected individuals were increased compared with those in healthy controls, and their peripheral monocytes produced increased amounts of IL-1β when stimulated by NLRP3 activators. Immunoblot studies probing the basis of these findings showed that mutated T60 CARD8 failed to downregulate the NLRP3 inflammasome because it did not bind to NLRP3 and inhibit its oligomerization. In addition, these studies showed that mutated T60 CARD8 exerted a dominant-negative effect by its capacity to bind to and form oligomers with unmutated T60 or T48 CARD8 that impeded their binding to NLRP3. Finally, inflammasome activation studies revealed that intact but not mutated CARD8 prevented NLRP3 deubiquitination and serine dephosphorylation. CD due to a CARD8 mutation was not effectively treated by anti-TNF-α, but did respond to IL-1β inhibitors. Thus, patients with anti-TNF-α-resistant CD may respond to this treatment option.

  10. Alterations of the Subgingival Microbiota in Pediatric Crohn's Disease Studied Longitudinally in Discovery and Validation Cohorts.

    Science.gov (United States)

    Kelsen, Judith; Bittinger, Kyle; Pauly-Hubbard, Helen; Posivak, Leah; Grunberg, Stephanie; Baldassano, Robert; Lewis, James D; Wu, Gary D; Bushman, Frederic D

    2015-12-01

    Oral manifestations are common in Crohn's disease (CD). Here we characterized the subgingival microbiota in pediatric patients with CD initiating therapy and after 8 weeks to identify microbial community features associated with CD and therapy. Pediatric patients with CD were recruited from The Children's Hospital of Pennsylvania. Healthy control subjects were recruited from primary care or orthopedics clinic. Subgingival plaque samples were collected at initiation of therapy and after 8 weeks. Treatment exposures included 5-ASAs, immunomodulators, steroids, and infliximab. The microbiota was characterized by 16S rRNA gene sequencing. The study was repeated in separate discovery (35 CD, 43 healthy) and validation cohorts (43 CD, 31 healthy). Most subjects in both cohorts demonstrated clinical response after 8 weeks of therapy (discovery cohort 88%, validation cohort 79%). At week 0, both antibiotic exposure and disease state were associated with differences in bacterial community composition. Seventeen genera were identified in the discovery cohort as candidate biomarkers, of which 11 were confirmed in the validation cohort. Capnocytophaga, Rothia, and TM7 were more abundant in CD relative to healthy controls. Other bacteria were reduced in abundance with antibiotic exposure among CD subjects. CD-associated genera were not enriched compared with healthy controls after 8 weeks of therapy. Subgingival microbial community structure differed with CD and antibiotic use. Results in the discovery cohort were replicated in a separate validation cohort. Several potentially pathogenic bacterial lineages were associated with CD but were not diminished in abundance by antibiotic treatment, suggesting targets for additional surveillance.

  11. Hemoglobin and hematocrit levels in the prediction of complicated Crohn's disease behavior--a cohort study.

    Science.gov (United States)

    Rieder, Florian; Paul, Gisela; Schnoy, Elisabeth; Schleder, Stephan; Wolf, Alexandra; Kamm, Florian; Dirmeier, Andrea; Strauch, Ulrike; Obermeier, Florian; Lopez, Rocio; Achkar, Jean-Paul; Rogler, Gerhard; Klebl, Frank

    2014-01-01

    Markers that predict the occurrence of a complicated disease behavior in patients with Crohn's disease (CD) can permit a more aggressive therapeutic regimen for patients at risk. The aim of this cohort study was to test the blood levels of hemoglobin (Hgb) and hematocrit (Hct) for the prediction of complicated CD behavior and CD related surgery in an adult patient population. Blood samples of 62 CD patients of the German Inflammatory Bowel Disease-network "Kompetenznetz CED" were tested for the levels of Hgb and Hct prior to the occurrence of complicated disease behavior or CD related surgery. The relation of these markers and clinical events was studied using Kaplan-Meier survival analysis and adjusted COX-proportional hazard regression models. The median follow-up time was 55.8 months. Of the 62 CD patients without any previous complication or surgery 34% developed a complication and/or underwent CD related surgery. Low Hgb or Hct levels were independent predictors of a shorter time to occurrence of the first complication or CD related surgery. This was true for early as well as late occurring complications. Stable low Hgb or Hct during serial follow-up measurements had a higher frequency of complications compared to patients with a stable normal Hgb or Hct, respectively. Determination of Hgb or Hct in complication and surgery naïve CD patients might serve as an additional tool for the prediction of complicated disease behavior.

  12. Genetic polymorphisms of tumour necrosis factor receptor superfamily 1b and fas ligand are associated with clinical efficacy and/or acute severe infusion reactions to infliximab in Crohn's disease

    DEFF Research Database (Denmark)

    Steenholdt, C; Enevold, C; Ainsworth, M A

    2012-01-01

    Single nucleotide polymorphisms (SNPs) in TNF receptor superfamily (TNFRSF) 1A and 1B, and Fas ligand (FASLG) genes, have been associated with responsiveness to infliximab (IFX) in Crohn's disease.......Single nucleotide polymorphisms (SNPs) in TNF receptor superfamily (TNFRSF) 1A and 1B, and Fas ligand (FASLG) genes, have been associated with responsiveness to infliximab (IFX) in Crohn's disease....

  13. VZTAH MEZI VĚDOMOSTMI O PROBLEMATICE POHYBOVÉ AKTIVITY A REALIZOVANOU POHYBOVOU AKTIVITOU U STŘEDOŠKOLSKÝCH STUDENTŮ [RELATIONSHIP BETWEEN KNOWLEDGE ABOUT PHYSICAL ACTIVITY AND PERFORMED PHYSICAL ACTIVITY IN HIGH SCHOOL STUDENTS

    Directory of Open Access Journals (Sweden)

    Jana Vašíčková

    2009-12-01

    Full Text Available VÝCHODISKA: Školní vzdělávací programy a změny výuky ve školách nabízejí prostor pro uchopení tématu zdravého životního stylu v životě člověka, a to jak po stránce zdravotní, nutriční, tak i pohybové. CÍLE: Cílem práce bylo zjistit, jaká je úroveň teoretických vědomostí o problematice zdraví a pohybové aktivity (PA, zda se prokáže rozdíl mezi chlapci a dívkami a do jaké míry existuje spojitost mezi vědomostmi a uskutečněným množstvím PA v rámci současných kurikul u studentů prvního ročníku středních škol. METODIKA: Výzkumného šetření se zúčastnilo 33 chlapců a 42 dívek prvního ročníku ze tří gymnázií a jedné střední odborné školy. Tito studenti v úvodu šetření vyplnili vědomostní test (VT k problematice zdraví a PA a dotazník ANEWS (Abbreviated Neighborhood Environment Walkability Scale. Poté po celý měsíc monitorovali krokoměrem Yamax Digiwalker SW-700 množství denních kroků, které zapisovali do brožury. Na závěr, po týdenní pauze od monitorování, studenti opět vyplnili vědomostní test a dotazník IPAQ (International Physical Activity Questionnaire – dlouhou verzi. Při podrobné analýze vztahu mezi vědomostmi a PA jsme se zaměřili také na PA různé intenzity a typu. VÝSLEDKY: Zjistili jsme, že dívky mají větší znalosti o problematice PA než chlapci ve všech sledovaných dimenzích, a to jak v pre-testu (18,26 vs. 16,55 bodů, tak i v post-testu (18,57 vs. 16,76 bodů. Korelační koeficient u chlapců mezi celkovou PA a VT byl rP = - 0,505 (p[BACKGROUND: School education programs and changes in teaching at schools offer the possibility to emphasize the topic of healthy lifestyle in human life with the impact on health, nutrition, and physical activity. OBJECTIVE: The main aim of this study was to find out the level of theoretical knowledge about health and physical activity (PA, the difference between genders and whether

  14. Contrast-enhanced MR enterography as a stand-alone tool to evaluate Crohn's disease in a paediatric population

    International Nuclear Information System (INIS)

    Spieler, B.; Hindman, N.; Levy, J.; Zabrieski, K.; Sahlein, D.; Seuss, C.; Kim, S.

    2013-01-01

    Aim: To assess the performance of contrast-enhanced T1-weighted magnetic resonance imaging (MRI) alone in the evaluation of Crohn's disease in comparison to all magnetic resonance enterography (MRE) imaging sequences together in an attempt to suggest limitation of the number of overall unenhanced sequences need for the follow-up evaluation. Materials and methods: Twenty-five paediatric patients (mean age 14.1 ± 3.7 years, male = 12, female = 13) underwent MRE at 1.5 T for evaluation of Crohn's disease. Two radiologists reviewed only contrast-enhanced T1-weighted images in consensus on the first session. Whole images including unenhanced (steady-state free precession, single-shot fast spin-echo (HASTE), fat-suppressed T2-weighted) and contrast-enhanced T1-weighted sequences were reviewed in consensus during the second session with a 1 month interval, which was used as a reference standard. The readers evaluated the presence or absence of disease in 10 bowel segments in each patient. For the abnormal bowel segments, the readers then evaluated for active versus inactive disease and for the presence or absence of abscess. Sensitivity, specificity, and overall accuracy were calculated for detecting active inflammation. Results: There were 53/250 bowel segments with active inflammation using the reference standard imaging method. The sensitivity, specificity, and accuracy for diagnosing active inflammation using contrast-enhanced images alone were 83.3%, 86.9%, and 84.9%. In five of the false-positive cases of detecting abscess from contrast-enhanced imaging alone, absence of abscesses was confirmed on the non-fat-suppressed HASTE images. Conclusion: The number of MRE sequences in paediatric Crohn's patients can be decreased while maintaining diagnostic accuracy using contrast-enhanced T1 and non-fat-suppressed HASTE images

  15. Birth outcome in women with ulcerative colitis and Crohn's disease, and pharmacoepidemiological aspects of anti-inflammatory drug therapy.

