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PubMed2006

Case report: lymphoma arising in an ileal pouch anal anastomosis after immunomodulatory therapy for inflammatory bowel disease.

The risk of lymphoma in inflammatory bowel disease (IBD) has raised concerns regarding the lymphogenic potential of immunomodulatory therapy. The link between immunosuppressive therapy and lymphoma risk is well established in patients with solid organ transplantations. In this population, it is postulated that lymphocytes infected with the Epstein-Barr virus (EBV) proliferate unchecked due to impaired cell-mediated immunity. A similar phenomenon may occur in IBD patients treated with multiple immunomodulators and biological agents. In this report, we describe a case of EBV-positive non-Hodgkin's lymphoma arising in the ileal pouch of a patient with ulcerative colitis. This patient was maintained on prednisone (>20 mg/day) for 8 months, cyclosporine for 7 months, and 6-mercaptopurine for nearly 2 years prior to a single infusion of infliximab (5 mg/kg). The cumulative effects of more than three agents, simultaneously and/or sequentially, may simulate posttransplantation immunosuppression and pose a significant threat of malignancy. Such patients may warrant more aggressive diagnostic surveillance and evaluation.

Adult↗
PubMed2004

The G2964A polymorphism of the STAT6 gene in inflammatory bowel disease.

BACKGROUND AND AIMS: Linkage of inflammatory bowel diseases to chromosome 12p13.2-q24.1 (IBD2) has been confirmed in several genome wide screens. The STAT6 gene is located within this chromosomal region. The transcription factor STAT6 is involved in the regulation of the TH1/TH2 immune response. Increased production of TH1 cytokines is crucial in the pathogenesis of Crohn's disease. PATIENTS AND METHODS: Therefore, we genotyped a single nucleotide polymorphism in the 3' untranslated region of the STAT6 gene (G2964A) in 243 patients with Crohn's disease, 100 patients with ulcerative colitis and 548 healthy controls. RESULTS: In comparison to controls, the G allele and the GG genotype frequencies were significantly increased only in Crohn's disease patients without a variation in the CARD15 gene (p<0.03 and p<0.02, respectively). CONCLUSIONS: Alterations in the STAT6 pathway may play a crucial role in the pathogenesis of distinct subgroups of patients with Crohn's disease.

Adult↗
PubMed1998

IL-10 synergizes with IL-4 and IL-13 in inhibiting lysosomal enzyme secretion by human monocytes and lamina propria mononuclear cells from patients with inflammatory bowel disease.

Tissue injury and inflammation in inflammatory bowel disease (IBD) are associated with enhanced monocytic lysosomal enzyme release. In this study, peripheral monocytes and lamina propria mononuclear cells (LPMNC) were isolated from IBD patients and normal controls. Cells were stimulated with lipopolysaccharide after treatment with IL-13, IL-4, and IL-10, and enzyme secretion was assessed by using the corresponding p-nitrophenyl glycosides as substrates. Molecular forms of cathepsin D were examined to describe the mode of enzyme release. IL-10 and IL-4 strongly down-regulate enzyme secretion in IBD monocytes. IBD monocytes showed a diminished responsiveness to the inhibitory effect of IL-13. Impaired monocyte response was not found with combinations of IL-13 and IL-10 or IL-4 and IL-10. LPMNC from involved IBD mucosa showed significantly higher enzyme secretion compared with LPMNC from noninvolved IBD mucosa but responded inefficiently to either IL-4, IL-13, or IL-10 alone. However, combined treatment with IL-10 and IL-4 or IL-10 and IL-13 strongly suppressed enzyme release by these cells. Both the precursor and mature forms of cathepsin D were elevated in IBD patients. While IL-13 reduced mainly the precursor form, the effect of IL-4 and IL-10 concerns both the precursor and mature form of cathepsin D. Our results favor the potent clinical utility of combined treatment, thus improving chances of developing effective treatments for human IBD.

Adult↗
PubMed2006

Screening of tumor necrosis factor receptor-associated factor 6 as a candidate gene for inflammatory bowel disease.

