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PubMed1984

[Chronic inflammatory bowel diseases].

Surgical decision making in inflammatory bowel disease also includes aspect of the patient's general condition. If conservative therapy fails surgical therapy in ulcerative colitis and diverticulitis is a curative procedure. In Crohn's disease the situation is principally different. Conservative and surgical treatment being only symptomatical, they cannot lead to a definite cure. Quality of life and disease-free interval must be compared to the general risk, i.e. lethality and morbidity of conservative therapy as well as of surgery. The analysis of our own patients shows a minimal risk after surgery.

Colectomy↗
PubMed2004

Relevance of serologic studies in inflammatory bowel disease.

The serologic panel for inflammatory bowel disease (IBD) is rapidly expanding. Antineutrophil cytoplasmic antibodies (ANCA) and anti-Saccharomyces cerevisiae mannan antibodies (ASCA) have remained the most widely studied markers, but immune reactivity against a new group of bacterial antigens such as I2, OmpC (outer membrane porin C), and flagellin, has been described in Crohn's disease. Several clinical avenues have been explored, such as the usefulness of serologic markers as screening tools for IBD and in accelerating a diagnosis in patients with indeterminate colitis. Another area of interest is disease stratification. Emerging data suggest there is a diversity of qualitative and quantitative responses to environmental antigens that differs among groups of IBD patients and may be associated with different clinical behaviors. As a result, it may be possible to tailor therapy on the basis of serologic responses. Prospective studies are needed before translating this concept into clinical practice. Clustering of IBD patients into more homogeneous subgroups based on antibody responses may help to unravel the pathophysiology of subsets of IBD.

Antibodies, Antineutrophil Cytoplasmic↗
PubMed2003

Treatment of Extraintestinal Manifestations in Inflammatory Bowel Disease.

Extraintestinal manifestations (EIM) of inflammatory bowel disease (IBD) occur rather frequently and may be found in up to 30% of patients. However, surprisingly few randomized, controlled studies have been conducted that were specifically aimed at the treatment of EIM of IBD patients. Therefore, most therapies of EIM are empiric or deduced from studies in populations with other type of patients. EIM may be associated with active IBD. Treatment of active IBD is, therefore, the mainstay of treatment of EIM. Lifestyle modification as a means of therapy is a recent subject of study in chronic conditions, such as IBD. Based on epidemiologic and experimental findings, EIM of various tracts can be modified by optimizing alimentary intake, refraining from sedentary lifestyle, and adapting smoking habits. Not many new drugs for treatment of EIM have been developed during the past few years; the role of infliximab has been extended in particular in Crohn's disease-related EIM. Careful consideration of prescribed drugs remains necessary due to potential interaction with the course of IBD.

Journal Article↗
PubMed1978

Antibodies to synthetic polyribonucleotides in spouses of patients with inflammatory bowel disease.

Serum from patients with inflammatory bowel disease (I.B.D.) and their unaffected spouses bound significantly more synthetic single-stranded (poly.rA) and double-stranded (poly.rA.poly.rU) R.N.A. but not KB cell D.N.A. than did serum from age-matched controls and their spouses. Binding activity resided in Ig fractions and was predominantly of IgM class. A significant corelation was observed between the amount of double-stranded but not single-stranded R.N.A. bound by serum from patients and from their respective spouses. These findings provide indirect support for the presence of R.N.A. viruses in patients with I.B.D. and the transmission of such agents to their close personal contacts.

Antibodies, Viral↗
PubMed2001

Pseudotumorous chronic pancreatitis associated with inflammatory bowel disease.

Chronic pancreatitis associated with inflammatory bowel disease is now considered as extraintestinal manifestation of that disease. The clinical and radiological features of the new entity are markedly different from those of chronic calcifying pancreatitis. We report the case of a 68-year-old man presenting with a pseudotumorous chronic pancreatitis associated with ulcerative colitis. Diagnosis was made after endoscopic retrograde cholangiopancreatography (ERCP) and cytological analysis of stenosis brushings and was confirmed by the clinical evolution. Existence of IBD-associated pancreatitis with pseudotumorous features has to be taken into account in order to avoid inappropriate pancreatic resection.