    Science.gov (United States)

    Nørgård, Bente Mertz

    2011-12-01

    The clinical epidemiological studies included in this thesis fall into three parts. The first part includes studies on birth outcome in women with ulcerative colitis. The second part includes pharmacoepidemiological studies on birth outcome after anti-inflammatory drug therapy in pregnancy, including patients with ulcerative colitis and Crohn's disease. The third part (and the latest publications) includes birth outcome in women with Crohn's disease; and the methods of cohort establishment in these studies are developed and improved due to the knowledge gathered from conducting the earlier studies. The birth outcomes in women with ulcerative colitis are examined in a nationwide, Danish, cohort of women based on data from the Danish National Hospital Discharge Registry and the Danish Medical Birth Registry, and within a Hungarian case-control data set. Our data suggest: 1) Significantly increased risk of preterm birth when women give birth 0-6 months after establishment of the diagnosis. It is considered whether the increased risk may be influenced by disease activity around the time of establishing the diagnosis. 2) No increased risk of giving birth to children with low birth weight, intrauterine growth retardation or congenital abnormalities (evaluated overall). 3) Significantly increased risk of some selected congenital abnormalities (limb deficiencies, obstructive urinary and multiple congenital abnormalities). No other studies have examined the risk of selected congenital abnormalities in children born by women with ulcerative colitis. The pharmacoepidemiological studies on birth outcomes after use of anti-inflammatory drug therapy in pregnancy, including women with ulcerative colitis and Crohn's disease, are based on data from the Hungarian case-control data set, a countywide Danish prescription Database, the Danish National Hospital Discharge Registry, the Danish Medical Birth Registry, and review of selected medical records. After exposure to sulfasalazine

  16. Comparison of CT enterography and MR enterography imaging features of active Crohn disease in children and adolescents

    Energy Technology Data Exchange (ETDEWEB)

    Gale, Heather I. [The Warren Alpert Medical School of Brown University, Department of Diagnostic Imaging, Rhode Island Hospital/Hasbro Children' s Children' s Hospital/Women and Infants Hospital, Providence, RI (United States); Sharatz, Steven M.; Nimkin, Katherine; Gee, Michael S. [MassGeneral Hospital for Children, Division of Pediatric Imaging, Department of Radiology, Harvard Medical School, Boston, MA (United States); Taphey, Mayureewan [Bumrungrad International Hospital, Bangkok (Thailand); Bradley, William F. [Cambridge Mobile Telematics, Cambridge, MA (United States)

    2017-09-15

    Assessment for active Crohn disease by CT enterography and MR enterography relies on identifying mural and perienteric imaging features. To evaluate the performance of established imaging features of active Crohn disease in children and adolescents on CT and MR enterography compared with histological reference. We included patients ages 18 years and younger who underwent either CT or MR enterography from 2007 to 2014 and had endoscopic biopsy within 28 days of imaging. Two pediatric radiologists blinded to the histological results reviewed imaging studies and scored the bowel for the presence or absence of mural features (wall thickening >3 mm, mural hyperenhancement) and perienteric features (mesenteric hypervascularity, edema, fibrofatty proliferation and lymphadenopathy) of active disease. We performed univariate analysis and multivariate logistic regression to compare imaging features with histological reference. We evaluated 452 bowel segments (135 from CT enterography, 317 from MR enterography) from 84 patients. Mural imaging features had the highest association with active inflammation both for MR enterography (wall thickening had 80% accuracy, 69% sensitivity and 91% specificity; mural hyperenhancement had 78%, 53% and 96%, respectively) and CT enterography (wall thickening had 84% accuracy, 72% sensitivity and 91% specificity; mural hyperenhancement had 76%, 51% and 91%, respectively), with perienteric imaging features performing significantly worse on MR enterography relative to CT enterography (P < 0.001). Mural features are predictors of active inflammation for both CT and MR enterography, while perienteric features can be distinguished better on CT enterography compared with MR enterography. This likely reflects the increased conspicuity of the mesentery on CT enterography and suggests that mural features are the most reliable imaging features of active Crohn disease in children and adolescents. (orig.)

  17. Psychological well-being and quality of life in Crohn's disease patients with an ostomy: a preliminary investigation.

    Science.gov (United States)

    Knowles, Simon R; Wilson, Jarrad; Wilkinson, Annette; Connell, William; Salzberg, Michael; Castle, David; Desmond, Paul; Kamm, Michael A

    2013-01-01

    The aims of this research were to explore associations among elective versus emergency surgery, type of ostomy (permanent vs temporary), illness perceptions and coping style, anxiety, depression, and health-related quality of life in persons with Crohn's disease. A further aim was to determine the extent of current and past use of psychological care and use of psychotropic medications. The sample comprised 31 persons (17 men and 14 women; mean age 45 years) with Crohn's disease and an ostomy from 2 large teaching hospitals in Melbourne, Australia. Data were collected using a descriptive, cross-sectional design. The questionnaire incorporated 3 validated instruments: the Brief Illness Perceptions Questionnaire, the Hospital Anxiety and Depression Scale, and the Stoma Quality of Life Scale. Poor illness perception correlated significantly with increased anxiety, depression, and reduced health-related quality of life (specifically, sexuality and body image, work and social functioning, stoma function, and financial concerns). Forty-eight percent of patients scored more than the cutoff for anxiety, and 42% scored more than the cutoff for depression on the Hospital Anxiety and Depression Scale. Of these, only 20% and 31%, respectively, reported currently receiving psychological care. The timing of ostomy surgery (planned vs emergency) or ostomy type (permanent vs temporary) was not significantly associated with anxiety, depression, or health-related impaired quality of life. In this exploratory, cross-sectional study, patients with Crohn's disease and a stoma had high rates of psychological comorbidity and low scores on quality of life. Adverse illness perception appeared to explain some of these findings, but most were not receiving psychological help. Psychological care is indicated for many of these patients and further research is indicated.

  18. Smoking does influence disease behaviour and impacts the need for therapy in Crohn's disease in the biologic era.

    Science.gov (United States)

    Nunes, T; Etchevers, M J; Domènech, E; García-Sánchez, V; Ber, Y; Peñalva, M; Merino, O; Nos, P; Garcia-Planella, E; Casbas, A G; Esteve, M; Taxonera Samsó, C; Montoro Huguet, M; Gisbert, J P; Martín Arranz, M D; García-Sepulcre, M F; Barreiro-de Acosta, M; Beltrán, B; Alcaide Suárez, N; Saro Gismera, C; Cabriada, J L; Cañas-Ventura, A; Gomollón, F; Panés, J

    2013-10-01

    Recently, the notion that smoking may adversely affect Crohn's disease (CD) outcomes has been challenged by the suggestion that the widespread use of immunosuppressants and anti-TNF drugs might offset the adverse effects of tobacco. To reassess the influence of tobacco smoking on disease phenotype and complications on a time-dependent analysis, taking into account the different therapeutic interventions. We designed a retrospective cohort study of 3224 patients with Crohn's disease. The data were collected from the Spanish national inflammatory bowel disease registry (ENEIDA), including information regarding demographics, clinical characteristics, disease complications, therapeutic interventions and smoking status. Patients were classified as nonsmokers, smokers and former smokers, according to their present and past smoking habits. In the univariate analysis, smokers had more strictures (22.6% vs. 19.3%, P < 0.05) and less colonic involvement (7.2% vs. 10.9%, P < 0.05), and were more frequently under treatment with steroids (91.6% vs. 85.8%, P < 0.05), immunosuppressants (73.5% vs. 63.6% P < 0.05) or anti-TNF drugs (31.4% vs. 25.1%, P < 0.05) than nonsmokers. In the time-dependent multivariate analysis, smokers were found to have a significantly decreased survival free of stricturing disease (HR: 1.5, CI 95% 1.18-1.90) or perianal complications (HR: 1.50, CI 95% 1.01-1.46), and had a higher risk for requiring thiopurine therapy (HR: 1.20, CI 95% 1.05-1.30). These results suggest that, despite the widespread use of immunosuppressants and anti-TNF drugs, smokers with Crohn's disease still have a more severe disease course, with increased therapeutic requirements when compared with nonsmokers. © 2013 John Wiley & Sons Ltd.

  19. Estudio mediante mecánica de fluidos computacional del efecto de la estenosis en el íleon provocada por la enfermedad de Crohn.

    OpenAIRE

    Abril López, Eduardo

    2016-01-01

    La enfermedad de Crohn es una enfermedad crónica que causa la inflamación de cualquier parte del sistema gastrointestinal, producido por el ataque al sistema inmunitario. En concreto, la parte que más suele afectarse es la parte inferior del intestino delgado (íleon) que es donde se va a centrar el estudio. Esta enfermedad de Crohn afecta al cuerpo humano inflamando el revestimiento de la parte afectada en el intestino delgado provocando una hinchazón de la pared. Si esta hinchazón (zona de l...

  20. Fistole retto-vaginali Crohn-relate trattate mediante trasposizione del muscolo gracile: risultati a lungo termine e qualità della vita

    OpenAIRE

    Tassone, Daniela

    2015-01-01

    OBIETTIVO: Le fistole retto-vaginali Crohn-relate hanno un impatto significativo sulla qualità della vita. Quando il canale anale è alterato da ulcerazioni e stenosi o in pazienti con difetti estesi del perineo, la chirurgia locale produce risultati insoddisfacenti. Lo scopo di questo studio è quello di valutare l'efficacia della trasposizione del muscolo gracile nelle fistole retto-vaginali Crohn-relate e determinare i suoi effetti sulla qualità della vita. MATERIALI E METODI: Da gennaio...

  1. A Calcium Enterolith in a Patient with Crohn's Disease and Its In Vitro Dissolubility in Citric Acid

    Science.gov (United States)

    Urata, Haruo; Ohmori, Masayasu; Kondo, Yoshitaka; Kawahara, Yoshiro; Okada, Hiroyuki

    2017-01-01

    The microstructure and dissolubility of a calcified enterolith and enterolith pieces removed from a 26-year-old Japanese woman with Crohn's disease were analyzed using scanning electron microscopy and energy dispersive X-ray spectroscopy. The enterolith showed a multilayered structure with fatty acid calcium and magnesium phosphate. The amount of calcium, magnesium, and phosphate decreased after they were immersed in a citric acid solution, suggesting a potential contribution of acidic aqueous solution to elute inorganic substances contained in calcified enteroliths. This is the first study to investigate the in vitro dissolubility of calcified enteroliths induced by citric acid solution. PMID:29082049

  2. Trace element determination in fingernails, hair and blood serum in patients with Crohn's disease using neutron activation analysis

    International Nuclear Information System (INIS)

    Buschmann, H.

    1984-01-01

    The determination of trace elements and electrolyte concentrations in blood serum, hair and fingernails of 16 patients with Crohn's disease was carried out by means of instrumental neutron activation analysis. In the serum a significant decline in the zinc content could be registered, while the remaining trace elements remained in the normal range. The parenteral nutrition also showed a zinc deficiency. There was, however, also an iron deficiency. The studies of the hair and fingernails gave the following results: Rubidium and antimony in the normal range; zinc, selenium, iron and cobalt below normal values. (orig./PW) [de

  3. Significance of X-ray examinations of patients with Crohn's disease after intestinal-tract resections

    Energy Technology Data Exchange (ETDEWEB)

    Kulke, H.; Hoerl, M.; Kasper, H.; Auer, I.O.

    1988-12-01

    After intestinal tract resection, the status of the intestinal tract of patients with Crohn's disease who had recurrent anastomoses versus those that did not analyzed using standardized procedures of stomach X-ray with small bowel follow through, barium enema and fistulography. The intestinal tract resections included ileostomy, transverse ileostomy, rectal ileostomy, and atypical procedures. The anstomoses and surrounding tissue were evaluated. The results were discussed and the X-ray characteristics of the current anastomosis and the existing changes in its environment were analyzed.

  4. The significance of X-ray examinations of patients with Crohn's disease after intestinal-tract resections

    International Nuclear Information System (INIS)

    Kulke, H.; Hoerl, M.; Kasper, H.; Auer, I.O.

