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At least 973 records · Page 54Linked to original sources
PubMed1991

Differential diagnosis of inflammatory bowel disease. A comparison of various diagnostic classifications.

Fifty consecutive patients with inflammatory bowel disease of the colon who presented at the University Hospital Rotterdam/Dijkzigt were assessed by four methods: clinical diagnosis, criteria defined by Lennard-Jones and by the Organisation Mondiale de Gastroenterologie (O.M.G.E.) scoring systems, and histologic slide review. All cases were classified into three diagnostic groups: established Crohn's disease (CD), indeterminate colitis, or definite ulcerative colitis (UC). The classifications were compared by kappa analysis. Eighteen of the 50 patients were classified as having established CD by the O.M.G.E. scoring system and Lennard-Jones criteria; 17 were so classified by clinicians, and only 8 by histologic slide review. The agreement among clinician's diagnosis, Lennard-Jones criteria, and the O.M.G.E. scoring system was good (Fleiss-Cohen-weighted kappa; p less than 0.001). Agreement among histology, Lennard-Jones criteria, and the O.M.G.E scoring system was less good (p less than 0.05) and not significantly associated with clinical diagnosis. Histology was less prone to diagnose established CD or established UC and more likely to diagnose indeterminate colitis. This study has shown that the systems of disease definition set out by Lennard-Jones and the O.M.G.E. are comparable and agree well with each other and clinicians's diagnosis, but biopsy specimens have a limited diagnostic value in disease differentiation in inflammatory bowel disease.

Colitis↗
PubMed2005

Current status of genetics research in inflammatory bowel disease.

The research on genetic susceptibility of inflammatory bowel diseases (IBD) has been tremendous and over 10 chromosomal regions have been identified by genome-wide scanning. Further fine mapping as well as candidate gene studies have already led to the identification of a number of susceptibility genes including CARD15, DLG5, OCTN1 and 2, NOD1, HLA, and TLR4. The CARD15 gene is undoubtedly replicated most widely and most understood at present. CARD15 is involved in the recognition of bacterial peptidoglycan-derived muramyl dipeptide (MDP) and will stimulate secretion of antimicrobial peptides including alpha-defensins (also called cryptdins) to protect the host from invasion. Genetic research in IBD has advanced our understanding of the clinical heterogeneity of the disease and has started to tackle the complex interactions between genetic risk factors and environmental risk factors in IBD. Genes also interfere with the metabolization of drugs and may influence the clinical response and the drug-related toxicity. Interesting pharmacogenetic data with respect to steroids, azathioprine, and infliximab have been generated in IBD. Overall, it is anticipated that genetic markers in the future will be implemented in an integrated molecular diagnostic and prognostic approach of our patients.

Colitis, Ulcerative↗
PubMed2001

Minimal renal dysfunction in inflammatory bowel disease is related to disease activity but not to 5-ASA use.

BACKGROUND: Conflicting data exist about proteinuria in inflammatory bowel diseases. It is still unclear whether the occurrence of proteinuria in inflammatory bowel disease patients is an extra-intestinal manifestation of disease or the result of adverse effects to medication, especially to aminosalicylates (ASA). METHODS: A total of 95 patients (51 with Crohn's disease and 44 with ulcerative colitis) were enrolled in the study. Disease activity was assessed by Crohn's Disease Activity Index (CDAI) or the Truelove index, respectively. Urine was collected over 24 h and protein excretion of specific marker proteins for tubular (alpha 1-microglobulin-alpha 1-MG) and glomerular (albumin-Alb, Immunoglobulin G-IgG) dysfunction was measured using a highly sensitive immunoluminometric assay. RESULTS: Out of 51 Crohn's disease patients, 20 showed elevated urinary alpha 1-MG. The amount of alpha 1-MGuria was strongly correlated to the CDAI (r=0.6, P < 0.001). Only four Crohn's disease patients showed slightly elevated values for glomerular proteins in urine. Similar results were obtained for ulcerative colitis: whereas only two ulcerative colitis patients showed albuminuria, tubular proteinuria was detected in 28 out of 44 ulcerative colitis patients. Proteinuria was strongly dependent on disease activity (P < 0.01) but was not related to ASA treatment. CONCLUSIONS: Proteinuria of tubular marker proteins occurs in the majority of inflammatory bowel disease patients and is related to disease activity rather than to ASA treatment. Tubular proteinuria seems to reflect a renal extra-intestinal manifestation of inflammatory bowel disease and may serve as a new relevant marker of disease activity.