OBJECTIVE: The two forms of inflammatory bowel disease (IBD), Crohn's disease (CD) and ulcerative colitis (UC), are thought to arise because of an interplay of unfavorable genetic and exogenous factors. During a genome-wide linkage study of IBD, we observed a nominal linkage to chromosome 11p12-q13 that was further confirmed upon fine density mapping. This chromosomal region contains a functional IBD candidate gene coding for tumor necrosis factor receptor-associated factor 6 (TRAF6), a signal transducer regulating innate and adaptive immunity as well as bone homeostasis. MATERIAL AND METHODS: Using denaturing high-performance liquid chromatography (dHPLC) and DNA sequencing, all exons and exon-intron boundaries of the TRAF6 gene in probands of 95 IBD families were initially screened; this material comprised 20 CD, 39 UC and 36 mixed families. RESULTS: No nucleotide changes in the coding sequence of TRAF6 were detected, but a single-base insertion/deletion polymorphism in a polythymine stretch (containing 8 or 7 thymines, respectively) in intron 3 was identified. However, examination of an extended material of 290 unrelated CD patients, 416 UC patients and 320 healthy blood donors failed to show any association with this 7T/8T variation and IBD, nor was this polymorphism related to specific clinical features in IBD. CONCLUSIONS: Our study tends to exclude a good positional and functional candidate gene, TRAF6, as an IBD predisposing gene and lends support to the idea that the function of TRAF6 is important enough not to permit structural alterations of this mediator.

Chromatography, High Pressure Liquid↗
PubMed2002

Update on genetics of inflammatory bowel disease.

Complex genetic disorders such as inflammatory bowel disease (IBD) result from the interplay between multiple genetic and environmental risk factors. The recent identification of variants of the CARD15/NOD2 protein as contributing to Crohn disease represents a major advance in defining disease pathogenesis. CARD15/NOD2 is expressed in monocytes and is capable of activating nuclear factor kappa B (NF-kappaB). Crohn disease-associated mutations in CARD15/NOD2 predominate in its C-terminus leucine-rich repeat domain, which is required for bacterial lipopolysaccharide-dependent induction of NF-kappaB activity. The relative risk of developing Crohn disease is estimated to be in the range of 2 to 3 in people carrying one mutation and 20 to 40 in people carrying two mutations in CARD15/NOD2. Homozygote and compound heterozygote carriers of CARD15/NOD2 mutations are characterized by an earlier age of onset, less involvement of the left colon, and positive association with stricturing disease. However, even carriers of two CARD15/NOD2 mutations have limited disease penetrance (ie, only a minority will develop the disease), suggesting that additional interacting genes and environmental triggers are required for disease expression. Several additional genetic regions have been implicated through genetic linkage and association studies.

Journal Article↗
PubMed1993

Growth failure in pediatric inflammatory bowel disease.

To assess whether children with inflammatory bowel disease (IBD) develop permanent impairment of linear growth, we analyzed records from 48 young adults who had IBD during childhood or early adolescence (Tanner I-III; 11.8 +/- 2.4 years old at diagnosis). All were fully grown (Tanner V; 21.1 +/- 3.0 years) at last examination. Adult heights were predicted from data obtained at or shortly after the diagnosis of IBD by three methods: height for age percentile, the Bailey-Pinneau (BP), and Roche-Wainer-Thissen (RWT) methods. Predicted adult heights were then compared with the actual ultimate height of each subject. Permanent growth failure occurred in 19-35% of subjects, depending upon the method used to assess growth. Overall, 31% (15 of 48) of the subjects had deficits of adult height identified by two or more methods, including 14 of 38 (37%) of those with Crohn's disease but only one of 10 with ulcerative colitis. Age at diagnosis of IBD, age at last examination, age at cessation of linear growth, and site of IBD did not differ between impaired and normal growth groups. Duration of corticosteroid use was longer (p < 0.05) in growth-impaired subjects. In addition, although 60% of all subjects had periods of poor growth that put them in height-for-age percentiles two or more major growth channels below previous percentiles, only 19% remained at these levels upon achieving their final adult heights. Permanent impairment of linear growth leading to clinically meaningful deficits of ultimate adult height is common in patients with IBD in childhood or early adolescence. New therapeutic approaches are needed to address this problem.

Adolescent↗
PubMed1982

Diagnosis of inflammatory bowel disease: an international multicentre scoring system.

Inflammatory bowel disease is being studied by the World Organisation of Gastroenterology (OMGE) Research Committee in a survey (currently) affecting 1696 patients presenting to 30 hospitals in 16 countries. A computer-aided diagnostic prediction system (when tested in 1056 patients) showed an accuracy of match between computer prediction and clinical diagnosis in 94% of these patients. Most centres, however, do not possess appropriate computing facilities. A simple diagnostic "scoring system", based on likelihood ratios, has therefore been developed, using a series of numbers set out on a single sheet of paper. The overall accuracy of the simple scoring system in the same 1056 patients was equivalent (93%) to the computer-aided system. In a further series of 510 "new" patients from eight fresh centres the diagnostic scoring system made a firm prediction in 490 cases (96%). Where made, the accuracy of match between the scoring system prediction and clinical diagnosis was 96%. It is suggested that this simple system, which requires no analytical resource and could be used by any gastroenterologist, might be of some value in clinical research and clinical practice.