    1988-01-01

    After intestinal tract resection, the status of the intestinal tract of patients with Crohn's disease who had recurrent anastomoses versus those that did not analyzed using standardized procedures of stomach X-ray with small bowel follow through, barium enema and fistulography. The intestinal tract resections included ileostomy, transverse ileostomy, rectal ileostomy, and atypical procedures. The anstomoses and surrounding tissue were evaluated. The results were discussed and the X-ray characteristics of the current anastomosis and the existing changes in its environment were analyzed. (orig.) [de

  5. Adalimumab in the induction of Crohn's disease remission: results of a Brazilian multicenter case series

    Directory of Open Access Journals (Sweden)

    Paulo Gustavo Kotze

    2011-09-01

    Full Text Available Introduction: Adalimumab (ADA is a subcutaneous fully-human anti-TNF antibody which has a significant role in the management of Crohn's disease (CD. Its efficacy has been demonstrated in several clinical trials. The main objective of this study was to evaluate the role of ADA in the induction of clinical remission in a Brazilian series of CD cases. Method: A retrospective analysis of CD patients treated with ADA was performed in three Brazilian inflammatory bowel diseases (IBD reference centers. The following characteristics were analyzed: gender, age, indication to ADA treatment, type of response, previous exposure to infliximab (IFX, concomitant use of immunomodulators and adverse events, among others. Results: 54 patients (29 females were included in this series, with mean age of 36.72 years (ranging from 15 to 62 years. After induction regimen, 26 patients (48.14% were in clinical remission, 26 (48.14% had partial response, and 2 (3.72% were primary non-responders. After a mean follow-up of 9.83 (2 to 28 months, 17 patients (31.48% presented adverse events. The most common event was pain on the injection site (7 patients - 12.96%. Conclusions: ADA was effective to induce CD remission in this Brazilian case series. The remission and response rates were similar to the literature, as well as the safety profile of this drug.Introdução: O adalimumabe (ADA é um anticorpo anti-fator de necrose tumoral alfa totalmente humano, de uso subcutâneo, com eficácia e perfil de segurança bem determinados na doença de Crohn (DC. O objetivo principal deste estudo foi determinar o papel do ADA na indução da remissão na DC, em uma série brasileira de casos. Método: Estudo retrospectivo, realizado em três centros de referência em doenças inflamatórias intestinais, com usuários do ADA para tratamento da DC. As variáveis analisadas foram: idade, sexo, indicação do tratamento, forma de apresentação da doença, tipo de resposta (total, parcial

  6. Molecular analysis of the gut microbiota of identical twins with Crohn's disease.

    Science.gov (United States)

    Dicksved, Johan; Halfvarson, Jonas; Rosenquist, Magnus; Järnerot, Gunnar; Tysk, Curt; Apajalahti, Juha; Engstrand, Lars; Jansson, Janet K

    2008-07-01

    Increasing evidence suggests that a combination of host genetics and the composition of the gut microbiota are important for development of Crohn's disease (CD). Our aim was to study identical twins with CD to determine microbial factors independent of host genetics. Fecal samples were studied from 10 monozygotic twin pairs with CD (discordant n=6 and concordant n=4) and 8 healthy twin pairs. DNA was extracted, 16S rRNA genes were PCR amplified and T-RFLP fingerprints generated using general bacterial and Bacteroides group-specific primers. The microbial communities were also profiled based on their percentage G+C contents. Bacteroides 16S rRNA genes were cloned and sequenced from a subset of the samples. The bacterial diversity in each sample and similarity indices between samples were estimated based on the T-RFLP data using a combination of statistical approaches. Healthy individuals had a significantly higher bacterial diversity compared to individuals with CD. The fecal microbial communities were more similar between healthy twins than between twins with CD, especially when these were discordant for the disease. The microbial community profiles of individuals with ileal CD were significantly different from healthy individuals and those with colonic CD. Also, CD individuals had a lower relative abundance of B. uniformis and higher relative abundances of B. ovatus and B. vulgatus. Our results suggest that genetics and/or environmental exposure during childhood, in part, determine the gut microbial composition. However, CD is associated with dramatic changes in the gut microbiota and this was particularly evident for individuals with ileal CD.

  7. Practice patterns and clinical significance of use of capsule endoscopy in suspected and established Crohn's disease

    Directory of Open Access Journals (Sweden)

    Yonghyun Kim

    2017-10-01

    Full Text Available Background/Aims: Although the role of capsule endoscopy (CE in Crohn's disease (CD has expanded, CE is not used routinely for diagnosing and evaluating CD in Korea. We aimed to investigate current patterns of practice and evaluate the clinical significance of the use of CE in CD in Korean patients.Methods: Among 651 CE procedures performed for various indications, we retrospectively analyzed the medical records of patients who underwent CE in 57 cases of suspected CD (sCD and 14 cases of established CD (eCD.Results: In the sCD group, CE was most commonly used for the initial diagnosis of CD (54.4%. Capsule retention was found in only 1 patient in the eCD group (1/71, 1.4%. In the sCD group, 28.1% of patients were diagnosed with CD on the basis of CE findings; other diseases diagnosed included tuberculous enteritis (7.0%, non-steroidal anti-inflammatory drug-induced enteropathy (5.3%, and other enteritis (17.5%. Only 11.5% of patients with eCD (14/122 underwent CE. The indication for CE in the 14 patients with eCD was to assess disease extent and activity. The overall diagnostic yield of CE was 59.7%. Therapeutic strategies were changed in 70.2% of patients in the sCD group and 50% of those in the eCD group based on CE findings.Conclusions: In clinical practice, CE was most commonly indicated for the initial diagnosis of CD and was not generally performed in patients with eCD. CE appears to be an effective diagnostic modality for evaluating sCD and is useful for determining therapeutic strategies for patients with sCD and those with eCD.

  8. Immunochip analysis identification of 6 additional susceptibility loci for Crohn's disease in Koreans.

    Science.gov (United States)

    Yang, Suk-Kyun; Hong, Myunghee; Choi, Hyunchul; Zhao, Wanting; Jung, Yusun; Haritunians, Talin; Ye, Byong Duk; Kim, Kyung-Jo; Park, Sang Hyoung; Lee, Inchul; Kim, Won Ho; Cheon, Jae Hee; Kim, Young-Ho; Jang, Byung Ik; Kim, Hyun-Soo; Choi, Jai Hyun; Koo, Ja Seol; Lee, Ji Hyun; Jung, Sung-Ae; Shin, Hyoung Doo; Kang, Daehee; Youn, Hee-Shang; Taylor, Kent D; Rotter, Jerome I; Liu, Jianjun; McGovern, Dermot P B; Song, Kyuyoung

    2015-01-01

    Crohn's disease (CD) is an intractable inflammatory bowel disease of unknown cause. Recent genome-wide association studies of CD in Korean and Japanese populations suggested marginal sharing of susceptibility loci between Caucasian and Asian populations. As the 7 identified loci altogether explain 5.31% of the risk for CD, the objective of this study was to identify additional CD susceptibility loci in the Korean population. Using the ImmunoChip custom single-nucleotide polymorphism array designed for dense genotyping of 186 loci identified through GWAS, we analyzed 722 individuals with CD and 461 controls for 96,048 SNP markers in the discovery stage, followed by validation in an additional 948 affected individuals and 977 controls. We confirmed 6 previously reported loci in Caucasian: GPR35 at 2q37 (rs3749172; P = 5.30 × 10, odds ratio [OR] = 1.45), ZNF365 at 10q21 (rs224143; P = 2.20 × 10, OR = 1.38), ZMIZ1 at 10q22 (rs1250569; P = 3.05 × 10, OR = 1.30), NKX2-3 at 10q24 (rs4409764; P = 7.93 × 10, OR = 1.32), PTPN2 at 18p11 (rs514000; P = 9.00 × 10, OR = 1.33), and USP25 at 21q11 (rs2823256; P = 2.49 × 10, OR = 1.35), bringing the number of known CD loci (including 3 in the HLA) in Koreans to 15. The 6 additional loci increased the total genetic variance for CD risk from 5.31% to 7.27% in Koreans. Although the different genetic backgrounds of CD between Asian and Western countries has been well established for the major susceptibility genes, our findings of overlapping associations offer new insights into the genetic architecture of CD.

  9. Luminally-polarized mural and vascular remodeling in ileal strictures of Crohn's Disease.

    Science.gov (United States)

    Zhang, Xiaofei; Ko, Huaibin Mabel; Torres, Joana; Panchal, Hinaben J; Cai, Zhenjian; Wagner, Mathilde; Sands, Bruce E; Colombel, Jean-Frederic; Cho, Judy; Taouli, Bachir; Harpaz, Noam

    2018-03-16

    Intestinal stricture, a major complication of Crohn's disease (CD), results from fibromuscular remodeling and expansion of the intestinal wall. The corresponding microanatomical alterations have not been fully described, hindering progress toward understanding their pathogenesis and devising appropriate treatments. We used tissue-specific staining and quantitative digital histomorphometry for this purpose. Serial histological sections from 37 surgically-resected ileal strictures and adjacent non-strictured controls from patients with CD were evaluated after staining for smooth muscle actin, collagen (Sirius red) and collagen types I, III and V. Overall mural thickening in strictures was increased 2.4±0.3-fold compared with non-strictured regions of the same specimens. The muscular layer most altered was the muscularis mucosae (MM). Compared with the inner and outer layers of the MP which were expanded 2.1±0.2- and 1.4±0.1-fold, respectively, the MM was expanded 22.1±3.6-fold, reflecting the combined effects of architectural disarray, an 11.6±1.4-fold increase smooth muscle content, and elaboration of pericellular type V collagen. In contrast, the architecture of the MP was preserved and pericellular collagen was virtually absent; rather, fibrosis in this layer was limited to expansion of the intramuscular septa by collagen types I and III. The muscular arteries and veins within the strictured submucosa frequently exhibited eccentric, luminally-oriented adventitial mantles comprising hyperplastic myocytes and extracellular type V collagen. We conclude that the fibromuscular remodeling which results in CD-associated ileal strictures predominantly involves the MM and submucosal vasculature in a luminally-polarized fashion and suggests that mucosal-based factors may contribute to stricture pathogenesis. Copyright © 2018. Published by Elsevier Inc.

  10. The link between negative affect, vagal tone, and visceral sensitivity in quiescent Crohn's disease.

    Science.gov (United States)

    Rubio, A; Pellissier, S; Picot, A; Dantzer, C; Bonaz, B

    2014-08-01

    Autonomic dysfunction and mood disorders are frequently described in Crohn's disease (CD) and are known to influence visceral sensitivity. We addressed the link between vagal tone, negative affect, and visceral sensitivity in CD patients without concomitant features of irritable bowel syndrome (IBS). Rectal distensions to a discomfort threshold of 70% and onset of pain were performed in nine CD patients in remission and eight healthy controls. Autonomic parameters were evaluated with heart rate variability and electrodermal reactivity. We showed that CD patients had (i) higher scores of depressive symptomatology (12 ± 3 in patients vs 4 ± 1 in controls on the Center for Epidemiologic Studies-Depression Scale; p = 0.038), (ii) reduced vagal tone (HF 257 ± 84 ms(2) vs 1607 ± 1032 ms(2) , p = 0.043; LF 455 ± 153 ms(2) vs 1629 ± 585 ms(2) , p = 0.047), (iii) decreased sympathetic reactivity during an aversive stimulus, and (iv) higher tolerance to rectal distension pressures (43 ± 3 mmHg vs 30 ± 2 mmHg, p = 0.002) and low sensitivity index scores. In conclusion, our results provide preliminary evidence that patients with quiescent CD, in the absence of IBS, are hyposensate to experimental rectal distension. These data provide further evidence that anxiety and depressive symptomatology in addition to autonomic dysfunction modulate visceral pain perception in quiescent CD patients in the absence of IBS. © 2014 John Wiley & Sons Ltd.

