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PubMed2000

Early vascular changes in Crohn's disease: an endoscopic fluorescence study.

BACKGROUND AND STUDY AIMS: Early recurrent lesions occurring after surgery in Crohn's disease may be the result of localized vasculitis. The aim of this study was use fluorescence endoscopy to evaluate the mucosal microcirculation of the neoterminal ileum in relation to endoscopic recurrence in patients who had undergone ileocolonic resection for Crohn's disease. PATIENTS AND METHODS: Ten patients were prospectively enrolled in an endoscopic follow-up study one year after surgery. Recurrence was assessed using routine and fluorescence endoscopy. Biopsies were taken from fluorescent and nonfluorescent sites to look for inflammation and mucosal vascular lesions using standard histological and immunohistochemical methods. RESULTS: Endoscopic recurrence was found in eight patients. At fluorescence endoscopy, the mucosa displayed a heterogeneous pattern, with fluorescent areas corresponding to aphthoid ulcerations; fluorescent rims surrounding dark zones, corresponding to stellar deep ulcers; and small bright spots distributed singly in the mucosa, which appeared normal on routine endoscopy. Histology revealed inflammatory changes with evidence of vascular involvement in 79% of the biopsies taken from the fluorescent spots. CONCLUSIONS: Endoscopic recurrence in Crohn's disease is associated with fluorescent aspects that may reflect vasodilation associated with inflammation, or genuine microvascular lesions. Correlation with the histological findings suggests that these early vascular lesions were secondary to the inflammatory process.

Adult↗
PubMed1993

Endoscopic and bioptic findings in the upper gastrointestinal tract in patients with Crohn's disease.

A prospective study was carried out on 41 patients diagnosed as having Crohn's disease (CD) to evaluate the degree of upper gastrointestinal tract involvement. In 23 patients (56%), endoscopic alterations were found most frequently affecting the antrum and duodenum. Lesions encountered were: Aphthoid erosions, ulcers, thickening of folds, nodules, erythema and stenosis. Granulomas were found in biopsies in 19.5% of the patients: They were more frequent in those demonstrating endoscopic alterations (26%) than in those with normal endoscopic findings (11%). Clinical evolution was favorable with conventional treatment for CD and ranitidine, although the endoscopic lesions did not totally disappear in any cases. We conclude that upper gastrointestinal endoscopy with biopsies is useful in evaluating the extension of disease and can be of diagnostic value in cases of indeterminate colitis.

Adult↗
PubMed1989

Diagnostic significance of endoscopic biopsy in Crohn's disease.

We investigated the diagnostic value of biopsies taken from Crohn's lesions such as ulcers, aphthoid lesions, cobble-stone epithelium and "pseudopolyps". One hundred and forty-six colonoscopies performed in 141 patients with Crohn's disease (CD) were analyzed. Biopsies were taken during colonoscopy from different gross lesions. Histologic confirmation of CD by granulomas and microgranulomas was obtained in 36 cases from 146 colonoscopies (24.7%). In 80 investigations (54.8%) the histologic findings were consistent with, but not diagnostic of, CD, in 30 cases (20.5%) histology was non-diagnostic. The lesions most likely to contain granulomas were ulcers and we therefore conclude that biopsies taken from ulcer are diagnostically superior to those taken from other lesions seen in CD.

Adolescent↗
PubMed1989

D-penicillamine-induced oesophageal ulcers.

A patient on treatment with D-penicillamine developed aphthoid ulcers of the oesophagus, which healed rapidly after withdrawal of this drug. The mechanism of these probably drug-induced oesophageal ulcerations is discussed.

Arthritis, Rheumatoid↗
PubMed1984

Distribution and spread of colonic lesions in shigellosis: a colonoscopic study.

In a study of the distribution and severity of colonic lesions in patients with shigellosis, colonoscopy was performed for 33 men with this disease. All 33 patients had inflammatory lesions in the rectosigmoid area; in 18 (55%) the lesions extended to the splenic flexure, in 14 (42%) the disease extended to the distal transverse colon, in nine (27%) the area of involvement included the proximal transverse colon, and in five (15%) pancolitis was evident. In most patients lesions were continuous and diffuse, with the intensity of inflammation decreasing in a proximal direction. Biopsied samples from proximal lesions usually showed less severe inflammation than did those from more distal lesions. Aphthoid erosions, which have not previously been described in shigellosis, were observed in five patients. Proximal colitis was associated with diarrhea of four or more days' duration (P less than .01, Fisher's exact test). These findings indicate that the rectosigmoid is the most frequently and most severely affected area of the colon in shigellosis and suggest that during the course of shigella infection, colonic lesions extend in a proximal direction.