Adult↗
PubMed1978

Escherichia coli antibodies in patients with inflammatory bowel disease.

Sera from 30 patients with inflammatory bowel disease (IBD) (16 with Crohn's disease (CD) and 14 with ulcerative colitis (UC) were assayed for the presence of antibodies against 159 Escherichia coli O-antigens and compared with sera from 16 matched control subjects. The majority of patients with IBD had agglutinating antibodies to a higher number of Escherichia coli O-antigens and in higher titres than the control group. The number of positive agglutinins was O-33 mean 13.8 in CD, O-26 mean 7.9 for UC, and O-7 mean 1.5 in controls. Eight patients with IBD and arthropathy had antibodies to fewer O-antigens (O-7 mean 3.2). The antibodies were in the IgG and IgM, in titres corresponding to original values. No specific O-serotypes were associated with IBD. Common serotypes, R-plasmid carrying serotypes, and those associated with shigella-like adult diarrhoea were detected. O14 was detected only in five patients and O119 in none. There was no correlation between the number of Escherichia coli agglutinins and the site and severity of the disease or type of therapy. It is suggested that the presence of the high numbers of Escherichia coli antibodies is secondary to the disease process and is unlikely to be causally involved in the pathogenesis of the disease, but may play a role in the perpetuation of the disease and in the extraintestinal complications.

Adult↗
PubMed1981

Chlamydiae and inflammatory bowel disease.

No association was found between inflammatory bowel disease and infection with C. trachomatis or C. psittaci when patients were tested for the presence of these organisms using immunohistological, cell culture isolation, and serological techniques.

Adult↗
PubMed2005

Asymptomatic inflammatory bowel disease presenting with mucocutaneous findings.

Although inflammatory bowel disease (IBD) typically presents with gastrointestinal complaints, mucocutaneous lesions are commonly associated and can precede gastrointestinal symptoms, thereby alerting the clinician to the diagnosis of IBD before the onset of gastrointestinal symptoms. Nine children are reported who had no gastrointestinal symptoms suggestive of IBD but presented with mucocutaneous findings of IBD and were subsequently diagnosed with Crohn's disease or ulcerative colitis based on characteristic features on gastrointestinal endoscopy and/or biopsies. The majority of the patients had oral and perianal lesions. We believe that IBD is a common etiology for persistent oral lesions in the pediatric population. In addition to a good history, children with unexplained oral mucous membrane lesions should have an examination of the rectal and genital mucosa as well as tests for complete blood count, iron levels, sedimentation rate, albumin, and occult blood in the stool with endoscopy and biopsies to rule out IBD if indicated.

Child↗
PubMed2002

Treatment of inflammatory bowel disease in the elderly: an update.

Inflammatory bowel disease (IBD) is most common in young adults, but it can also present in the elderly. Furthermore, with the aging of the population, the number of elderly patients with IBD is expected to grow. Other conditions, such as diverticulitis and ischaemic colitis, may be more common in the elderly and need to be considered in the differential diagnosis. Management of elderly patients with IBD follows the same principles as in younger patients, with a few exceptions. For patients with mild-to-moderate colitis, a 5-aminosalicylate drug is often used (sulfasalazine, olsalazine, mesalazine, balsalazide). Topical therapy may be sufficient for those with distal colitis, whereas an oral preparation is used for more extensive disease. In those with more severe or refractory symptoms, corticosteroids are used, although the elderly appear to be at increased risk for corticosteroid-associated complications. For patients with corticosteroid-dependent or corticosteroid-refractory disease, immunosuppression with azathioprine or mercaptopurine may help avoid surgery. In patients with Crohn's disease, a similar approach is followed, with the additional consideration that the formulation of drug used must ensure delivery of drug to the site of inflammation. In fistulising Crohn's disease, antibacterials, immunosuppressive drugs, infliximab and surgery are often used in combination. Controlled trials and clinical experience have shown that infliximab is a significant addition to the therapeutic armamentarium for patients with Crohn's disease.

Aged↗
PubMed1985

Precancer and cancer in inflammatory bowel disease.

The risk of cancer in inflammatory bowel disease (IBD) is increased although it remains low. A clinical subgroup of patients with extensive or total ulcerative colitis and a history of symptoms for more than 10 yr is at greatest risk. In these patients biopsy evidence of epithelial dysplasia has successfully been used as a marker for increased cancer risk. A classification system for dysplasia has recently been devised, consisting of 3 categories: negative, indefinite and positive for dysplasia. The criteria for each category are discussed. For patients at high risk who decline prophylactic colectomy, a cancer surveillance programme involving periodic clinical assessment, sigmoidoscopy, colonoscopy and rectal and colonic biopsies has provided a reasonable alternative.