Adolescent↗
PubMed2001

Non-invasive investigation of inflammatory bowel disease.

The assessment of inflammatory activity in intestinal disease in man can be done using a variety of different techniques. These range from the use of non-invasive acute phase inflammatory markers measured in plasma such as C reactive protein (CRP) and the erythrocyte sedimentation rate (ESR) (both of which give an indirect assessment of disease activity) to the direct assessment of disease activity by intestinal biopsy performed during endoscopy in association with endoscopic scoring systems. Both radiology and endoscopy are conventional for the diagnosis of inflammatory bowel disease (IBD). However these techniques have severe limitations when it comes to assessing functional components of the disease such as activity and prognosis. Here we briefly review the value of two emerging intestinal function tests. Intestinal permeability, although ideally suited for diagnostic screening for small bowel Crohn's disease, appears to give reliable predictive data for imminent relapse of small bowel Crohn's disease and it can be used to assess responses to treatment. More significantly it is now clear that single stool assay of neutrophil specific proteins (calprotectin, lactoferrin) give the same quantitative data on intestinal inflammation as the 4 day faecal excretion of 111Indium labelled white cells. Faecal calprotectin is shown to be increased in over 95% of patients with IBD and correlates with clinical disease activity. It reliably differentiates between patients with IBD and irritable bowel syndrome. More importantly, at a given faecal calprotectin concentration in patients with quiescent IBD, the test has a specificity and sensitivity in excess of 85% in predicting clinical relapse of disease. This suggests that relapse of IBD is closely related to the degree of intestinal inflammation and suggests that targeted treatment at an asymptomatic stage of the disease may be indicated.

Biomarkers↗
PubMed1990

Health status in inflammatory bowel disease. Biological and behavioral considerations.

The existing clinical measures of disease activity for inflammatory bowel disease are insufficient to explain a patient's illness experience or health outcomes. Although many disease activity measures have been devised, they are not widely accepted by clinicians because existing ones are no better than a carefully obtained clinical assessment. Furthermore, health status is determined not only by disease activity, but also by the psychological state, cultural influences, degree of social support, and effects of complications, previous surgery, and medication. To develop more accurate appraisals of the impact and severity of IBD, we must prospectively evaluate the biological and psychosocial measures that predict clinically relevant outcomes. We should then be able to develop statistically weighted scales related to specific outcome variables. Such knowledge will help us to develop more sensitive measures of illness, particularly in patients with mild disease for whom present indices are insensitive. This type of assessment should also aid in the understanding of health care utilization, medical vs. surgical options, resource allocation, and the efficacy of therapeutic trials.

Adult↗
PubMed2007

Group-based intervention program in inflammatory bowel disease patients: effects on quality of life.

BACKGROUND: Inflammatory bowel diseases (IBD) such as ulcerative colitis (UC) and Crohn's disease (CD) have great impact on patients' health-related quality of life (HRQOL). The aim of this study was to develop an integrated medical and psychological/ psychosocial group-based intervention program for IBD patients and to evaluate if such a program could influence the patients' HRQOL and coping abilities. METHODS: IBD patients in remission or with low disease activity were randomized to intervention or control groups. The intervention comprised nine weekly sessions, alternating lectures, and group therapy sessions. The Inflammatory Bowel Disease Questionnaire (IBDQ) and the Sense of Coherence scale (SOC) were used to measure HRQOL and coping ability at 0, 6, and 12 months. The intervention was evaluated by a visual analog scale (VAS) and written comments by a content analysis. RESULTS: In all, 24 patients were included in the intervention group and 20 in the control group. The mean IBDQ score showed no statistically significant differences before (173.9) or after the intervention at month 6 (175.7) or at month 12 (171.8), or when comparing intervention and controls at month 12. Similarly, there were no statistically significant differences in mean SOC before or after intervention or when comparing groups. The VAS and the content analysis showed that the intervention was well appreciated by the patients. CONCLUSIONS: The group-based intervention program was feasible and highly appreciated. There were no statistically significant differences in average IBDQ or SOC over time or in comparison with controls, although a significant increase was seen in patients with short disease duration.

Adaptation, Psychological↗
PubMed2006

Evaluation of the Inflammatory Bowel Disease Questionnaire in Swedish patients with Crohn's disease.