Adult↗
PubMed1982

The pathology of Yersinia enterocolitica ileocolitis.

The terminal ileum and proximal colon were resected in two children presenting with fever and right lower quadrant abdominal pain. The pathological findings were characteristic; elongated ulcerations with underlying lymphoid hyperplasia involved the distal ileum and smaller punctate aphthoid ulcers involved the distal ileum and colon. Transmural inflammation was seen in both cases and resulted in thickened, erythematous distal ileum mistaken at surgery for Crohn's disease. Yersinia enterocolitica was recovered from operative cultures of both the specimens. One of the two patients had a 1:1280 serological titer for Yersinia enterocolitica 1 week after surgery. The pathologic findings of Yersinia enterocolitica ileocolitis are distinctive and easily differentiated from Crohn's disease and other pathologic processes in this region. Operative diagnosis can be difficult but if the possibility of Yersinia infection is considered, the correct diagnosis can usually be made without unnecessary surgical resection.

Child↗
PubMed1986

The colitis of Behçet's syndrome.

A 29-year-old woman with Behçet's syndrome developed a severe colitis that ultimately required colectomy. The colectomy specimen showed extensive mucosal ulceration with varying longitudinal, fissuring, and aphthoid configurations, usually occurring within a background of normal or focally inflamed mucosa, and associated with a lymphocytic vasculitis involving submucosal veins. A review of the literature reveals 29 additional cases of colitis complicating Behçet's syndrome. The colitis is characterized by multiple ulcers of diverse size, appearance, and depth of penetration involving any portion of the large bowel, occasionally with coexistent ileal or anal disease. Vasculitis may be the underlying process. Although it resembles other types of colitis, particularly Crohn's colitis, differences in clinical and pathologic features suggest that the colitis of Behçet's syndrome represents a distinct condition.

Adult↗
PubMed1986

Crohn's disease of the esophagus.

Crohn's disease only rarely affects the esophagus, usually producing strictures and fistulas. Superficial lesions such as erosive esophagitis are infrequent. Histological proof of esophageal Crohn's disease is only exceptionally obtained with endoscopic biopsies. In a 4-year period we have followed 500 patients with Crohn's disease. Esophageal involvement was recognized in nine patients, usually because of painful dysphagia. Esophagoscopy revealed large aphthoid lesions. The clinical picture was characterized by: (a) involvement of multiple segments of the gastrointestinal tract, (b) extraintestinal manifestations, and (c) critical illness of the patients. Esophageal lesions and symptoms disappeared quickly with therapy. Routine histology of esophagoscopic biopsies revealed granulomas in only two patients, but additional sections showed granulomas in another five.

Adolescent↗
PubMed1999

Strongyloidiasis colitis: a case report and review of the literature.

A case is described of a nonimmunocompromised man who presented with diarrhea, weight loss, and microcytic anemia. Colonoscopy revealed a pancolitis characterized by aphthoid ulceration on endoscopy and intense tissue eosinophilic infiltrates on biopsy. Both colonic biopsies and stool aspirates revealed the larvae of Strongyloides stercoralis, thus confirming this parasite as the causative agent for the colitis.

Aged↗
PubMedDate not supplied

Endoscopic findings in pediatric patients with Henoch-Schonlein purpura and gastrointestinal symptoms.

We report the gastrointestinal endoscopic findings in nine patients with Henoch-Schonlein purpura. Eight patients underwent upper gastrointestinal endoscopy, which revealed erosive gastritis in one patient, hemorrhagic-erosive duodenitis in four, and both findings in one. The rectum and the sigmoid colon were examined in six patients. Aphthoid ulcers were noted in two. In one of these patients, a rectal ulcer was also noted. Severe inflammatory changes and angiitis were found in the biopsy specimens obtained from the duodenum and the colon. The vascular abnormalities in the gastrointestinal mucosa are similar histologically to those found in the skin in Henoch-Schonlein purpura.

Adolescent↗
PubMed1999

Development and validation of an ultrasonographic activity index of Crohn's disease.

