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PubMed1978

Influence of inflammatory bowel disease on intestinal microflora.

The microflora of the jejunum, ileum, and colon has been studied from operative samples in Crohn's disease (n = 30), ulcerative colitis (n = 15), and controls (n = 40). There was no significant difference in the flora of patients with ulcerative colitis compared with controls. In Crohn's disease there was a significant increase in E. coli (P less than 0.001) and B. fragilis (P less than 0.001) in the ileum and of E. coli (P less than 0.001) and lactobacilli (P less than 0.01) in the colon. The abnormal ileal flora in Crohn's disease was unrelated to serological evidence of disease activity (indices: ESR, serum albumin, serum seromucoids), diameter of the ileum, or excision of the ileocaecal valve. The abnormal colonic flora in Crohn's disease was not related to presence of macroscopic colitis.

Bacteroides fragilis↗
PubMed1994

Distribution of the matrix metalloproteinases stromelysin, gelatinases A and B, and collagenase in Crohn's disease and normal intestine.

AIMS: To investigate the role of the matrix metalloproteinases (MMPs) in the connective tissue changes seen in the intestine in Crohn's disease. METHODS: Indirect immunofluorescence microscopy using specific antibodies to the MMPs (collagenase, gelatinase A and B, and stromelysin) were used to assess the distribution of these enzymes in normal and diseased intestine. RESULTS: In normal intestine the matrix metalloproteinases were confined to a few isolated inflammatory cells, but in Crohn's disease, the inflammatory infiltrate was associated with increased numbers of polymorphonuclear leucocytes which stained positive for gelatinase B. Stromelysin was also detected extracellularly on the connective tissue matrix in regions of smooth muscle cell proliferation and mucosal degradation. Interestingly, in ulcerative colitis, another inflammatory bowel disease, stromelysin was localised in the lamina propria in regions of mucosal loss. CONCLUSIONS: The increased numbers of inflammatory cells containing gelatinase B, and the localisation of extracellular stromelysin in regions of fibrosis and mucosal degradation, suggest that these enzymes have a role in the pathological changes seen in Crohn's disease. In cases of ulcerative colitis stromelysin was also detected on the lamina propria in regions of mucosal loss, and seems to be associated with the connective tissue changes that precede mucosal loss.

Colitis, Ulcerative↗
PubMed1998

Tapeworm infection is a significant risk factor for spasmodic colic and ileal impaction colic in the horse.

The association between the equine intestinal tapeworm Anoplocephala perfoliata and specific types of intestinal disease was investigated by matched case-control study using coprological and serological diagnosis. We have previously shown that the host IgG(T) response to 12/13 kDa antigens of A. perfoliata correlates well with infection intensity, therefore this antibody response was used to investigate the risk of colic at different levels of parasite infection intensity. One hundred and three spasmodic colic cases with an equal number of controls matched for age, breed and gender, and 20 ileal impaction cases each with 2 similarly matched controls were obtained. Cases of spasmodic colic were much more likely (odds ratio = 8.0) to be associated with A. perfoliata infection detected coprologically than controls. Serological diagnosis revealed an increasing risk of spasmodic colic with increasing infection intensity. Calculation of an aetiological fraction suggests that 22% of spasmodic colic cases in this study were tapeworm associated. No significant association was found between colic and strongyle egg count. Conditional logistic regression analysis demonstrated that the relationship between colic and A. perfoliata infection intensity was not confounded by strongyle egg count and there was a linear relationship between infection intensity and the log-odds of spasmodic colic. For cases of ileal impaction, a strong association was found between colic and A. perfoliata as diagnosed by coprological means (odds ratio of 34.0). Serological diagnosis also revealed a strong association that increased with higher levels of infection intensity (odds ratio = 26.0). The aetiological fraction for the ileal impaction data suggests that 81% of the ileal impaction cases in this study were tapeworm associated. This study concludes that A. perfoliata is a significant risk factor for spasmodic colic and ileal impaction colic in the horse; and that the risk of spasmodic colic increases with infection intensity.

Animals↗
PubMed2000

Crohn's disease and intestinal endometriosis: an intriguing co-existence.