Colitis↗
PubMed2006

Family and twin studies in inflammatory bowel disease.

Studies examining the inheritance of inflammatory bowel disease (IBD) within different family groups have been the basis for recent molecular advances in the genetics of IBD. The derived heritability in Crohn's disease (CD) is higher than in many other complex diseases. The risk of IBD is highest in first-degree relatives of a CD proband, but first-degree relatives of a proband suffering from ulcerative colitis (UC) and more distant relatives are also at increased risk. Disease concordance rates in IBD have been examined in multiplex families and in three large European twin studies.

Colitis, Ulcerative↗
PubMed2000

[Tobacco and inflammatory bowel disease].

The relationship between tobacco and inflammatory bowel diseases is reported by many epidemiological studies. Smoking has a protective effect in ulcerative colitis. It delays the developing of the disease and improves the clinical pattern. Whereas smoking and passive smoking increase the risk of developing Crohn's disease. Tobacco is also a risk factor for severe symptoms, surgery and clinical relapses. The active substance was identified as nicotine. The major sites of nicotine effect are colonic mucus, intestinal permeability and cellular immunity. In practice, patients with Crohn's disease should stop smoking. Transdermal nicotine for ulcerative colitis could be effective.

Colitis, Ulcerative↗
PubMed1988

Smoking and inflammatory bowel disease in families.

Smoking habits of inflammatory bowel disease (IBD) patients were compared with family members with IBD to determine the effects of cigarette smoking on the development of either ulcerative colitis or Crohn's disease. In a previous study of patients randomly selected from the University of Chicago IBD Registry, 40 patients with IBD were identified as having a confirmed IBD family history. Thirty-one of those probands and relatives were contacted and included in this study. Of the 36 patients in the study with Crohn's disease, 78% were former or current smokers, whereas only 27% of the 26 patients with ulcerative colitis were former or current smokers. Eighty-three percent of all those who had ever smoked, started before the onset of symptoms of their disease. There were high concordance rates for type of IBD (81%) and for smoking habits (65%, when a history of smoking was compared with a history of never having smoked) among the matched pairs. The concordance rates were not significantly different from each other, but the magnitude of concordance of each suggests that both smoking habits and consanguinity may be important factors in the pathogenesis of this disease.

Adult↗
PubMed1987

Imaging inflammatory bowel disease in the pediatric patient.

Idiopathic inflammatory bowel disease in childhood was once considered rare but is now being increasingly recognized. Although ulcerative colitis and Crohn's disease, the two most common types, have some features in common with the adult form, in all of these diseases the differential diagnoses, presentation, and therapy differ in many important ways from those in adults. Infants are also susceptible to diseases not seen in older children. These differences and the often extremely young age of the patient markedly affect the choice and performance of diagnostic imaging techniques. These techniques have to be modeled more to the individual's requirements than in adults, and infants need a different approach even from older children.

Adolescent↗
PubMed1985

Hepatobiliary disorders in inflammatory bowel disease.

Every physician managing patients with inflammatory bowel disease should be alert to the possibility of the development of hepatobiliary disorders, especially in patients with extensive colonic involvement. There is the question concerning type of follow-up study to be instituted in patients with IBD. Elevation of the level of serum alkaline phosphatase appears to be the most useful and consistent biochemical indicator of hepatic dysfunction (101). This should be estimated at six monthly intervals. A persistent elevation of the level of serum alkaline phosphatase or more overt clinical manifestations, such as pain in the right upper quadrant, hepatomegaly, obstructive jaundice or weight loss, would all indicate the need for further investigations. This would normally take the form of roentgenologic investigation of the biliary tree and biopsy of the liver. Once a patient with IBD has been diagnosed as having one or more hepatobiliary disorders, what is the appropriate management? Each instance should be treated individually according to the nature of the disorder. In general, most of these conditions are histologic abnormalities and are of little clinical importance. There is the question of whether or not there is a role for prophylactic colectomy. There has been conflicting evidence to both support and refute the rationale that colectomy will prevent the development of, or arrest, existing disease of the liver. In the view of the authors, based upon a large experience with the management of these patients, the indication for colectomy should be based upon the severity and extent of colonic disease and almost never upon the existence of associated hepatobiliary disorders.

Adenocarcinoma↗
PubMed1984

Inflammatory bowel disease and leukemia.

Five patients with inflammatory bowel disease developed leukemia. In the literature, only a single report was found in which five patients developed acute myelogenous leukemia during the course of ulcerative colitis. Four of our patients had myelogenous and one lymphocytic leukemia. Three patients had Crohn's disease involving primarily the small bowel; and the other two cases involved ulcerative colitis.

Adolescent↗