OBJECTIVES: We developed and validated an ultrasonographic index of intestinal inflammatory activity for patients with Crohn's disease. METHODS: Fifty-five patients with Crohn's disease were examined by transabdominal ultrasonography. The pathological findings were classified into three types (A-C) on the basis of wall thickness and wall stratification. To calculate the index, we divided the intestine into eight segments, and the scores for each segment were summed to calculate the index (ultrasonographic activity index of Crohn's disease) as follows: 1 point for type A lesions, [wall thickness (mm) -2] x 2 for type B lesions, and [wall thickness (mm) -2] x 4 for type C lesions. Endoscopic or barium contrast findings were also scored in a similar fashion, with the following parametric scores: 10 for cobblestoning, 5 for longitudinal ulcers, 3 for aphthoid ulcers, and 1 for chronic inflammatory changes. RESULTS: A strong correlation (r2 = 0.62, P<0.01) was found between the ultrasound index and the endoscopic/radiological score, while weak correlations were found between the endoscopic/radiological score and the Crohn's disease activity index or biological indices of inflammation. CONCLUSIONS: Our results show that the ultrasonographic activity index of Crohn's disease can be of value in the ongoing assessment and treatment of patients.

Adolescent↗
PubMed1994

M-cells are damaged and increased in number in inflamed human ileal mucosa.

Ileocolonoscopy and biopsies of patients with spondylarthropathy reveal gut inflammation in 62% of cases. In order to better understand the pathogenetic mechanisms of spondylarthropathy-related gut inflammation, the follicle-associated epithelium was examined. Biopsies from nine controls and 18 patients with spondylarthropathy were studied by electronmicroscopy. Membranous (M) cells were investigated in normal and inflamed ileum. In normal mucosa, M-cells were scarce whereas in inflamed mucosa their number was increased (up to 24% of follicle-associated epithelial cells). They showed a thin rim of cytoplasm covering groups of lymphocytes. In chronic ileitis, necrotic M-cells, rupture of M-cells and lymphocytes entering the gut lumen were observed. The bursting of M-cells at the top of the lymphoid follicles leads to interruption of the gut epithelial lining and gives the luminal content access to the lymphoid tissue. This pathogenetic mechanism may cause aphthoid ulcers.

Adolescent↗
PubMed1996

Does Crohn's disease need differentiation from tuberculosis?

Crohn's disease (CD) and tuberculosis (TB) of the gastrointestinal tract pose major diagnostic problems for clinicians where these conditions coexist. Clinically and radiologically, the diseases are similar. In the West, TB is considered in the differential diagnosis of all suspected cases of CD, particularly among Asian migrants. Earlier age of presentation, perianal disease and enteric fistulae favour a diagnosis of CD. Aphthoid ulceration, pseudopolyps and filiform mucosa at endoscopy are suggestive of CD and a negative tuberculin test us useful. The final diagnosis depends largely on histopathology and the presence or absence of acid fast bacilli. Tuberculosis is more common in developing countries and intestinal TB frequently coexists with pulmonary tuberculosis. TB is known to affect all age groups and fistulous communication, although uncommon, does occur. In addition to radiology and endoscopy, laparotomy may be required to establish the diagnosis. In developing countries, CD is uncommon and remains largely a diagnosis of exclusion. A trial of anti-tuberculosis therapy may often be prescribed before definitely diagnosing CD. The development of molecular biology techniques had led to a revival of interest in mycobacteria as a possible aetiological agent in CD. DNA from Mycobacterium paratuberculosis and Mycobacterium kansaii have both been identified in CD cases but the significance of this finding has not been established. However, in the near future polymerase chain reaction will become increasingly useful in differentiating CD from intestinal TB because it allows the amplification and identification of very small quantities of mycobacterium DNA.

Crohn Disease↗
PubMed2000

[A case of amebic colitis cured with multiple cicatricial strictures].

A 53-year-old male was admitted to Gifu Red Cross Hospital with the complaints of diarrhea, abdominal pain, and fever. He had a temperature of 38.4 degrees C and diffuse abdominal tenderness without guarding or rebound. Plain film of the abdomen showed marked dilatation of the transverse colon. Sigmoidoscopy showed multiple aphthoid erosions and pseudomorphic ulcers, and mucosal biopsies demonstrated numerous trophozoites of Entamoeba histolytica. The patient was treated with oral metronidazole with rapid improvement. Barium enema and colonoscopy after improvement showed multiple cicatricial strictures. Although prompt diagnosis and therapy prevented fulminant changes, the patient was cured with multiple cicatricial strictures, a rare complication of amebic colitis. It is important to keep in mind severe amebic colitis in the differential diagnosis of patients with diarrhea and high fever.