OBJECTIVE: Health-related quality of life (HRQoL) is an important measure of inflammatory bowel disease (IBD) health outcome. The Inflammatory Bowel Disease Questionnaire (IBDQ) comprising 32 items grouped into four dimensions is a widely used IBD-specific HRQoL instrument. The purpose of this study was to evaluate the validity, reliability and responsiveness of the Swedish translation of the IBDQ in patients with Crohn's disease (CD). MATERIAL AND METHODS: Four hundred and forty-eight patients with CD completed the IBDQ and three other HRQoL questionnaires (Rating Form of IBD Patient Concerns; Short Form-36; and the Psychological General Well-Being Index) in connection with their regular visit at the outpatient clinic. Disease activity was assessed by the physician on a 4-point Likert scale. Thirty-two patients who were stable in remission completed the questionnaires a second time, 4 weeks later. A total of 418 patients repeated all measurements after 6 months. RESULTS: The dimensional scores were highly correlated with other measures of corresponding aspects of HRQoL and were significantly better in remission than in relapse. High test-retest correlations indicated good reliability. Responsiveness was confirmed in patients whose disease activity changed over time. However, high correlations between the dimensions, poor correlations between items within each dimension, and factor analysis all indicated that the original grouping of the items is not valid for Swedish CD patients. CONCLUSIONS: Although the Swedish IBDQ has good external validity, reliability and responsiveness for patients with CD, our results did not support the original grouping of the items.

Adult↗
PubMed1997

Asymptomatic uveitis in young people with inflammatory bowel disease.

PURPOSE: To ascertain the prevalence of uveitis in a population of pediatric patients with inflammatory bowel disease without ocular symptoms. METHODS: We prospectively evaluated all young people who came to the pediatric gastroenterology clinic with endoscopically proven inflammatory bowel disease between March 1994 and June 1995. All the patients were examined for evidence of ocular manifestations of inflammatory bowel disease. The examination consisted of slit-lamp examination, tonometry, and indirect ophthalmoscopy. None of the patients had visual or ocular symptoms. Eighteen patients had Crohn's disease and 14 had ulcerative colitis. RESULTS: Of the 32 patients evaluated, four (12.5%) had evidence of asymptomatic ocular inflammation, defined as anterior chamber cell and flare. All patients with ocular inflammation were male. Three of these four male patients had Crohn's disease; the other had ulcerative colitis. Five patients had posterior subcapsular cataract, one had esotropia and amblyopia, and one had unilateral high myopia. CONCLUSIONS: The prevalence of asymptomatic uveitis in our population of young people with inflammatory bowel disease was 12.5%. These findings suggest the need for a screening ophthalmologic examination to rule out occult eye disease in young people with inflammatory bowel disease.

Adolescent↗
PubMed1995

Phenotypic and functional characteristics of colonic lymphocytes isolated from patients with primary sclerosing cholangitis and inflammatory bowel disease.

Because primary sclerosing cholangitis (PSC) frequently is associated with inflammatory bowel disease, the phenotypic and functional characteristics of lymphocytes isolated from colonic mucosa were studied in patients with primary sclerosing cholangitis (PSC), patients with ulcerative colitis and patients with other colonic and hepatic disorders. To accomplish this, lymphocytes isolated from colonic biopsies obtained at the time of colonoscopy were expanded in vitro in the presence of interleukin 2 (IL2). Cell propagation was similar in patients with PSC with or without associated inflammatory bowel disease but was diminished significantly when compared to results obtained in patients with ulcerative colitis not associated with PSC. The CD4:CD8 ratio of the propagated lymphocytes was increased in patients with PSC compared to controls. The Leu 19+ subset of cells was also increased in PSC patients. In patients with inflammatory bowel disease, increased cytotoxicity was noted at low effector to target cell ratios with SK-HEP (hepatocellular carcinoma) but not RPMI 7451 (cholangiocarcinoma) targets. No differences between PSC patients and controls were observed for NK sensitive and NK resistant targets. Based upon these studies it can be concluded that: 1) expansion of lymphocytes obtained from endoscopic colonic biopsies using recombinant IL2 represents an alternative method by which intestinal lymphocytes can be studied; 2) natural killer cells are increased in the colonic mucosa of patients with primary sclerosing cholangitis; 3) colonic cytotoxic T lymphocytes may be more active in patients with chronic liver disease and particularly those with associated inflammatory bowel disease.

Adult↗
PubMed1996

[Physician-patient relations and stress caused by coloscopy in patients with chronic inflammatory bowel disease].