Aged↗
PubMed2004

Treatment of anaemia in inflammatory bowel disease with iron sucrose.

BACKGROUND: Inflammatory bowel disease (IBD)-associated anaemia usually responds to intravenous iron. If not, additive treatment with erythropoietin has been proposed. The objective of the present retrospective study was to evaluate the effectiveness of treatment with iron sucrose alone. METHODS: Sixty-one patients with IBD and anaemia (average haemoglobin 97 g/L) were treated with iron sucrose (iron dose 1.4 +/- 0.5 g). The indications for iron sucrose were poor response and/or intolerance to oral iron. Treatment response was defined as an increase in haemoglobin of > or = 20 g/L or to normal haemoglobin levels (> or = 120 g/L). Two independent investigators retrospectively assessed laboratory variables, clinical findings, and concomitant medication. RESULTS: Two patients were transferred to other hospitals after treatment and therefore could not be evaluated. Fifty-four of the remaining 59 patients (91%) responded within 12 weeks. Sixty percent of the patients had responded within 8 weeks. Five patients had no or only a partial response to iron sucrose of which three had prolonged gastrointestinal blood losses. Eight patients with normal or elevated levels of ferritin could be considered to have anaemia of chronic disease, and all of them responded to iron sucrose. During a follow-up period of 117 +/- 85 (4-291) (mean +/- s (standard deviation) (range)) weeks 19 patients (32%) needed at least one second course of iron sucrose because of recurrent disease. CONCLUSIONS: Anaemia associated with IBD can be successfully treated with intravenously administered iron sucrose, provided that bowel inflammation is treated adequately and enough iron is given. Treatment with iron sucrose is safe. Follow-up of haemoglobin and iron parameters to avoid further iron deficiency anaemia is recommended.

Adolescent↗
PubMed2002

Advances in the medical therapy of inflammatory bowel disease.

The medical therapy of inflammatory bowel disease (IBD) has advanced significantly over the past year. Serologic markers of IBD have been further investigated and better defined, showing some discriminatory power with potential therapeutic implications. Studies of azathioprine and 6-mercaptopurine metabolites will make it easier and safer to use these effective drugs. Clinical data using other immunomodulators, including 6-thioguanine, mycophenolate mofetil, cyclosporine, and tacrolimus, continue to accrue with positive results. Infliximab has become even more firmly established as a reliable and effective therapy for active and fistulizing Crohn disease and may even be helpful in some patients with resistant ulcerative colitis. However, the recognition of potential complications of infliximab therapy has increased with the accumulated clinical experience. Results from trials of other biologic therapies directed at tumor necrosis factor alpha have been disappointing so far, although preliminary studies with biologics directed at adhesion molecules are encouraging. Growing appreciation of the importance of the enteric microflora in IBD has led to a considerable interest in manipulating intestinal bacteria for therapeutic benefit, and trials of both probiotics and prebiotics show promise.

Journal Article↗
PubMed1999

Asian ethnic origin and the risk of inflammatory bowel disease.

OBJECTIVE: To assess whether inflammatory bowel disease (IBD) is more prevalent in young Asians than Europeans living in Great Britain. DESIGN: Longitudinal birth cohort study of all those born 5-11 April 1970 in Great Britain--the 1970 British Cohort Study (BCS70). METHODS: The relationship of a diagnosis of ulcerative colitis or Crohn's disease by age 26 years with ethnic origin was investigated among 8,432 cohort members with complete data using multiple logistic regression. We adjusted for potential confounding factors, household crowding and sex, as well as for a family history of IBD. RESULTS: Young Asians born in Britain were significantly more likely than indigenous Europeans to have a diagnosis of IBD by age 26 years, with relative odds of 6.10 (95% CI 2.14-17.33). This group of cohort members had ethnic origins in India, Pakistan or Bangladesh (although none of those from Bangladesh had IBD). This relationship remained statistically significant after adjustment for the potential confounding factors and family history of IBD. CONCLUSION: Young Asians who were born in Britain are at a significantly higher risk of developing IBD than the indigenous European population. This may reflect a greater genetic predisposition to IBD that is uncovered by exposure to environmental factors.

