[Chronic inflammatory bowel diseases: Crohn disease and ulcerative colitis. 1: Etiology and pathogenesis, diagnosis. Diagnostic imaging in Crohn disease].
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Colitis, Ulcerative↗
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[Interdisciplinary guidelines: inflammatory bowel diseases (Crohn disease, ulcerative colitis)].
Crohn's disease and ulcerative colitis are characterized by common problems and findings but also disease-specific differences. The most frequent indication for surgery concerns the refractory situation occurring both after and during systematic conservative treatment. The aim of surgery in patients with Crohn's disease is to induce remission of symptoms by removing the segment of diseased bowel. Because of the relatively high rate of postoperative recurrence, extensive resections should be avoided. Proctocolectomy with ileal pouch--anal anastomosis has become the surgical treatment of choice for most patients with uncontrolled ulcerative colitis. This technique offers these patients cure of the disease and in most cases a better quality of life.
Colitis, Ulcerative↗
[Inflammatory bowel diseases (Crohn disease and ulcerative colitis). Possibilities and limitations of surgical therapy].
Ulcerative colitis can be cured by surgical therapy. Indications for surgery are severe disease not controlled by medical therapy, complication of colitis and prophylaxis of malignancy. Operation of choice is proctocolectomy and ileoanal anastomosis with pelvic ileal pouch, preserving continence. Alternatives are colectomy and ileo-recto-anastomosis if the rectum is free of disease and proctocolectomy with ileostomy if the rectum is involved. Crohn's disease cannot be cured by surgery. Indications for surgery are obstructing or perforating complications of enterocolitis. Basis of surgical therapy is resection, which should be restricted to the severely diseased bowel segment. Structureplasty can correct short bowel stenosis without resection. Surgery for anal Crohn's disease should be limited to drainage of septic complications. Postoperative results support a tendency towards early surgery in ulcerative colitis, while surgery in Crohn's disease should be reserved for severe and complicated disease.
Anastomosis, Surgical↗
[Pre-conception counseling and pregnancy in chronic inflammatory bowel diseases--Crohn disease and ulcerative colitis].
Since chronic inflammatory diseases start to develop during the fertile years, the possibility of a mutual influence of pregnancy and bowel disease obviously must be considered. The knowledge about the interference between disease and pregnancy influences the management of pregnancy and delivery as well as of the disease itself. Intensive care, including genetic counseling, dietary management, and drug therapy ought to start even before pregnancy. In the care of the pregnant patient with Crohn's disease or ulcerative colitis corticosteroids and sulphasalazine may be used just as in the nonpregnant patient. An increased activity of the disease in the beginning of pregnancy causes high rates of prematurity, spontaneous abortions, and stillbirths. Frequency of defects in embryonic development varies between 0 and 4% and is even higher in severe cases of Crohn's disease. Prophylactic drug administration in pregnancy is not suitable to decrease the risk of exacerbation. Several studies revealed that the risk of exacerbation is not increased during pregnancy. Low activity in the onset of pregnancy is continued in 61%. Higher rates of abdominal and vaginal operative deliveries (26% in Crohn's disease) seems to be associated with active intervention on the base of activity indices.
Colitis, Ulcerative↗
[Interdisciplinary guidelines: inflammatory bowel diseases--Crohn disease, ulcerative colitis].
Guidelines for medical, nutritional, and surgical treatment of Crohn's disease have been drawn up recently by gastroenterologists and abdominal surgeons from the "Deutsche Gesellschaft für Verdauungs- und Stoffwechselkrankheiten". These data have not yet been published, but are presented here. Medical treatment of ulcerative colitis during acute attacks and remission depends widely on the extent and activity of the disease. Recently published guidelines for surveillance of patients with long-lasting ulcerative colitis to prevent colorectal cancer by American gastroenterologists and surgeons are discussed.
Colitis, Ulcerative↗
[Home enteral nutrition in gastrointestinal diseases (Crohn disease)].
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Crohn Disease↗
[Does sugar play a role in the development of gastroenterologic diseases (Crohn disease, gallstones, cancer)?].
The consumption of cane- and beet-sugars per person has today reached a level of 100 g per day. In a discussion of the role of sugar in gastrointestinal diseases there must be a differentiation between a direct effect directly related to high sugar-consumption, and an indirect effect where sugar displaces other nutritive substances in the diet. Not only epidemiological, but also experimental data support that sugar has no direct, toxicological, carcinogenic or disease-inducing disposition for gastroenterological diseases. Investigating several diseases (e.g. M. Crohn) a final determination could not be made, but there is strong indication that an overconsumption of easily reabsorbable carbohydrates is not responsible for the development of diseases. An indirect, shared responsibility of high sugar consumption and reduced consumption of dietary fiber seems to be likely. Further investigations, for example by dietary tests with constant sugar content at variable consumptions of non-participating substances is necessary before a final judgment can be made. There are no useful data in humans at present, of whether food additives, such as hydrocolloids in confections play a casual role.
Cholelithiasis↗
[Immunologic findings in patients with chronic inflammatory bowel diseases. Crohn disease and ulcerative colitis].
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Colitis, Ulcerative↗
[Molecular biological study of physiopathology of inflammatory bowel diseases (Crohn disease and ulcerative colitis)].
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Animals↗
Functional variants of OCTN cation transporter genes are associated with Crohn disease.