OBJECTIVES: We present a series of eight female patients who came to surgery for complicated Crohn's disease of the terminal ileum (n = 7) or colon (n = 1). Indications for surgery were medically intractable disease in three, steroid dependence in four and ileal perforation in one. RESULTS: Histological examination using routine haematoxylin-eosin stained sections revealed the presence of intestinal endometriosis of the ileum (n = 6), colon (n = 1) or ileum and rectum (n = 1) in addition to the typical features of Crohn's disease. In particular, chronic transmural inflammation was observed in locations other than the endometriotic deposits, which were confined to the serosa in three, the muscularis propria in two, both the serosa and the muscularis propria in one and the serosa, muscularis propria and submucosa in two. In none of these patients had the diagnosis of intestinal endometriosis been suspected pre-operatively based on clinical (gynaecological) or radiological tests. CONCLUSION: Intestinal endometriosis and Crohn's disease can occur simultaneously. The diagnosis is often only made after surgical resection of the diseased segment. In Crohn's disease, endometriosis of the terminal ileum seems more common.

Adolescent↗
PubMed1997

Biochemical tests in diseases of the intestinal tract: their contributions to diagnosis, management, and understanding the pathophysiology of specific disease states.

Biochemical testing plays a major role in the complete evaluation of patients with suspected or established intestinal disease. We have classified these tests according to the medium in which they are performed: breath tests, including isotopic and nonisotopic tests, fecal tests, urine tests, serum tests, tissue tests, and other tests. The principles of various tests are outlined, and the role of each test in the evaluation of particular gastrointestinal disorders is discussed.

Biochemistry↗
PubMedDate not supplied

Normal colonic wall thickness at CT and its relation to colonic distension.

PURPOSE: The purpose of this work was to analyze the relation between normal colonic wall thickness at CT and local colonic distension. METHOD: One hundred consecutively acquired patients were included in our study. All patients were asymptomatic regarding their intestine, and their history was always negative for intestinal disease. All CT examinations were performed for other reasons than intestinal disease. Colonic wall thickness at CT was measured digitally in every patient at four locations and set in relation to the local colonic distension. RESULTS: The normal colonic wall thickness ranged from 0 to 2 mm in colonic segments with a diameter of >/=4-6 cm, from 0.2 to 2.5 mm in colonic segments with a diameter of 3-4 cm, from 0.3 to 4 mm in colonic segments with a diameter of 2-3 cm, and from 0.5 to 5 mm in colonic segments with a diameter of 1-2 cm. Maximal colonic wall thickness ranged up to 6 and 8 mm in the proximal and distal colon, respectively, if the measured colonic segment showed a luminal width of <1 cm according to contraction. DISCUSSION: The normal colonic wall thickness at CT should be regarded as a dynamic value that stays in clear relation to the local colonic distension. In contracted colonic segments, a colonic wall thickness of 6-8 mm may still be normal. On the other hand, a colonic wall measuring 5 and 3 mm should be regarded as thickened if found in colonic segments with a luminal width of >2 and 4 cm, respectively.

Colon↗
PubMed1999

Environmental stress causes mast cell degranulation, endothelial and epithelial changes, and edema in the rat intestinal mucosa.

OBJECTIVE: Mental stress has been shown to produce intestinal disease, but the effects of a mild environmental stress on intestinal physiology have not been elucidated. This study was performed to determine the effects of environmental stress on the ultrastructure of the intestinal mucosa, using the rat as an experimental model. METHODS: One group of rats (group A, n = 3) was examined immediately upon arrival at the animal care facility. Groups B (n = 6) and C (n = 6) were housed in rooms with high and low personnel activity, respectively, for up to 4 wk. Group D (n = 8) was housed in the high activity room for 3 to 4 wk followed by 1, 2, or 3 in the low activity room. RESULTS: Rats in group B had the greatest number of degranulated intestinal mucosal mast cells, and activated goblet cells. Intestinal villi were edematous and epithelial cells were detaching from the basement membrane at villus tips. Changes were observed in capillary endothelial ultrastructure. In group B there were greater numbers of vesicles and multilamellar fenestral diaphragms compared to group C. Rats in groups A and C had the lowest numbers of degranulated mast cells and activated goblet cells. Intestinal villi showed normal ultrastructure. Group D was in a recovery phase and the condition of the intestinal mucosa was improved relative to group B, but the number of degranulated mast cells was not significantly reduced. CONCLUSIONS: This study demonstrates that environmentally induced stress causes pathological changes in the rat intestinal mucosa that compromise the epithelial-endothelial exchange barrier. These results emphasize the importance of closely monitoring the environment of experimental animals and provide evidence to stimulate further research into the mechanisms linking mental stress to gastrointestinal dysfunction in humans.