The relationship between doctors and patients with inflammatory bowel disease is usually considered complex and difficult. We analyzed the quality of this relationship and the stress inflicted on the patients by endoscopy. 76 patients with Crohn's disease or ulcerative colitis answered a questionnaire. More than three quarters considered their relationship to their doctors good or very good. The patients expressed a wish for more information on the pathophysiology and treatment options of their disease. The stress placed on the patients by endoscopy was considered severe or very severe by 57%. We conclude that the relationship between doctor and patients with inflammatory bowel disease is generally considered good or very good. Endoscopies are highly stressful for most patients and we recommend appropriate sedation.

Colonoscopy↗
PubMed1994

Analysis of T-lymphocyte subpopulations in inflammatory bowel diseases by three-color flow cytometry.

In order to better define changes in the relative proportion of peripheral blood T-lymphocyte subpopulations in patients with inflammatory diseases of the bowel, we performed simultaneous three-color fluorescence-activated cytometric (FACS) analysis using fluorophore-conjugated monoclonal antibodies with specificity for CD4, CD8, Leu 8, and CD45RA on 22 normal control subjects, 28 patients with Crohn's disease (CD), 15 patients with ulcerative colitis (UC), and 11 patients with intestinal inflammation secondary to etiologies other than inflammatory bowel disease (NIBD). This staining combination allowed enumeration of distinct T-cell subpopulations as follows: virgin CD4+, recall antigen helper T cells, nonspecific B-cell helper T cell, virgin CD8+, cytotoxic effector and suppressor effector and recall antigen cytotoxic T cells based on a synthesis of published functional analyses. No differences in the proportion of CD4+ or CD8+ cells or in the CD4+/CD8+ ratios were evident when UC and NIBD patients were compared to normal subjects. A significant reduction in the proportion of CD4+ cells and an increase in CD8+ cells was observed, however, in the CD group. When two-color analysis was performed, several significant differences in the proportions of circulating lymphocytes were seen. Specifically, these included significant increases in the number of CD4+, Leu 8- (P < 0.01) cells in all disease groups and an increase in CD4+, CD45RA+ cells in the NIBD group. Conversely, significant decreases in the proportions of CD8+, Leu 8+ (P < 0.01) cells were evident in the Crohn's disease group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2005

[Inflammatory bowel disease: knowledge advancement of the last sixty years].

Inflammatory bowel diseases, Crohn's disease and ulcerative colitis, were discovered in the twentieth century. The etiology and pathogenesis has been unsolved until now. At present, three etiological mutually involved factors can be considered. The most important turned out to be the genetics component, which can lead to the chronic inflammation of the bowel. The significant effects of infectious and environmental factors were proven in the pathogenesis of inflammatory bowel diseases. Despite many years elapsed, the "The binary pathogenesis theory of ulcerative colitis", postulated by Maratka in the sixties, can be still accepted.

Humans↗
PubMed1990

Lack of induction of suppressor T cells by intestinal epithelial cells from patients with inflammatory bowel disease.

The mechanisms underlying the chronic unrelenting inflammatory response seen in inflammatory bowel disease (IBD) are poorly understood. We have recently proposed a novel role for the normal intestinal enterocyte, that of antigen presenting cell. However, in contrast to conventional antigen presenting cells, normal enterocytes appear to selectively activate CD8+ antigen nonspecific suppressor T cells. To determine whether failure of this process may be occurring in inflammatory bowel disease, freshly isolated enterocytes from small and large bowel from normal patients, patients with Crohn's disease, ulcerative colitis, and inflammatory (diverticulitis, ischemic colitis, and gold induced colitis) controls were co-cultured with allogeneic T cells in a modified mixed lymphocyte reaction. In contrast to normal enterocytes, 42/42 Crohn's and 35/38 ulcerative colitis-derived epithelial cells stimulated CD4+ T cells, whereas 65/66 and 9/9 normal and inflammatory control enterocytes, respectively, stimulated CD8+ T cells (as previously described), suggesting that the results seen were not just a reflection of underlying inflammation. Furthermore, IBD enterocytes from both histologically involved and uninvolved tissue were similar in their ability to selectively activate CD4+ T cells, speaking for a more global defect in epithelial cells in IBD. Finally, activated T cells from IBD epithelial cell-stimulated mixed lymphocyte cultures displayed potent T helper activity in an antigen nonspecific fashion. Taken together, these data suggest that there may be an intrinsic defect in epithelial cells from patients with IBD, resulting in the inability to normally stimulate suppressor T cells in an antigen overloaded environment.