  11. Characterization of changes in serum anti-glycan antibodies in Crohn's disease--a longitudinal analysis.

    Directory of Open Access Journals (Sweden)

    Florian Rieder

    Full Text Available INTRODUCTION: Anti-glycan antibodies are a promising tool for differential diagnosis and disease stratification of patients with Crohn's disease (CD. We longitudinally assessed level and status changes of anti-glycan antibodies over time in individual CD patients as well as determinants of this phenomenon. METHODS: 859 serum samples derived from a cohort of 253 inflammatory bowel disease (IBD patients (207 CD, 46 ulcerative colitis (UC were tested for the presence of anti-laminarin (Anti-L, anti-chitin (Anti-C, anti-chitobioside (ACCA, anti-laminaribioside (ALCA, anti-mannobioside (AMCA and anti-Saccharomyces cerevisiae (gASCA antibodies by ELISA. All patients had at least two and up to eleven serum samples taken during the disease course. RESULTS: Median follow-up time for CD was 17.4 months (Interquartile range (IQR 8.0, 31.6 months and for UC 10.9 months (IQR 4.9, 21.0 months. In a subgroup of CD subjects marked changes in the overall immune response (quartile sum score and levels of individual markers were observed over time. The marker status (positive versus negative remained widely stable. Neither clinical phenotype nor NOD2 genotype was associated with the observed fluctuations. In a longitudinal analysis neither changes in disease activity nor CD behavior led to alterations in the levels of the glycan markers. The ability of the panel to discriminate CD from UC or its association with CD phenotypes remained stable during follow-up. In the serum of UC patients neither significant level nor status changes were observed. CONCLUSIONS: While the levels of anti-glycan antibodies fluctuate in a subgroup of CD patients the antibody status is widely stable over time.

  12. Is There a Link Between H. Pylori and the Epidemiology of Crohn's Disease?

    Science.gov (United States)

    Shah, Ayesha; Talley, Nicholas J; Walker, Marjorie; Koloski, Natasha; Morrison, Mark; Burger, Daniel; Andrews, Jane M; McGuckin, Michael; Jones, Mike; Holtmann, Gerald

    2017-09-01

    Case control studies suggest an inverse association between Helicobacter pylori (H. pylori) and Crohn's disease (CD). It is possible this could be accounted for by confounders such as antibiotic therapy. Analyzing the geographic distribution of H. pylori and the links with the incidence and prevalence of CD would be an alternative approach to circumvent these confounders. The literature was searched for studies published between 1990 and 2016 that reported incidence or prevalence data for CD in random population samples in developed countries (GDP per capita >20,000 USD/year). Corresponding prevalence studies for H. pylori in these same regions were then sought matched to the same time period (±6 years). The association between the incidence and prevalence of CD and H. pylori prevalence rates were assessed before and after adjusting for GDP and life expectancy. A total of 19 CD prevalence and 22 CD incidence studies from 10 European countries, Japan, USA, and Australia with date-matched H. pylori prevalence data were identified. The mean H. pylori prevalence rate was 43.4% (range 15.5-85%), and the mean rates for incidence and prevalence for CD were 6.9 and 91.0/100,000 respectively. The incidence (r = -0.469, p H. pylori infection. Our data demonstrate a significant inverse association between geographic distribution of H. pylori and CD. Thus, it is highly unlikely that the findings of previous case control studies were simply due to confounding factors such as concomitant antibiotic use in CD patients.

  13. Mycobacterium avium subspecies paratuberculosis causes Crohn's disease in some inflammatory bowel disease patients.

    Science.gov (United States)

    Naser, Saleh A; Sagramsingh, Sudesh R; Naser, Abed S; Thanigachalam, Saisathya

    2014-06-21

    Crohn's disease (CD) is a chronic inflammatory condition that plagues millions all over the world. This debilitating bowel disease can start in early childhood and continue into late adulthood. Signs and symptoms are usually many and multiple tests are often required for the diagnosis and confirmation of this disease. However, little is still understood about the cause(s) of CD. As a result, several theories have been proposed over the years. One theory in particular is that Mycobacterium avium subspecies paratuberculosis (MAP) is intimately linked to the etiology of CD. This fastidious bacterium also known to cause Johne's disease in cattle has infected the intestines of animals for years. It is believed that due to the thick, waxy cell wall of MAP it is able to survive the process of pasteurization as well as chemical processes seen in irrigation purification systems. Subsequently meat, dairy products and water serve as key vehicles in the transmission of MAP infection to humans (from farm to fork) who have a genetic predisposition, thus leading to the development of CD. The challenges faced in culturing this bacterium from CD are many. Examples include its extreme slow growth, lack of cell wall, low abundance, and its mycobactin dependency. In this review article, data from 60 studies showing the detection and isolation of MAP by PCR and culture techniques have been reviewed. Although this review may not be 100% comprehensive of all studies, clearly the majority of the studies overwhelmingly and definitively support the role of MAP in at least 30%-50% of CD patients. It is very possible that lack of detection of MAP from some CD patients may be due to the absence of MAP role in these patients. The latter statement is conditional on utilization of methodology appropriate for detection of human MAP strains. Ultimately, stratification of CD and inflammatory bowel disease patients for the presence or absence of MAP is necessary for appropriate and effective

  14. Whole body BMC in pediatric Crohn disease: independent effects of altered growth, maturation, and body composition.

    Science.gov (United States)

    Burnham, Jon M; Shults, Justine; Semeao, Edisio; Foster, Bethany; Zemel, Babette S; Stallings, Virginia A; Leonard, Mary B

    2004-12-01

    Whole body BMC was assessed in 104 children and young adults with CD and 233 healthy controls. CD was associated with significant deficits in BMC and lean mass, relative to height. Adjustment for lean mass eliminated the bone deficit in CD. Steroid exposure was associated with short stature but not bone deficits relative to height. Children with Crohn disease (CD) have multiple risk factors for impaired bone accrual. The confounding effects of poor growth and delayed maturation limit the interpretation of prior studies of bone health in CD. The objective of this study was to assess BMC relative to growth, body composition, and maturation in CD compared with controls. Whole body BMC and lean mass were assessed by DXA in 104 CD subjects and 233 healthy controls, 4-26 years of age. Multivariable linear regression models were developed to sequentially adjust for differences in skeletal size, pubertal maturation, and muscle mass. BMC-for-height z scores were derived to determine CD-specific covariates associated with bone deficits. Subjects with CD had significantly lower height z score, body mass index z score, and lean mass relative to height compared with controls (all p BMC in CD relative to controls was significantly reduced in males (0.86; 95% CI, 0.83, 0.94) and females (0.91; 95% CI, 0.85, 0.98) with CD. Adjustment for pubertal maturation did not alter the estimate; however, addition of lean mass to the model eliminated the bone deficit. Steroid exposure was associated with short stature but not bone deficits. This study shows the importance of considering differences in body size and composition when interpreting DXA data in children with chronic inflammatory conditions and shows an association between deficits in muscle mass and bone in pediatric CD.

  15. Contrast-enhanced Ultrasound for Detection of Crohn's Disease Activity: Systematic Review and Meta-analysis.

    Science.gov (United States)

    Serafin, Zbigniew; Białecki, Marcin; Białecka, Agnieszka; Sconfienza, Luca Maria; Kłopocka, Maria

    2016-03-01

    Reports on imaging of active Crohn's disease (aCD) using contrast-enhanced ultrasound (CEUS) are encouraging. However, the statistical power of most published papers is limited due to the small size of the patient groups included. This study was performed to verify the diagnostic value of CEUS in detecting aCD. A systematic literature search was performed by two independent reviewers for articles on the test characteristics of CEUS for the identification of aCD. The quality of the analysed studies was evaluated using a quality assessment tool for diagnostic accuracy studies (QUADAS-2). Pooling was performed using a diagnostic random-effect model and bivariate analysis. Eight articles were included in the final analysis, with a total of 332 patients. There was no significant publication bias. Significant heterogeneity was found regarding CEUS methodology and sonographic definitions of aCD. In a bivariate analysis, pooled sensitivity was 0.94 (95% CI 0.87-0.97) and pooled specificity was 0.79 (95% CI 0.67-0.88). Spearman correlation statistics presented no significant diagnostic threshold effect (r = 0.12, p > 0.9). Subgroup analysis showed that relative intestine wall enhancement had the highest diagnostic value (area under the curve 94%), while the presence of enhancement and analysis of the slope were less useful (area under the curve 91 and 90%, respectively). CEUS presents good sensitivity and moderate specificity in the detection of the aCD. Large-scale randomized trials with quantitative evaluation of CEUS images are necessary to promote this technique in clinical practice. Copyright © 2015 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  16. Increased fracture risk assessed by fracture risk assessment tool in Greek patients with Crohn's disease.

    Science.gov (United States)

    Terzoudis, Sotirios; Zavos, Christos; Damilakis, John; Neratzoulakis, John; Dimitriadi, Daphne Anna; Roussomoustakaki, Maria; Kouroumalis, Elias A; Koutroubakis, Ioannis E

    2013-01-01

    The World Health Organization has recently developed the fracture risk assessment tool (FRAX) based on clinical risk factors and bone mineral density (BMD) for evaluation of the 10-year probability of a hip or a major osteoporotic fracture. The aim of this study was to evaluate the use of the FRAX tool in Greek patients with inflammatory bowel disease (IBD). FRAX scores were applied to 134 IBD patients [68 Crohn's disease (CD); 66 ulcerative colitis (UC)] who underwent dual-energy X-ray absorptiometry scans at the femoral neck and lumbar spine during the period 2007-2012. Calculation of the FRAX scores, with or without BMD, was made through a web-based probability model used to compute individual fracture probabilities according to specific clinical risk factors. The median 10-year probability of a major osteoporotic fracture for IBD patients based on clinical data was 7.1%, and including the BMD was 6.2%. A significant overestimation with the first method was found (P = 0.01). Both scores with and without BMD were significantly higher in CD patients compared with UC patients (P = 0.02 and P = 0.005, respectively). The median 10-year probability of hip fracture based on clinical data was 0.8%, and including the BMD was 0.9%. The score with use of BMD was significantly higher in CD compared with UC patients (P = 0.04). CD patients have significantly higher FRAX scores and possibly fracture risk compared with UC patients. The clinical FRAX score alone seems to overestimate the risk of osteoporotic fracture in Greek IBD patients.