Adult↗
PubMed2006

Effect of race and ethnicity on perceptions of inflammatory bowel disease.

BACKGROUND AND AIMS: Historically, inflammatory bowel disease (IBD) was thought to predominantly affect whites. However, IBD is now increasingly recognized in diverse ethnic populations. There is a paucity of studies of IBD in nonwhite populations, especially in Mexican Americans. The aims of this study were to compare the impact of IBD on the quality of life of whites, African Americans, and Mexican Americans and to evaluate differing patient understanding and beliefs regarding IBD. MATERIALS AND METHODS: A questionnaire was administered to 148 patients between June 1999 and November 2003 at a university gastroenterology practice in Houston, Tex. RESULTS: Caucasians (W) comprised 40%, African Americans (AA) 37%, and Mexican Americans (MA) 20% of the respondents. AA and W had predominantly Crohn's disease (CD), whereas MA had predominantly ulcerative colitis (UC; P<0.05). We therefore compared W and AA with CD and W and MA with UC. W were more likely to tell their employers (57% vs 27.5%, P=0.02), fellow employees (68% vs 43.8%, P=0.02) and friends (100% vs 79%, P=0.034) that they had CD. W and AA were equally as likely to have regular checkups by a physician, and there was no difference in the access to gastroenterologists or surveillance colonoscopy. There were fewer differences between MA and W with UC. MA were more likely to believe that UC was caused by stress (70% vs 37%, p=0.044) and cigarette smoking. CONCLUSIONS: Significant differences appear among racial and ethnic groups with IBD regarding attitudes toward disease and impact on daily life. Appreciation of varying ethnic and racial perceptions, attitudes, and beliefs among patients with IBD may be critical to more effective management.

Black or African American↗
PubMed2006

The search for a common thrombophilic state during the active state of inflammatory bowel disease.

The clinical course of inflammatory bowel disease (IBD) is frequently associated with thromboembolic complications. The aim of this study was to investigate common thrombophilic markers in Turkish patients with active IBD. Twenty-seven consecutive patients with IBD who were followed-up at the Hacettepe University Hospital were recruited. All the patients were in the active disease state. International normalized ratio, activated partial thromboplastin time, lupus anticoagulant, anticardiolipin IgG, IgM antibodies, protein C, protein S, antithrombin-III, factor V, and factor II mutation of all the IBD patients and of a sex-matched and age-matched control group of non-IBD patients were measured. International normalized ratio, activated partial thromboplastin time, protein C, protein S, lupus anticoagulant, anticardiolipin IgG and IgM, and Proteins C and S mutations were comparable between the 2 groups, but antithrombin-III was significantly lower in the IBD group compared with healthy control group (P<0.0001). As a conclusion, it is reasonable to assume that there may be a subpopulation of the patients with IBD, in whom thrombophilic abnormalities might be important for either disease manifestation or for thrombotic complications. Those hemostatic abnormalities could be either inherited or secondary to the ongoing disease process. Routine screening for the common markers of thrombophilia does not seem to be warranted unless simultaneous arterial and venous thrombosis, major organ thrombosis, strong family history of thrombophilia, unusual and recurrent thrombosis resistant to standard anticoagulant therapy are present. Further studies are definitely required to clarify these complicated associations.

Adolescent↗
PubMed1976

Characterization of anti-lymphocyte antibodies in inflammatory bowel disease.