Antigens, Differentiation, T-Lymphocyte↗
PubMed1984

International comparison of mortality from inflammatory bowel disease in the Latin-speaking countries Venezuela, Italy, and France.

Mortality data for ulcerative colitis, Crohn's disease, and unspecified inflammatory bowel disease were examined for the countries Venezuela, Italy, and France during the decade 1969-1978. These figures were compared with similar data from England and Wales obtained from 1965 to 1975. In Italy and France deaths from Crohn's disease and ulcerative colitis were low and showed little change during the period of observation. Figures for inflammatory bowel disease from Venezuela were high and appeared to show a marked fall which may simply reflect a change in diagnostic criteria.

Colitis, Ulcerative↗
PubMed2005

Antibacterial and antimycobacterial treatment for inflammatory bowel disease.

A variety of medicines have been used for the treatment of inflammatory bowel disease. Antibacterial therapy has demonstrated promise by both improving symptoms and causing disease remission. The mechanism is unknown, but may be related to either eliminating a key pathogen, decreasing the number of bacterial secretory products or defective particles, a direct immunomodulating effect, or reducing secondary bacterial invasion. Historically, a large number of bacterial species have been suspected as being major contributors to the etiology of inflammatory bowel disease, including ulcerative colitis and Crohn's disease. Many trials of antibacterial agents have been carried out in inflammatory bowel disease. Recently, treatments have focused on Gram-negative anaerobes and mycobacteria. The present paper briefly reviews antimicrobial and antimycobacterial treatments in inflammatory bowel disease.

Animals↗
PubMed2006

Natural coagulation inhibitory proteins and activated protein C resistance in Turkish patients with inflammatory bowel disease.

BACKGROUND/AIMS: Thromboembolic events are a rare but significant complication of inflammatory bowel disease. The aim of this study was to investigate the level of natural coagulation inhibitors and activated protein C resistance in Turkish patients with inflammatory bowel disease. METHODS: Fifty patients (29 male, 21 female) without venous thrombosis history and 37 healthy controls were included in the study. Erythrocyte sedimentation rate, C-reactive protein, thrombocyte count, prothrombin time, activated partial thromboplastin time, fibrinogen concentration, von Willebrand factor antigen, factor VIII activity, activated protein C resistance, functional levels of antithrombin III, protein C and protein S were measured. Patients and controls with activated protein C resistance were further studied using a polymerase chain reaction assay for factor V Leiden mutation. RESULTS: There was no significant difference between patients and the controls in terms of antithrombin III, protein C, protein S, factor (F) VIII and Willebrand factor levels. The mean thrombocyte counts, fibrinogen levels, and Willebrand factor levels were found to be significantly higher in patients who were in the active period of the disease than in controls and patients in remission. No significant difference was observed in those showing activated protein C resistance and factor V Leiden mutation between patients and controls. CONCLUSIONS: The presence of inherited thrombophilic defects, in particular activated protein C resistance and natural coagulation inhibitor deficiency, is uncommon in Turkish patients with inflammatory bowel disease in both active and remission periods. As a result, a controlled study in inflammatory bowel disease patients with thrombosis history is recommended.

Activated Protein C Resistance↗
PubMed1986

The epidemiology of inflammatory bowel disease in Cape Town 1980-1984.

Patients with inflammatory bowel disease diagnosed in the greater Cape Town area between the years 1980 and 1984 inclusive were studied to establish the incidence and presenting features of these diseases. Case details were obtained from the records of the Groote Schuur Hospital group and Tygerberg Hospital as well as from questionnaires completed by 97% of 731 medical practitioners in the area. There were 134 patients with Crohn's disease, 197 with ulcerative colitis and 16 with indeterminate colitis. The incidences of Crohn's disease in the coloured, white and black population groups were calculated to be 1.8, 2.6 and 0.3/100 000 per year respectively and those for ulcerative colitis 1.9, 5.0 and 0.6/100 000 respectively. Among Jews the incidence was higher for both Crohn's disease (10.4/100 000) and ulcerative colitis (17.0/100 000). Of patients with ulcerative colitis 35% had limited proctitis, 26% proctosigmoiditis, 12% left-sided disease and 27% total colitis. Of patients with Crohn's disease 27% had colonic involvement alone, 37% ileocolitis and 36% small-bowel involvement alone. The incidence of inflammatory bowel disease has increased in the greater Cape Town area over the last 10 years, while the pattern of disease has remained similar to that previously reported for this geographical area.

Adolescent↗