  17. Polyethylene glycol and contrast-enhanced MRI of Crohn's disease in children: preliminary experience.

    Science.gov (United States)

    Magnano, Gianmichele; Granata, Claudio; Barabino, Arrigo; Magnaguagno, Francesca; Rossi, Umberto; Calevo, Maria Grazia; Toma, Paolo

    2003-06-01

    To assess the ability of MRI to detect bowel abnormalities in children affected by Crohn's disease (CD). We studied 22 children (age range 8-18 years) referred to us with a known history of CD. MRI was carried out using a 1.5-T unit with a maximum gradient field strength of 16 mT and a phased-array body coil. The sequences performed were breath-hold coronal and axial T2-weighted, express fat saturation, followed by T1-weighted, spoiled gradient, fast fat saturation after IV injection of gadolinium chelate (0.3 mmol/kg) for contrast enhancement of the bowel wall. Bowel distension was achieved using oral administration of isosmotic polyethylene glycol solution. Ileo-colonoscopy was considered the gold standard for evaluation of superficial abnormalities and stenoses of the colon and terminal ileum. MRI findings of bowel-wall thickening, increased vascularisation and extramural involvement were compared with the findings using B-mode and Doppler US. Concordance between MRI and endoscopy, B-mode US and Doppler US findings was determined by the Kappa statistical method. Superficial lesions were not shown by MRI. MR enteroclysis easily detected stenoses, thickening and hyperaemia of bowel wall. Concordance of findings between MRI and endoscopy was 90% (K=0.79, substantial concordance). Concordance of findings between MRI and US concerning bowel-wall thickening and increased vascularisation was 95% (K=0.875, excellent concordance) and 80% (K=0.6, fairly good concordance), respectively. Our initial results show that MRI can detect intra- and extra-mural lesions of CD. The high concordance observed between MRI, endoscopy, US and Doppler US findings suggests that MRI is at least comparable for diagnostic capability with these techniques offering, thanks to multiplanar projections, an improved visualisation of the bowel without ionising radiation.

  18. Polyethylene glycol and contrast-enhanced MRI of Crohn's disease in children: preliminary experience

    International Nuclear Information System (INIS)

    Magnano, Gianmichele; Granata, Claudio; Magnaguagno, Francesca; Rossi, Umberto; Toma, Paolo; Barabino, Arrigo; Calevo, Maria Grazia

    2003-01-01

    To assess the ability of MRI to detect bowel abnormalities in children affected by Crohn's disease (CD). We studied 22 children (age range 8-18 years) referred to us with a known history of CD. MRI was carried out using a 1.5-T unit with a maximum gradient field strength of 16 mT and a phased-array body coil. The sequences performed were breath-hold coronal and axial T2-weighted, express fat saturation, followed by T1-weighted, spoiled gradient, fast fat saturation after IV injection of gadolinium chelate (0.3 mmol/kg) for contrast enhancement of the bowel wall. Bowel distension was achieved using oral administration of isosmotic polyethylene glycol solution. Ileo-colonoscopy was considered the gold standard for evaluation of superficial abnormalities and stenoses of the colon and terminal ileum. MRI findings of bowel-wall thickening, increased vascularisation and extramural involvement were compared with the findings using B-mode and Doppler US. Concordance between MRI and endoscopy, B-mode US and Doppler US findings was determined by the Kappa statistical method. Superficial lesions were not shown by MRI. MR enteroclysis easily detected stenoses, thickening and hyperaemia of bowel wall. Concordance of findings between MRI and endoscopy was 90% (K=0.79, substantial concordance). Concordance of findings between MRI and US concerning bowel-wall thickening and increased vascularisation was 95% (K=0.875, excellent concordance) and 80% (K=0.6, fairly good concordance), respectively. Our initial results show that MRI can detect intra- and extra-mural lesions of CD. The high concordance observed between MRI, endoscopy, US and Doppler US findings suggests that MRI is at least comparable for diagnostic capability with these techniques offering, thanks to multiplanar projections, an improved visualisation of the bowel without ionising radiation. (orig.)

  19. Molecular analysis of the gut microbiota of identical twins with Crohn's disease

    Energy Technology Data Exchange (ETDEWEB)

    Jansson, Janet; Dicksved, Johan; Halfvarson, Jonas; Rosenquist, Magnus; Jarnerot, Gunnar; Tysk, Curt; Apajalahti, Juha; Engstrand, Lars; Jansson, Janet K.

    2008-03-14

    Increasing evidence suggests that a combination of host genetics and the composition of the gut microbiota are important for development of Crohn's disease (CD). Our aim was to study identical twins with CD to determine microbial factors independently of host genetics. Fecal samples were studied from 10 monozygotic twin pairs with CD (discordant n=6, concordant n=4) and 8 healthy twin pairs. DNA was extracted, 16S rRNA genes were PCR amplified and T-RFLP fingerprints generated using general bacterial and Bacteroides group specific primers. The microbial communities were also profiled based on their % G+C contents. Bacteroides 16S rRNA genes were cloned and sequenced from a subset of the samples. The bacterial diversity in each sample and similarity indices between samples were estimated based on the T-RFLP data using a combination of statistical approaches. Healthy individuals had a significantly higher bacterial diversity compared to individuals with CD. The fecal microbial communities were more similar between healthy twins than between twins with CD, especially when these were discordant for the disease. The microbial community profiles of individuals with ileal CD were significantly different from healthy individuals and those with colonic CD. Also, CD individuals had a lower relative abundance of B. uniformis and higher relative abundances of B. ovatus and B. vulgatus. Our results suggest that genetics and/or environmental exposure during childhood in part determine the gut microbial composition. However, CD is associated with dramatic changes in the gut microbiota and this was particularly evident for individuals with ileal CD.

  20. Quantification, validation, and follow-up of small bowel motility in Crohn's disease

    Science.gov (United States)

    Cerrolaza, Juan J.; Peng, Jennifer Q.; Safdar, Nabile M.; Conklin, Laurie; Sze, Raymond; Linguraru, Marius George

    2015-03-01

    The use of magnetic resonance enterography (MRE) has become a mainstay in the evaluation, assessment and follow up of inflammatory bowel diseases, such as Crohn's disease (CD), thanks to its high image quality and its non-ionizing nature. In particular, the advent of faster MRE sequences less sensitive to image-motion artifacts offers the possibility to obtain visual, structural and functional information of the patient's small bowel. However, the inherent subjectivity of the mere visual inspection of these images often hinders the accurate identification and monitoring of the pathological areas. In this paper, we present a framework that provides quantitative and objective motility information of the small bowel from free-breathing MRE dynamic sequences. After compensating for the breathing motion of the patient, we create personalized peristaltic activity maps via optical flow analysis. The result is the creation of a new set of images providing objective and precise functional information of the small bowel. The accuracy of the new method was also evaluated from two different perspectives: objective accuracy (1.1 ± 0.6 mm/s of error), i.e., the ability of the system to provide quantitative and accurate information about the motility of moving bowel landmarks, and subjective accuracy (avg. difference of 0.7 ± 0.7 in a range of 1 to 5), i.e., the degree of agreement with the subjective evaluation of an expert. Finally, the practical utility of the new method was successfully evaluated in a preliminary study with 32 studies of healthy and CD cases, showing its potential for the fast and accurate assessment and follow up of CD in the small bowel.

  1. Complications after intestinal resection in Crohn's disease: laparoscopic versus conventional approach

    Directory of Open Access Journals (Sweden)

    Paulo Gustavo Kotze

    2013-07-01

    Full Text Available Background: significant advances in medical therapy for Crohn's disease (CD occurred in the last 12 years, mainly due to the introduction of anti-TNF therapy. Laparoscopic colorectal surgery represented the most important advance on surgical treatment in the management of CD, as it also had developed in the treatment of other conditions. There is a tendency for lower complication rates after laparoscopic bowel resections as compared to open surgery. The aim of this study was to analyze and compare the complication rates after bowel resections for CD between the two approaches in a Brazilian case series. Methods: this was a retrospective longitudinal study, including CD patients submitted to bowel resections from a single Brazilian Inflammatory Bowel Diseases (IBD referral center, treated between January 2008 and June 2012 with laparoscopic approach (LA or conventional approach (CA. Variables analyzed: age at surgery, gender, Montreal classification, smoking, concomitant medication, type of surgery, surgical approach, presence and type of complication up to 30 days after the procedures. Readmission and reoperation rates, as well as mortality, were also analyzed. Patients were allocated in two groups regarding the type of procedure (LA or CA, and complication rates and characteristics were compared. Statistical analysis was performed with Mann-Whitney test (quantitative variables and chi-square test (qualitative variables, with p < 0.05 considered significant. Results: a total of 46 patients (25 men were included (16 submitted to LA, with mean age of 38.1 (± 12.7 years. The groups were considered homogeneous according to age, gender, CD location, perianal disease and concomitant medications. There were more patients with fistulizing CD on the CA group (p = 0.029. The most common procedure performed was ileocolic resection on both groups (56.7% of the CA and 75% of the LA patients – p = 0.566. Overall, total complications (surgical and medical

  2. CD40: Novel Association with Crohn's Disease and Replication in Multiple Sclerosis Susceptibility

    Science.gov (United States)

    Alcina, Antonio; Teruel, María; Díaz-Gallo, Lina M.; Gómez-García, María; López-Nevot, Miguel A.; Rodrigo, Luis; Nieto, Antonio; Cardeña, Carlos; Alcain, Guillermo; Díaz-Rubio, Manuel; de la Concha, Emilio G.; Fernandez, Oscar; Arroyo, Rafael

    2010-01-01

    Background A functional polymorphism located at −1 from the start codon of the CD40 gene, rs1883832, was previously reported to disrupt a Kozak sequence essential for translation. It has been consistently associated with Graves' disease risk in populations of different ethnicity and genetic proxies of this variant evaluated in genome-wide association studies have shown evidence of an effect in rheumatoid arthritis and multiple sclerosis (MS) susceptibility. However, the protective allele associated with Graves' disease or rheumatoid arthritis has shown a risk role in MS, an effect that we aimed to replicate in the present work. We hypothesized that this functional polymorphism might also show an association with other complex autoimmune condition such as inflammatory bowel disease, given the CD40 overexpression previously observed in Crohn's disease (CD) lesions. Methodology Genotyping of rs1883832C>T was performed in 1564 MS, 1102 CD and 969 ulcerative colitis (UC) Spanish patients and in 2948 ethnically matched controls by TaqMan chemistry. Principal Findings The observed effect of the minor allele rs1883832T was replicated in our independent Spanish MS cohort [p = 0.025; OR (95% CI) = 1.12 (1.01–1.23)]. The frequency of the minor allele was also significantly higher in CD patients than in controls [p = 0.002; OR (95% CI) = 1.19 (1.06–1.33)]. This increased predisposition was not detected in UC patients [p = 0.5; OR (95% CI) = 1.04 (0.93–1.17)]. Conclusion The impact of CD40 rs1883832 on MS and CD risk points to a common signaling shared by these autoimmune conditions. PMID:20634952

  3. A sonographic lesion index for Crohn's disease helps monitor changes in transmural bowel damage during therapy.

    Science.gov (United States)

    Zorzi, Francesca; Stasi, Elisa; Bevivino, Gerolamo; Scarozza, Patrizio; Biancone, Livia; Zuzzi, Sara; Rossi, Carla; Pallone, Francesco; Calabrese, Emma

    2014-12-01

    Therapeutic antibodies against tumor necrosis factor α (anti-TNF) are effective in patients with Crohn's disease (CD). Mucosal healing is a surrogate marker of efficacy, but little is known about the effects of anti-TNF agents on structural damage in the intestine. Small-intestine contrast ultrasonography (SICUS) is a valuable tool for assessing CD lesions. A new sonographic quantitative index (the sonographic lesion index for CD [SLIC]) was developed to quantify changes in CD lesions detected by SICUS. We explored whether the SLIC can be used to monitor transmural bowel damage in CD patients during anti-TNF therapy. We performed a prospective study of 29 patients with ileal or ileocolonic CD treated with anti-TNF agents; patients underwent SICUS before and after scheduled induction and maintenance therapy. To determine whether changes that can be detected by SICUS occur independently of anti-TNF therapy, 7 patients with ileal CD treated with mesalamine were enrolled as controls. A clinical response was defined as steroid-free remission, with CD activity index scores less than 150. We observed significant improvements in SLIC scores and subscores after induction and maintenance therapy with anti-TNFs, compared with before therapy. SLIC scores and subscores and index classes were improved significantly in patients with vs without clinical responses. Controls had no improvements in terms of CD activity index or SLIC scores, or index classes. Sonographic assessment using the quantitative index SLIC can be used to monitor changes in transmural bowel damage during anti-TNF therapy for CD. Copyright © 2014 AGA Institute. Published by Elsevier Inc. All rights reserved.