Sera from patients with inflammatory bowel disease (IBD) showing broad lymphocytotoxic or lymphocyte-binding activity were subjected to additional analysis to further characterize their properties. Lymphocytotoxins appear to be antibodies predominantly of IgM class as determined by [1] 2-mercaptoethanol sensitivity, [2] serum fractionation by sucrose density gradient sedimentation, Sephadex G-200 filtration, and DEAE ion exchange chromatography, and [3] absorption by anti-Ig immunoadsorbent columns. Lymphocyte-binding antibody was found to be IgG, IgA, and IgM, as determined by indirect immunofluorescent staining of acetone-fixed lymphocytes. Individual IBD sera showed marked variability in occurrence of cytotoxic and binding antibodies when tested against the same donor panel of lymphocytes. These studies emphasize the marked heterogeneity of anti-lymphocyte antibodies occurring in IBD.

Absorption↗
PubMed1981

Trauma and the pyoderma gangrenosum of inflammatory bowel disease.

In five patients with inflammatory bowel disease (three with ulcerative colitis, two with Crohn's disease), pyoderma gangrenosum developed on a lower extremity at the site of trauma. In these subjects, the pyoderma was not clearly correlated with disease activity.

Adult↗
PubMed2003

Surgical treatment of severe inflammatory bowel diseases.

Surgical treatment of severe inflammatory bowel diseases is required in failed medical treatment, in emergencies and for complications. Indications for surgery and operative techniques have changed significantly over the last few years. There is a clear tendency towards earlier and less invasive surgical interventions performed in specialized and experienced centers. Improved quality of life of patients with Crohn's disease or ulcerative colitis after surgical therapy supports an earlier consideration of the surgical treatment option. A close cooperation with the involved gastroenterologist is mandatory in this context.

Colitis, Ulcerative↗
PubMed1977

Bile acids in liver disease associated with inflammatory bowel disease.

To investigate the possibility that bowel-related liver disease is due to accumulation of abnormal bile acids in the enterohepatic circulation, bile acids have been measured in gall-bladder bile and portal blood of patients with chronic bowel disease, none of whom had liver disease. There was no difference in the composition and concentration of bile acids in bile and portal blood compared with control patients. In a second study, serum bile acid composition and concentrations were similar in two groups of patients with liver disease, whether they had bowel disease or not. In a further study, post-prandial serum bile acid concentrations were not elevated in a group of patients with chronic bowel disease, making it unlikely that subcliical liver disease was present. No evidence has been found to support the hypothesis that bowel-related liver disease in man results from the action of abnormal bile acids.

Adult↗
PubMed1978

Cellular and humoral indices of disease activity in inflammatory bowel disease.

In 51 untreated cases of ulcerative colitis and Crohn's disease some cellular (neutrophil alkaline phosphatase activity, neutrophil NBT reducing capacity, and neutrophil and plasma lysozyme activities) and humoral (serum orosomucoid and serum haptoglobin) indices of disease activity were quantitated. The most pronounced signs of disease activity, thus, were found in severe cases of ulcerative colitis. Combining lysozyme activities with other disease activity indices seems to facilitate the distinction between severe cases of Crohn's disease and ulcerative colitis. Beyond this the addition of the humoral indices seemed not to offer substantial help.

Adolescent↗
PubMed1982

An international study of mortality from inflammatory bowel disease.

The mortality rates from inflammatory bowel disease were compared for the period 1965-1975 in 12 different countries. Mortality was greatest in north-western Europe and least in the southern hemisphere in Australia, New Zealand and South Africa. In seven of the countries, mortality from Crohn's disease and ulcerative colitis were recorded separately and, during the period, mortality from Crohn's disease increased in all but one country, in contrast to ulcerative colitis where a fall occurred in each country. In those countries where one of the disease was common, the other was usually also common. The findings suggest that Crohn's disease and ulcerative colitis may have some common aetiological factors and the country of residence is more important than race.

Colitis, Ulcerative↗