Cicatrix↗
PubMed2006

[Pseudomembranous colitis after Helicobacter pylori eradication therapy].

A 69-year-old woman with gastritis was prescribed a 1-week triple regimen therapy of Amoxicillin, Clarithromycin, and Lansoprazole to eradicate Helicobacter pylori (H. pylori) starting on March 7, 2005. H. pylori was detected on the gastric mucosa by the urease test. Twenty days after eradication therapy, she began to suffer from profuse watery diarrhea. Colonoscopy on April 12 showed multiple pseudomembranes in the cecum and the transverse colon, leading to a diagnosis of pseudomembranous colitis. Because she had not taken Vancomycin (VCM) (500 mg/day) as directed, she had a relapse of watery diarrhea and was admitted on April 30. A stool test for Clostridium difficile (CD) toxin was positive, although colonoscopy showed only a few aphthoid erosions in the cecum and the transverse colon on May 6. She was treated with oral VCM (2000 mg/day) from May 6, and diarrhea disappeared by May 11. The stool test for CD toxin was negative, so VCM was discontinued. Care must thus be taken in H. pylori eradication to ensure that the triple regimen therapy does not lead to pseudomembranous colitis.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2005

Small bowel involvement in Crohn's disease: a prospective comparison of wireless capsule endoscopy and computed tomography enteroclysis.

BACKGROUND: Wireless capsule endoscopy (WCE) offers endoscopic access to the small bowel and may therefore change diagnostic and therapeutic strategies in small bowel diseases. AIM: The aim of this prospective study was to validate the gain in information and therapeutic impact of WCE in patients with Crohn's disease. METHODS: Fifty six consecutive patients with Crohn's disease underwent computed tomography (CT) enteroclysis, and if stenoses <10 mm were excluded, WCE was carried out. RESULTS: In 15 patients (27%), WCE could not be performed due to strictures detected by CT enteroclysis. From the other 41 patients, jejunal or ileal lesions were found in 25 patients by WCE compared with 12 by CT enteroclysis (p=0.004). This gain in information was mainly due to detection of small mucosal lesions such as villous denudation, aphthoid ulcerations, or erosions. Both methods were not significantly different in the detection of lesions in the terminal/neoterminal ileum (WCE 24 patients, CT enteroclysis 20 patients). Therapy was changed due to WCE findings in 10 patients. Consecutively, all of them improved clinically. CONCLUSIONS: Capsule endoscopy improves the diagnosis of small bowel Crohn's disease. This may have significant therapeutic impact.

Adult↗
PubMed1987

Crohn's disease with respiratory tract involvement.

Symptomatic respiratory tract involvement with granulomatous bronchial lesions has not yet been described in Crohn's disease. We report two patients with colonic Crohn's disease and severe respiratory symptoms (dyspnoea associated in one of the patients with voicelessness); erythema, aphthoid and superficial ulcerations were found in the colon and whitish granulations in the bronchi at endoscopy. Non-caseating tuberculoid granulomas were found in the colonic mucosa of both patients, as well as in the bronchial mucosa of one of them; in the second a diffuse inflammatory infiltrate including epithelioid cells was found underneath an erosion of bronchial epithelium. Both patients improved on oral prednisone. These two patients probably had bronchial involvement by Crohn's disease.

Adolescent↗
PubMed1993

Early mucosal changes in Crohn's disease.

Aphthoid ulceration has been regarded as an early macroscopic feature of Crohn's disease, yet the cause of this mucosal lesion is unknown. Examination of areas of apparently normal and non-inflamed bowel in Crohn's disease has allowed the identification of mucosal changes which occur before macroscopic and microscopic ulceration. Thirty five resection specimens from patients with Crohn's disease were compared with 12 specimens from patients with ulcerative colitis and 13 controls. Specimens were fixed either by immersion in formalin in the routine way or by perfusion fixation with formalin at mean arterial pressure. Immunostaining for macrophages, vessel wall, and blood constituents allowed identification of small mucosal capillaries which were not apparent otherwise. In Crohn's disease damage and rupture of these small capillaries occurred before infiltration of the lamina propria by inflammatory cells. Loss of the overlying epithelium seemed to follow this vascular damage.

Capillaries↗