  4. Changes in serum levels of lipopolysaccharides and CD26 in patients with Crohn's disease

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    Kotze, Paulo Gustavo; Martinez, Carlos Augusto Real; Camargo, Michel Gardere; Guadagnini, Dioze; Calixto, Antonio Ramos; Vasques, Ana Carolina Junqueira; Ayrizono, Maria de Lourdes Setsuko; Geloneze, Bruno; Pareja, José Carlos; Saad, Mario José; Coy, Claudio Saddy Rodrigues

    2017-01-01

    Background/Aims Lipopolysaccharide (LPS) is a molecule formed by lipids and polysaccharides and is the major cell wall component of gram-negative bacteria. High LPS levels are known to block CD26 expression by activating Toll-like receptor 4. The aim of this study was to correlate the serum levels of LPS and CD26 in Crohn's disease (CD) patients with serum levels of C-reactive protein (CRP), interleukins, CD activity index, and tumor necrosis factor-α (TNF-α). Methods Serum samples were collected from 27 individuals (10 with active CD, 10 with inactive CD, and 7 controls) and the levels of LPS, CD26, TNF-α, interleukin-1β (IL-1β), IL-6, IL-17, and CRP were determined by enzyme-linked immunosorbent assay. The levels of LPS and CD26 were then tested for correlation with TNF-α, IL-1β, IL-6, IL-17, and CRP. Results Serum levels of LPS were significantly elevated in the active CD group (P=0.003). Levels of IL-1β (P=0.002), IL-6 (P=0.003), and IL-17 (P<0.001) were lower in the CD groups. Serum TNF-α levels were increased in the active CD group. The CRP levels were elevated in the CD groups when compared to controls (P<0.001). The CD26 levels were lower in the CD groups than in the control group (P<0.001). Among the variables analyzed, there was a correlation between LPS and CRP (r=−0.53, P=0.016) in the CD groups. Conclusions Individuals with CD exhibited higher serum levels of LPS varying from a 2- to 6-fold increase depending on disease activity, when compared with healthy controls. CD26 levels were lower in the CD groups. Both LPS and CD26 correlated with disease severity and serve as potential CD biomarkers. PMID:28670232

  5. Disease susceptibility genes shared by primary biliary cirrhosis and Crohn's disease in the Japanese population.

    Science.gov (United States)

    Aiba, Yoshihiro; Yamazaki, Keiko; Nishida, Nao; Kawashima, Minae; Hitomi, Yuki; Nakamura, Hitomi; Komori, Atsumasa; Fuyuno, Yuta; Takahashi, Atsushi; Kawaguchi, Takaaki; Takazoe, Masakazu; Suzuki, Yasuo; Motoya, Satoshi; Matsui, Toshiyuki; Esaki, Motohiro; Matsumoto, Takayuki; Kubo, Michiaki; Tokunaga, Katsushi; Nakamura, Minoru

    2015-09-01

    We previously identified TNFSF15 as the most significant susceptibility gene at non-HLA loci for both primary biliary cirrhosis (PBC) and Crohn's diseases (CD) in the Japanese population. The aim of this study is to identify further disease susceptibility genes shared by PBC and CD. We selected 15 and 33 genetic variants that were significantly associated with PBC and CD, respectively, based on previously reported genome-wide association studies of the Japanese population. Next, an association study was independently performed for these genetic variants in CD (1312 CD patients and 3331 healthy controls) and PBC (1279 PBC patients and 1015 healthy controls) cohorts. Two CD susceptibility genes, ICOSLG rs2838519 and IL12B rs6556412, were also nominally associated with susceptibility to PBC (P=3.85 × 10(-2) and P=8.40 × 10(-3), respectively). Three PBC susceptibility genes, CXCR5 rs6421571, STAT4 rs7574865 and NFKB1 rs230534, were nominally associated with susceptibility to CD (P=2.82 × 10(-2), P=3.88 × 10(-2) and P=2.04 × 10(-2), respectively). The effect of ICOSLG and CXCR5 variants were concordant but the effect of STAT4, NFKB1 and IL12B variants were discordant for PBC and CD. TNFSF15 and ICOSLG-CXCR5 might constitute a shared pathogenic pathway in the development of PBC and CD in the Japanese population, whereas IL12B-STAT4-NFKB1 might constitute an opposite pathogenic pathway, reflecting the different balance between Th1 and Th17 in the two diseases.

  6. Clinical experience with infliximab therapy in 100 patients with Crohn's disease.

    Science.gov (United States)

    Farrell, R J; Shah, S A; Lodhavia, P J; Alsahli, M; Falchuk, K R; Michetti, P; Peppercorn, M A

    2000-12-01

    The aim of this study was to assess our clinical experience with infliximab, a monoclonal antitumor necrosis factor antibody, following its approval for treatment of refractory Crohn's disease (CD). We followed 100 consecutive patients with CD (53 women and 47 men; mean age, 41 yr) who received a total of 233 infliximab (5 mg/kg) infusions. Adverse events were noted and clinical response assessed every 2 wk for 6 months after each infusion using the Harvey Bradshaw Index (HBI) for active disease, the Perianal Disease Activity Index (PDAI) for fistulous disease, and steroid withdrawal rates for steroid-sparing efficacy. Indications for therapy were active disease (n = 57), perianal fistulous disease (n = 33), and steroid dependency (n = 10). Significant infusion reactions occurred in 16 patients (6.9% of infusions) including anaphylactic shock in one patient. Fourteen patients experienced infectious adverse events, 13 of whom were on concurrent steroids. Sixty percent of patients with active disease experienced > or = 50% HBI reduction at 2 wk; mean duration of response, 8.2 wk. Three of 26 first-time nonresponders with active disease (12%) responded to a second infusion. Sixty-nine percent of patients with fistulous disease experienced >50% reduction in their PDAI at 2 wk; mean duration of response, 10.9 wk. Four of 10 steroid-dependent patients (40%) discontinued steroid therapy, one of whom recommenced steroid therapy at 24 wk. Our clinical response rates mirror the efficacy reported in the controlled trials for active and fistulous disease. Steroid-sparing efficacy was seen in 40% of steroid-dependent patients. Concurrent steroids did not reduce the risk of significant infusion reactions (6.9%), but did increase the risk of infections.

  7. Socioeconomic deprivation does not influence the severity of Crohn's disease: Results of a prospective multicenter study.

    Science.gov (United States)

    Nahon, Stéphane; Lahmek, Pierre; Macaigne, Gilles; Faurel, Jean-Pierre; Sass, Catherine; Howaizi, Mehran; Fleury, Antoine; Baju, A; Locher, Christophe; Barjonet, Georges; Saillant, GillesGatineau; Moulin, Jean-Jacques; Poupardin, Cécile

    2009-04-01

    Socioeconomic deprivation is associated with poor health. The aims of this study were to evaluate the influence of deprivation in the characteristics and comparisons of deprived and nondeprived Crohn's disease (CD) patients. CD patients were prospectively recruited from September 2006 to June 2007 in 6 hospitals in the Paris area. To assess the level of deprivation we used the EPICES score (Evaluation of Precarity and Inequalities in Health Examination Centers; http://www.cetaf.asso.fr), a validated individual index of deprivation developed in France, a score >30 defining deprivation. We defined CD as severe when at least 1 of the conventionally predefined criteria of clinical severity was present. In all, 207 patients (128 women and 79 men, mean age 40 years) were included and had a median score of deprivation of 20.7 (0-100). Seventy-three (35%) were deprived. There were no statistical differences between deprived and nondeprived patients for the following parameters: 1) mean age: 39 +/- 14.6 versus 40.6 +/- 13.5, P = 0.4; 2) sex ratio (female/male): 87/47 (65%) versus 41/32 (56%), P = 0.2; 3) duration of disease (years) 9 +/- 8.8 versus 8.5 +/- 7.2, P = 0.7; 4) delay from onset of symptoms to diagnosis >1 year: 22/115 (19%) versus 13/63 (21%), P = 0.8; and 5) severity of disease 71% versus 70% (P = 0.9). Nondeprived patients had a lower rate of hospitalization (40 versus 56%, P = 0,04) and a higher rate of surgery (44 versus 22%, P = 0,004); the rate of surgery was only identified by logistic regression. In this study deprivation does not seem to influence the severity of CD. This can be explained by easy access to healthcare in France.

  8. Ileal Crohn disease: mural microvascularity quantified with contrast-enhanced US correlates with disease activity.

    Science.gov (United States)

    De Franco, Antonio; Di Veronica, Alessandra; Armuzzi, Alessandro; Roberto, Italia; Marzo, Manuela; De Pascalis, Barbara; De Vitis, Italo; Papa, Alfredo; Bock, Enrico; Danza, Francesco M; Bonomo, Lorenzo; Guidi, Luisa

    2012-02-01

    To quantitatively assess microvascular activation in the thickened ileal walls of patients with Crohn disease (CD) by using contrast-enhanced ultrasonography (US) and evaluate its correlation with widely used indexes of CD activity. This prospective study was approved by the ethics committee, and written informed consent was obtained from all patients. The authors examined 54 consecutively enrolled patients (mean age, 35.29 years; age range, 18-69 years; 39 men, 15 women) with endoscopically confirmed CD of the terminal ileum. Ileal wall segments thicker than 3 mm were examined with low-mechanical-index contrast-enhanced US and a second-generation US contrast agent. The authors analyzed software-plotted time-enhancement intensity curves to determine the maximum peak intensity (MPI) and wash-in slope coefficient (β) and evaluated their correlation with (a) the composite index of CD activity (CICDA), (b) the CD activity index (CDAI), and (c) the simplified endoscopic score for CD (SES-CD, evaluated in 37 patients) for the terminal ileum. Statistical analysis was performed with the Mann-Whitney test, Spearman rank test, and receiver operating characteristic (ROC) analysis. MPI and β coefficients were significantly increased in the 36 patients with a CICDA indicative of active disease (P<.0001 for both), the 33 patients with a CDAI of at least 150 (P<.032 and P<.0074, respectively), and the 26 patients with an SES-CD of at least 1 (P<.0001 and P<.002, respectively). ROC analysis revealed accurate identification (compared with CICDA) of active CD with an MPI threshold of 24 video intensity (VI) (sensitivity, 97%; specificity, 83%) and a β coefficient of 4.5 VI/sec (sensitivity, 86%; specificity, 83%). Contrast-enhanced US of the ileal wall is a promising method for objective, reproducible assessment of disease activity in patients with ileal CD. © RSNA, 2011

  9. Simple pain measures reveal psycho-social pathology in patients with Crohn's disease.

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    Odes, Shmuel; Friger, Michael; Sergienko, Ruslan; Schwartz, Doron; Sarid, Orly; Slonim-Nevo, Vered; Singer, Terri; Chernin, Elena; Vardi, Hillel; Greenberg, Dan; Israel Ibd Research Nucleus