Animals↗
PubMed2004

[Extraintestinal manifestations of inflammatory bowel disease].

Extraintestinal manifestations of Crohn's disease and ulcerative colitis are found in > 50% of all patients. These extraintestinal manifestations sometimes impair the overall life quality much more than the bowel-related symptoms. Extraintestinal manifestations need to be distinguished from secondary diseases or complications of inflammatory bowel diseases, as they require a different and specific therapy. Complications of the intestinal disease, such as vitamin deficiency or osteoporosis, can be treated specifically by substitution of vitamin D, calcium, or other vitamins. However, extraintestinal manifestations of Crohn's disease and ulcerative colitis, such as primary sclerosing cholangitis, arthritis or granulomatous inflammation of the skin, lung, or liver, are much more difficult to treat sufficiently. Almost every organ can be a localization of extraintestinal symptoms of inflammatory bowel diseases. It is important to acquire knowledge on these extraintestinal manifestations of Crohn's disease and ulcerative colitis to start the respective treatment early. Perhaps even more important, these extraintestinal symptoms can be the primary manifestation of Crohn's disease and ulcerative colitis. Therefore, they have to be recognized as extraintestinal manifestations to adequately treat the intestinal disease.

Arthritis, Rheumatoid↗
PubMed2001

[Peripheral neuropathy associated with intestinal inflammatory disease].

The association of outlying peripheral neuropathy and inflammatory bowel disease is a rare fact leaving aside factors like the deficit of intestinal absorption of vitamins or the neurotoxicity of drugs employed for the treatment of the inflammatory bowel disease. We presented a series of four patients with this association, to whom a retrospective study was carried out. In all cases polineuropathy followed a course parallel to the inflammatory bowel disease, being acute and reversible in two cases. The polyneuropathy could be attributed to a deficit of vitamin B12 in one case and to metronidazole neurotoxicity in the other; in the remaining two cases the polineuropathy was chronic and no etiological factor could be found except for the own activity of the inflammatory bowel disease. We think that the neuropathy can represent a rare extraintestinal manifestation of the illness with a common autoimmune pathogenic mechanism. In one of our cases, the nerve biopsy demonstrated an axonal neuropathy with an alteration of the epineural vessels which showed a healed aspect.

Adult↗
PubMed1992

[Clinical importance of organ-specific antibodies in ulcerative colitis and Crohn disease].

In 479 patients with chronic inflammatory intestinal diseases and other abdominal diseases autoantibodies against intestinal goblet cells and exocrine pancreas were determined by indirect immunofluorescence. In ulcerative colitis 17% had serum antibodies against intestinal goblet cells, in Crohn's disease 26% against exocrine pancreas. Autoantibody prevalence and level of the titre were dependent on the inflammatory activity of both diseases but independent on the therapy. In Crohn's disease high level of titres of antibodies against exocrine pancreas we found in cases with multiple complications. Antibodies titres against intestinal goblet cells in ulcerative colitis and against exocrine pancreas in Crohn's disease exceeding 1:100 improved the diagnostic decision. Besides clinical states, endoscopic and histological findings a positive result of the antibody investigations had to be considered for final diagnosis.

Adult↗
PubMed2002

[Disorders of hemostasis in clinical picture and pathogenesis of inflammatory diseases of the colon (literature review)].

Hemostatic disorders are involved in the pathogenesis of inflammatory large intestine diseases. Both thrombocytes and humoral coagulation factors are involved in this process. An attempt to correct these disorders will allow not only to declare a new approach to the treatment of inflammatory large intestine diseases but also to clarify their role in the occurrence and persistence of an active inflammation during these diseases.

Blood Coagulation Disorders↗
PubMed2004

Neutrophilic phlebitis is characteristic of intestinal Behçet's disease and simple ulcer syndrome.