    2017-02-14

    To determine whether pain has psycho-social associations in adult Crohn's disease (CD) patients. Patients completed demographics, disease status, Patient Harvey-Bradshaw Index (P-HBI), Short Form Health Survey (SF-36), Short Inflammatory Bowel Disease Questionnaire (SIBDQ), and five socio-psychological questionnaires: Brief Symptom Inventory, Brief COPE Inventory, Family Assessment Device, Satisfaction with Life Scale, and Work Productivity and Activity Impairment Questionnaire. Pain sub-scales in P-HBI, SF-36 and SIBDQ measures were recoded into 4 identical scores for univariate and multinomial logistic regression analysis of associations with psycho-social variables. The cohort comprised 594 patients, mean age 38.6 ± 14.8 years, women 52.5%, P-HBI 5.76 ± 5.15. P-HBI, SF-36 and SIBDQ broadly agreed in their assessment of pain intensity. More severe pain was significantly associated with female gender, low socio-economic status, unemployment, Israeli birth and smoking. Higher pain scores correlated positively with psychological stress, dysfunctional coping strategies, poor family relationships, absenteeism, presenteeism, productivity loss and activity impairment and all WPAI sub-scores. Patients exhibiting greater satisfaction with life had less pain. The regression showed increasing odds ratios for psychological stress (lowest 2.26, highest 12.17) and female gender (highest 3.19) with increasing pain. Internet-recruited patients were sicker and differed from hardcopy questionnaire patients in their associations with pain. Pain measures in P-HBI, SF-36 and SIBDQ correlate with psycho-social pathology in CD. Physicians should be aware also of these relationships in approaching CD patients with pain.

  10. Inflammation drives dysbiosis and bacterial invasion in murine models of ileal Crohn's disease.

    Directory of Open Access Journals (Sweden)

    Melanie Craven

    Full Text Available Understanding the interplay between genetic susceptibility, the microbiome, the environment and the immune system in Crohn's Disease (CD is essential for developing optimal therapeutic strategies. We sought to examine the dynamics of the relationship between inflammation, the ileal microbiome, and host genetics in murine models of ileitis.We induced ileal inflammation of graded severity in C57BL6 mice by gavage with Toxoplasma gondii, Giardia muris, low dose indomethacin (LDI; 0.1 mg/mouse, or high dose indomethacin (HDI; 1 mg/mouse. The composition and spatial distribution of the mucosal microbiome was evaluated by 16S rDNA pyrosequencing and fluorescence in situ hybridization. Mucosal E. coli were enumerated by quantitative PCR, and characterized by phylogroup, genotype and pathotype.Moderate to severe ileitis induced by T. gondii (day 8 and HDI caused a consistent shift from >95% gram + Firmicutes to >95% gram - Proteobacteria. This was accompanied by reduced microbial diversity and mucosal invasion by adherent and invasive E. coli, mirroring the dysbiosis of ileal CD. In contrast, dysbiosis and bacterial invasion did not develop in mice with mild ileitis induced by Giardia muris. Superimposition of genetic susceptibility and T. Gondii infection revealed greatest dysbiosis and bacterial invasion in the CD-susceptible genotype, NOD2(-/-, and reduced dysbiosis in ileitis-resistant CCR2(-/- mice. Abrogating inflammation with the CD therapeutic anti-TNF-α-mAb tempered dysbiosis and bacterial invasion.Acute ileitis induces dysbiosis and proliferation of mucosally invasive E. coli, irrespective of trigger and genotype. The identification of CCR2 as a target for therapeutic intervention, and discovery that host genotype and therapeutic blockade of inflammation impact the threshold and extent of ileal dysbiosis are of high relevance to developing effective therapies for CD.

  11. Inflammation drives dysbiosis and bacterial invasion in murine models of ileal Crohn's disease.

    Science.gov (United States)

    Craven, Melanie; Egan, Charlotte E; Dowd, Scot E; McDonough, Sean P; Dogan, Belgin; Denkers, Eric Y; Bowman, Dwight; Scherl, Ellen J; Simpson, Kenneth W

    2012-01-01

    Understanding the interplay between genetic susceptibility, the microbiome, the environment and the immune system in Crohn's Disease (CD) is essential for developing optimal therapeutic strategies. We sought to examine the dynamics of the relationship between inflammation, the ileal microbiome, and host genetics in murine models of ileitis. We induced ileal inflammation of graded severity in C57BL6 mice by gavage with Toxoplasma gondii, Giardia muris, low dose indomethacin (LDI; 0.1 mg/mouse), or high dose indomethacin (HDI; 1 mg/mouse). The composition and spatial distribution of the mucosal microbiome was evaluated by 16S rDNA pyrosequencing and fluorescence in situ hybridization. Mucosal E. coli were enumerated by quantitative PCR, and characterized by phylogroup, genotype and pathotype. Moderate to severe ileitis induced by T. gondii (day 8) and HDI caused a consistent shift from >95% gram + Firmicutes to >95% gram - Proteobacteria. This was accompanied by reduced microbial diversity and mucosal invasion by adherent and invasive E. coli, mirroring the dysbiosis of ileal CD. In contrast, dysbiosis and bacterial invasion did not develop in mice with mild ileitis induced by Giardia muris. Superimposition of genetic susceptibility and T. Gondii infection revealed greatest dysbiosis and bacterial invasion in the CD-susceptible genotype, NOD2(-/-), and reduced dysbiosis in ileitis-resistant CCR2(-/-) mice. Abrogating inflammation with the CD therapeutic anti-TNF-α-mAb tempered dysbiosis and bacterial invasion. Acute ileitis induces dysbiosis and proliferation of mucosally invasive E. coli, irrespective of trigger and genotype. The identification of CCR2 as a target for therapeutic intervention, and discovery that host genotype and therapeutic blockade of inflammation impact the threshold and extent of ileal dysbiosis are of high relevance to developing effective therapies for CD.

  12. Funding a smoking cessation program for Crohn's disease: an economic evaluation.

    Science.gov (United States)

    Coward, Stephanie; Heitman, Steven J; Clement, Fiona; Negron, Maria; Panaccione, Remo; Ghosh, Subrata; Barkema, Herman W; Seow, Cynthia; Leung, Yvette P Y; Kaplan, Gilaad G

    2015-03-01

    Patients with Crohn's disease (CD) who smoke are at a higher risk of flaring and requiring surgery. Cost-effectiveness studies of funding smoking cessation programs are lacking. Thus, we performed a cost-utility analysis of funding smoking cessation programs for CD. A cost-utility analysis was performed comparing five smoking cessation strategies: No Program, Counseling, Nicotine Replacement Therapy (NRT), NRT+Counseling, and Varenicline. The time horizon for the Markov model was 5 years. The health states included medical remission (azathioprine or antitumor necrosis factor (anti-TNF), dose escalation of an anti-TNF, second anti-TNF, surgery, and death. Probabilities were taken from peer-reviewed literature, and costs (CAN$) for surgery, medications, and smoking cessation programs were estimated locally. The primary outcome was the cost per quality-adjusted life year (QALY) gained associated with each smoking cessation strategy. Threshold, three-way sensitivity, probabilistic sensitivity analysis (PSA), and budget impact analysis (BIA) were carried out. All strategies dominated No Program. Strategies from most to least cost effective were as follows: Varenicline (cost: $55,614, QALY: 3.70), NRT+Counseling (cost: $58,878, QALY: 3.69), NRT (cost: $59,540, QALY: 3.69), Counseling (cost: $61,029, QALY: 3.68), and No Program (cost: $63,601, QALY: 3.67). Three-way sensitivity analysis demonstrated that No Program was only more cost effective when every strategy's cost exceeded approximately 10 times their estimated costs. The PSA showed that No Program was the most cost-effective system money over No Program. Health-care systems should consider funding smoking cessation programs for CD, as they improve health outcomes and reduce costs.

  13. [Value of adhesion molecules for evaluating the efficiency of therapy for ulcerative colitis and Crohn's disease].

    Science.gov (United States)

    Parfenov, A I; Boldyreva, O N; Ruchkina, I N; Knyazev, O V; Sagynbaeva, V E; Shcherbakov, P L; Khomeriki, S G; Lazebnik, L B; Konoplyannikov, A G

    2014-01-01

    To define the value of adhesion molecules (sVCAM-1 integrin, P-selectin, E-selectin, and L-selectin) for the prediction and evaluation of the efficiency of treatment in patients with ulcerative colitis (UC) and Crohn's disease. Twenty-six patients with UC and 14 patients with CD were examined. Of them, 16 patients took infliximab (INF) in a dose of 5 mg/kg of body weight according to the standard scheme; 14 patients received cultured mesenchymal stem stromal cells (MSSCs) in a quantity of 150 x 10(8) cells, and 10 had azathioprine (AZA) 2 mg/kg and glucocorticosteroids (GCS) 1 mg/kg of body weight. Enzyme immunoassay was used to determine the serum concentration of the adhesion molecules (L-selectin, E-selectin, P-selectin, and sVCAM-1 integrin) before and 2 months after treatment. The signs of bowel inflammatory disease activity and the elevated levels of adhesion molecules whose synthesis did not occur under normal conditions remained in the patients receiving GCS and AZA. INF treatment caused a decrease in P-selectin, E-selectin, and sVCAM-1 levels to 8.9 +/- 1.0, 5.5 +/- 1.7, and 9.5 +/- 4.4 ng/ml, respectively (p 0.1); that of L-selectin did not drop after MSSC administration and INF induction therapy. P-selectin, E-selectin, L-selectin, and sVCAM-1 integrin are current inflammatory markers and may be used to evaluate the efficiency of standard and biological therapies for inflammatory bowel diseases and to predict disease course.

  14. Methotrexate for the Treatment of Pediatric Crohn's Disease: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Colman, Ruben J; Lawton, Rachel C; Dubinsky, Marla C; Rubin, David T

    2018-04-23

    Methotrexate (MTX) is an immunomodulator used for the treatment of pediatric inflammatory bowel disease (IBD). There are currently no RCTs that assess the treatment efficacy of methotrexate within the pediatric IBD patient population. This systematic review and meta-analysis assesses the efficacy of MTX therapy among the existing pediatric literature. A systematic literature search was performed using MEDLINE and the Cochrane library from inception until March 2016. Synonyms for 'pediatric', 'methotrexate' and 'IBD' were utilized as both free text and MESH search terms. The studies included contained clinical remission (CR) rates for MTX treatment of pediatric IBD patients 18 yrs old, as mono- or combination therapy. Case studies with <10 patients were excluded. Quality assessment was performed with the Newcastle-Ottawa Scale. Meta-analysis calculated pooled CR rates. A random-effects meta-analysis with forest plots was performed using R. Fourteen (11 monotherapy, 1 combination therapy, 2 both; n = 886 patients) observational studies were eligible out of 202 studies. No interventional studies were identified. The pooled achieved CR rate for pediatric CD patients on monotherapy within 3-6 months was 57.7% (95% CI 48.2-66.6%), (P =0.22; I2 = 29.8%). The CR was 37.1% (95% CI 29.5-45.5%), (P = 0.20; I2 = 37.4%) for maintenance therapy at 12 months. Sub-analysis could not identify CR differences between MTX administration types, thiopurine exposure. This meta-analysis demonstrated that, over 50% of pediatric Crohn's disease patients induced with methotrexate achieved clinical remission, while 12-month remission rate was only 37%. Prospective controlled interventional trials should assess treatment efficacy among patient subgroups. 10.1093/ibd/izy078_video1izy078.video15774883936001.

  15. Sarcopenia is a predictive factor for intestinal resection in admitted patients with Crohn's disease.

    Directory of Open Access Journals (Sweden)

    Shigeki Bamba

    Full Text Available The relationship between skeletal muscle volume and the prognosis of patients with inflammatory bowel disease (IBD remains undetermined. We conducted a retrospective study of 72 IBD patients who were admitted to the hospital due to disease exacerbation. We enrolled IBD patients who had undergone abdominal computed tomography and assessed the nutritional indices, such as the Onodera's prognostic nutritional index (O-PNI and the controlling nutritional status (CONUT index. The L3 skeletal muscle index (SMI, which is the ratio of the cross-sectional area of skeletal muscles at the level of the third lumbar (L3 vertebra to the height squared, was used to identify sarcopenia. Sarcopenia, defined as a low SMI, was observed in 42% of all IBD patients (37% with Crohn's disease (CD and 48% with ulcerative colitis (UC. In UC patients, the O-PNI and CONUT values, height, and albumin levels were significantly lower than in CD patients. The SMI strongly correlated with sex, body weight, albumin level, and O-PNI in IBD patients. Multivariate analysis using the Cox regression model demonstrated that the presence of sarcopenia (P = 0.015 and disease type (CD or UC (P = 0.007 were significant factors predicting intestinal resection. The cumulative operation-free survival rate was significantly lower for sarcopenic patients than in all IBD patients (P = 0.003 and a stratified analysis of CD patients (P = 0.001 using the Kaplan-Meier method and log-rank test. The L3 skeletal muscle area is a prognostic factor for intestinal resection in patients with CD.

  16. Standard versus rapid food reintroduction after exclusive enteral nutritional therapy in paediatric Crohn's disease.

    Science.gov (United States)

    Faiman, Abi; Mutalib, Mohamed; Moylan, Alexander; Morgan, Natalie; Crespi, Daniel; Furman, Mark; Kader, Ajmal

    2014-03-01

    In paediatric Crohn's disease (PCD), 6-8 weeks of exclusive enteral nutrition (EEN) is effective in 60-80% cases. EEN is followed by gradual food reintroduction over variable (1-5 weeks) periods. Currently, there is no recommended duration or method for food reintroduction. The rationale for slow reintroduction is unclear and may be because of concerns about food intolerance or to maintain longer remission. The aims of this study were as follows: to compare relapse rates following standard and rapid reintroduction of food after EEN in PCD and to determine the duration of maintained remission in two groups of PCD patients. Two groups with PCD were compared: group A received standard food reintroduction over 5 weeks and group B received rapid reintroduction over 3 days. Data were collected over two consecutive time periods: group A (2005-2009) and group B (2009-2011). Only patients with a new diagnosis of PCD were included. Those with strictures and those on steroids or biologicals during EEN were excluded. The minimum duration of follow-up was 1 year. Group A included 20 patients and group B included 19 patients. In these groups, EEN led to clinical remission in 80% of the patients in group A and in 76% of the patients in group B. At 6 months, one-third of the patients from each group had developed relapse and a year after EEN, 50% of the patients in group A and 47% of the patients in group B developed relapse. Time to first relapse was 188 days (group A) and 136 days (group B). None of these results were statistically significant. In PCD, rapid food reintroduction following 6-week EEN is safe and equally effective as longer food reintroduction. We propose that a rapid food reintroduction schedule be recommended as the most tolerable approach for food reintroduction. Relapse rate and duration of remission are uninfluenced by the type of food reintroduction.

  17. Utility of ultrasonography in the diagnosis and follow-up of Crohn's disease

    International Nuclear Information System (INIS)

    Talens, A.; Vernetta, M. L.; Gil de Ramales, V.; Tome, A.; Garcia, J. R.; Bulto, J. A.; Miranda, V.; Celma, J.; Val, A. del

    1999-01-01

    To study the ultrasonographic findings in a series of patients with Crohn's disease (CD). The series consisted of 80 patients who underwent abdominal ultrasound over a three-year period for whom there was no prior knowledge of radiologic and/or endoscopic findings. The technique involved gradually applying pressure to the abdomen, and a thickening of the intestinal wall of 4 mm or more was considered indicative of disease. The localization, extension, lesions, activity and possible complications associated with the process were established definitively by endoscopy, intestinal transit, barium enema and/or computed tomography, depending on the type of intestinal involvement. Ultrasound disclosed the presence of inflammatory bowel disease in 71 of the 80 patients. Of these, 69 presented CD; the other two patients were finally diagnosed as having ulcerative colitis and infectious enterocolitis, respectively. The results of the study were considered to be normal in 7 patients in whom the disease was in an inactive phase. In 2 cases, ultrasound demonstrated the presence of acute appendicitis and histological examination confirmed it to be granulomatous appendicitis. Thickening of the bowel wall, proliferation of mesenteric fat, and ulcers and fissures in abdominal wall were the most common findings. The most predominant complications were fistulas, stenosis and abscesses. Ultrasound is a highly useful method for the diagnosis, assessment of activity, follow-up and detection of complications in this inflammatory bowel disease. Among the advantages are its low cost and the possibility of performing repeated studies without exposing the patient to radiation or the discomfort of endoscopy. (Author) 17 refs

  18. Risk Matrix for Prediction of Disease Progression in a Referral Cohort of Patients with Crohn's Disease.

    Science.gov (United States)

    Lakatos, Peter L; Sipeki, Nora; Kovacs, Gyorgy; Palyu, Eszter; Norman, Gary L; Shums, Zakera; Golovics, Petra A; Lovasz, Barbara D; Antal-Szalmas, Peter; Papp, Maria

    2015-10-01

    Early identification of patients with Crohn's disease (CD) at risk of subsequent complications is essential for adapting the treatment strategy. We aimed to develop a prediction model including clinical and serological markers for assessing the probability of developing advanced disease in a prospective referral CD cohort. Two hundred and seventy-one consecutive CD patients (42.4% males, median follow-up 108 months) were included and followed up prospectively. Anti-Saccharomyces cerevisiae antibodies (ASCA IgA/IgG) were determined by enzyme-linked immunosorbent assay. The final analysis was limited to patients with inflammatory disease behaviour at diagnosis. The final definition of advanced disease outcome was having intestinal resection or disease behaviour progression. Antibody (ASCA IgA and/or IgG) status, disease location and need for early azathioprine were included in a 3-, 5- and 7-year prediction matrix. The probability of advanced disease after 5 years varied from 6.2 to 55% depending on the combination of predictors. Similar findings were obtained in Kaplan-Meier analysis; the combination of ASCA, location and early use of azathioprine was associated with the probability of developing advanced disease (p < 0.001, log rank test). Our prediction models identified substantial differences in the probability of developing advanced disease in the early disease course of CD. Markers identified in this referral cohort were different from those previously published in a population-based cohort, suggesting that different prediction models should be used in the referral setting. Copyright © 2015 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  19. Effectiveness and Safety of Immunomodulators With Anti-Tumor Necrosis Factor Therapy in Crohn's Disease.

    Science.gov (United States)

    Osterman, Mark T; Haynes, Kevin; Delzell, Elizabeth; Zhang, Jie; Bewtra, Meenakshi; Brensinger, Colleen M; Chen, Lang; Xie, Fenglong; Curtis, Jeffrey R; Lewis, James D

    2015-07-01

    The benefit of continuing immunomodulators when "stepping up" to anti-tumor necrosis factor (anti-TNF) therapy for Crohn's disease (CD) is uncertain. This study assessed the effectiveness and safety of immunomodulators with anti-TNF therapy in CD. We conducted a retrospective cohort study of new users of anti-TNF therapy for CD in Medicare. Users of anti-TNF combination therapy with immunomodulators were matched to up to 3 users of anti-TNF monotherapy via propensity score and compared by using 3 metrics of effectiveness-surgery, hospitalization, and discontinuation of anti-TNF therapy or surgery-and 2 metrics of safety-serious infection and non-Candida opportunistic infection. Cox regression was used for all analyses. Among new users of infliximab, we matched 381 users of combination therapy to 912 users of monotherapy; among new users of adalimumab, we matched 196 users of combination therapy to 505 users of monotherapy. Combination therapy occurred predominantly as "step up" after thiopurine therapy. The rates of surgery (hazard ratio [HR], 1.20; 95% confidence interval, 0.73-1.96), hospitalization (HR, 0.82; 0.57-1.19), discontinuation of anti-TNF therapy or surgery (HR, 1.09; 0.88-1.34), and serious infection (HR, 0.93; 0.88-1.34) did not differ between users of anti-TNF combination therapy and monotherapy. However, the risks of opportunistic infection (HR, 2.64; 1.21-5.73) and herpes zoster (HR, 3.16; 1.25-7.97) were increased with combination therapy. We found that continuation of immunomodulators after "stepping up" to anti-TNF therapy did not improve outcomes but was associated with an increased risk of opportunistic infection. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.

  20. Effectiveness and Safety of Immunomodulators with Anti-TNF Therapy in Crohn's Disease

    Science.gov (United States)

    Osterman, Mark T.; Haynes, Kevin; Delzell, Elizabeth; Zhang, Jie; Bewtra, Meenakshi; Brensinger, Colleen M.; Chen, Lang; Xie, Fenglong; Curtis, Jeffrey R.; Lewis, James D.

    2015-01-01

    Background & Aims The benefit of continuing immunomodulators when “stepping up” to anti-tumor necrosis factor (anti-TNF) therapy for Crohn's disease (CD) is uncertain. This study assessed the effectiveness and safety of immunomodulators with anti-TNF therapy in CD. Methods We conducted a retrospective cohort study of new users of anti-TNF therapy for CD in Medicare. Users of anti-TNF combination therapy with immunomodulators were matched to up to 3 users of anti-TNF monotherapy via propensity score and compared using 3 metrics of effectiveness – surgery, hospitalization, and discontinuation of anti-TNF therapy or surgery – and 2 metrics of safety – serious infection and non-Candida opportunistic infection. Cox regression was used for all analyses. Results Among new users of infliximab, we matched 381 users of combination therapy to 912 users of monotherapy; among new users of adalimumab, we matched 196 users of combination therapy to 505 users of monotherapy. Combination therapy occurred predominantly as “step up” after thiopurine therapy. The rates of surgery (hazard ratio [HR] 1.20, 95% CI 0.73-1.96), hospitalization (HR 0.82 [0.57-1.19]), discontinuation of anti-TNF therapy or surgery (HR 1.09, [0.88-1.34]), and serious infection (HR 0.93 [0.88-1.34]) did not differ between users of anti-TNF combination therapy and monotherapy. However, the risk of opportunistic infection (HR 2.64 [1.21-5.73]) and herpes zoster (HR 3.16 [1.25-7.97]) were increased with combination therapy. Conclusions We found that continuation of immunomodulators after “stepping up” to anti-TNF therapy did not improve outcomes but was associated with an increased risk of opportunistic infection. PMID:25724699