AIM: To characterize the histological features of intestinal Behcet's disease and simple ulcer syndrome and to clarify the possible mechanisms involved in their development by analysing the type of inflammatory infiltrates in the diseased intestine and the expression of adhesion molecules on endothelial cells. METHODS AND RESULTS: Tissue samples from 10 patients diagnosed as having intestinal Behcet's disease or simple ulcer syndrome were studied. Immunohistochemical studies were performed on paraffin-embedded tissue using a labelled streptavidin-biotin method. In all cases, phlebitis was remarkably seen in submucosal inflammatory lesions, but the adjacent arteries were not affected. Inflammatory infiltrates around the affected vessels consisted of neutrophils and mononuclear cells, and neutrophils predominated over CD68+ macrophages and lymphocytes. The majority of mononuclear cells were CD3+ T cells, and CD4+ cells were more frequent than CD8+ T cells. As for adhesion molecule expression, intercellular adhesion molecule-1, but not vascular cell adhesion molecule-1, was expressed in most endothelial cells of the vessels with phlebitis, some of which were also positive for HLA-DR. CONCLUSION: Neutrophilic phlebitis may be involved in the pathogenesis of intestinal Behcet's disease and simple ulcer syndrome.

Adult↗
PubMed2005

[Essential thrombocythemia associated with incomplete type intestinal Behçet disease during hydroxyurea treatment].

A 77-year-old man was diagnosed as having essential thrombocythemia in 1992. Treatment with hydroxyurea was started in 1997, which stabilized the platelet count. The patient then suffered from pharyngalgia and rhinitis with a high fever, immediately after which he developed tarry stools and anemia and was admitted to our hospital. The physical examination revealed splenomegaly, oral aphthous ulcers, genital ulcers and skin lesions on the lower limbs. His hematological and biochemical tests revealed anemia and increased level of C-reactive protein. He also had an HLA-B51 phenotype. The findings of gastro-intestinal and colon fiberoscopy showed a duodenal ulcer and multiple ulcers on ascending colon. He was thus diagnosed as having intestinal tract-type Behçet disease. After withdrawal of the hydroxyurea administration, the intestinal ulcers, oral aphthous ulcers and genital ulcers improved.

Aged↗
PubMedDate not supplied

[Chronic intestinal inflammatory diseases].

In the last years the research on the etiopathogenesis of the inflammatory bowel disease (IBD) is focused around immunological aspects. Many authors consider that the intestinal inflammation is due to an inappropriate immunological response to normally present antigens in the gut. Two aspects must to be considered between IBD: Crohn's disease and ulcerative colitis. IBD's diagnosis is based on the symptomatology, (cramps, liquid feces with mucus and blood, anorexia and weight loss), hemato-clinical tests (ESR, PCR, blood platelet, mucoprotein, sideremia) and radiological tests (tenuis Rx, abdominal echography, fibro endoscophy and scintigraphy). Principal aim of the therapy is the clinical remission. Following the remission starts a maintenance protocol. Parenteral nutrition is used in paediatric and adolescent age. Diets have been used to provide a convenient nutritious contribution with growth improvement and partial remission of activity index of the disease. Pharmacology therapy represents a valid instrument to obtain the remission. Colectomy is performed on unsuccessful medical therapy. Early studies on IBD's pathogenesis bring to the use of biological therapies that show beneficial effects on the disease.

Humans↗
PubMed1990

Radiological changes of the ileum in children with coeliac disease: is "intestinal adaptation" a specific radiographic sign?

We retrospectively reviewed the radiographic findings of 86 children with chronic diarrhoea and/or short stature. Radiographic small intestine examination showed morphologic changes characteristic for the malabsorption syndrome in 58 children with coeliac disease on a gluten-containing diet. In addition, 32 (55%) of these children showed "intestinal adaptation" or "jejunalization" (increase in the number and thickness of the folds). In the control group (28 children, cross-matched) 11 (39%) presented non specific radiological changes while the others presented a normal mucosal pattern. No features of "intestinal adaptation" were noted. No significant differences between CD patients with and without "intestinal adaptation" were found in the evaluation of the nutritional status, including serum levels of albumin, iron, transferrin, ferritin and zinc, and in the results of the one-hr xylose test and 72-hr faecal fat absorption test, and anti-gliadin antibody levels (IgA and IgG). No significant correlation was noted between the duration of gluten-containing diet and the presence of "intestinal adaptation". It appears that "intestinal adaptation" lends specificity to the radiographic small intestine examination, also in paediatric practice.

Adolescent↗