Crohn disease is a chronic, inflammatory disease of the gastrointestinal tract. A locus of approximately 250 kb at 5q31 (IBD5) was previously associated with susceptibility to Crohn disease, as indicated by increased prevalence of a risk haplotype of 11 single-nucleotide polymorphisms among individuals with Crohn disease, but the pathogenic lesion in the region has not yet been identified. We report here that two variants in the organic cation transporter cluster at 5q31 (a missense substitution in SLC22A4 and a G-->C transversion in the SLC22A5 promoter) form a haplotype associated with susceptibility to Crohn disease. These variants alter transcription and transporter functions of the organic cation transporters and interact with variants in another gene associated with Crohn disease, CARD15, to increase risk of Crohn disease. These results suggest that SLC22A4, SLC22A5 and CARD15 act in a common pathogenic pathway to cause Crohn disease.
Amino Acid Sequence↗
Omega-3 fatty acids as adjunctive therapy in Crohns disease.
Crohns disease is an inflammatory bowel disease that can have a significant impact on the health of those afflicted. The etiology of the disease is unknown, but genetic, environmental, dietary, and immunological factors are thought to be involved. Multiple nutrients can become depleted during active disease due to inadequate intake or malabsorption. Preventing these deficiencies is paramount in the care of those suffering from Crohns disease. Often the traditional treatments (medications) have limited effectiveness and negative side effects that inhibit their use. Enteral nutrition has promising therapeutic benefits, but its use is often limited to the pediatric population due to poor patient acceptability. Omega-3 fatty acids have been investigated for their anti-inflammatory properties as an alternative to traditional care. This article reviews the etiology of Crohns disease, nutritional deficiencies, traditional treatments, and the use of omega-3 fatty acids in the prevention of Crohns recurrence. The results from clinical trials have been conflicting, but a new fish oil preparation that limits the side effects of traditional fish oil therapy shows promise as an adjunctive treatment for Crohns disease. Continued research is needed to validate these findings.
Causality↗
CD28+ intraepithelial lymphocytes with long telomeres are recruited within the inflamed ileal mucosa in Crohn disease.
Crohn disease is a chronic inflammatory bowel disease that involves all the intestine but predominantly alters the ileum. The disease largely depends on T cells, but the biologic role of intestinal intraepithelial lymphocytes (IEL) in transmural inflammation remains poorly characterized. To address this issue, a comparison of IEL and lamina propria lymphocytes (LPL) isolated from the uninvolved and the inflamed ileal mucosa of Crohn disease patients was performed. More CD8+ IEL (26% versus 8%) from the inflamed ileal mucosa expressed the CD28 receptor and the CD11a integrin than IEL from the uninvolved ileal mucosa, which were mostly CD28-. IEL had longer telomeres in the inflamed than in the uninvolved areas and a TCR Vbeta repertoire more similar to circulating T cells, suggesting that the increased proportion of CD28+ TCRalphabeta+ IEL within the inflamed mucosa is more likely due to recruited lymphocytes from the periphery that populate the epithelial layer than to the acquisition of the CD28 molecule by activated resident lymphocytes. In the uninvolved ileal mucosa, IEL from Crohn disease patients had shorter telomeric lengths than IEL from control patients, suggesting that they have been chronically stimulated. Such perturbation of the IEL population within the ileal mucosa could contribute to the inflammation in Crohn disease.
Adult↗
Focal inflammatory infiltrations in gastric biopsy specimens are suggestive of Crohn's disease. Crohn's Disease Study Group, Germany.
BACKGROUND: Crohn's disease is a systemic inflammatory disease that may involve all regions of the gut. METHODS: Thirty-six patients with Crohn's disease and 36 age- and sex-matched control patients were prospectively evaluated by upper endoscopy. Biopsy specimens were taken from the oesophagus, duodenum, and 10 locations in the antrum and corpus. RESULTS: Granulomas were found in four patients (11.13%) with Crohn's disease but in none of the control patients (P > 0.5). In 23 of 36 patients (63.9%) with Crohn's disease focal inflammatory infiltrations were found, as compared with 7 of 36 (19.4%) of the controls (P < 0.001). For focal inflammatory infiltrations, an odds ratio of 7.33 (2.55-21.38) was calculated, which increased to 20.04 (4.07-98.45) when only specimens from the angulus were considered. Helicobacter pylori infection was present in 13 of 36 controls (36.1%) and in 3 of 36 patients (8.3%) with Crohn's disease (P = 0.009). CONCLUSION: These data suggest that Crohn's disease is typically associated with focal inflammatory infiltrations of the gastric mucosa.
Adult↗
On the etiology of Crohn disease.
Crohn disease (CD) is a chronic, panenteric intestinal inflammatory disease. Its etiology is unknown. Analogous to the tuberculoid and lepromatous forms of leprosy, CD may have two clinical manifestations. One is aggressive and fistulizing (perforating), and the other is contained, indolent, and obstructive (nonperforating) [Gi]-berts, E. C. A. M., Greenstein, A. J., Katsel, P., Harpaz, N. & Greenstein, R. J. (1994) Proc. Natl. Acad. Sci. USA 91, 12721-127241. The etiology, if infections, may be due to Mycobacterium paratuberculosis. We employed reverse transcription PCR using M. paratuberculosis subspecies-specific primers (IS 900) on total RNA from 12 ileal mucosal specimens (CD, n = 8; controls, n = 4, 2 with ulcerative colitis and 2 with colonic cancer). As a negative control, we used Myobacterium avium DNA, originally cultured from the drinking water of a major city in the United States. cDNA sequence analysis shows that all eight cases of Crohn's disease and both samples from the patients with ulcerative colitis contained M. paratuberculosis RNA. Additionally, the M. avium control has the DNA sequence of M. paratuberculosis. We demonstrate the DNA sequence of M. paratuberculosis from mucosal specimens from humans with CD. The potable water supply may be a reservoir of infection. Although M. paratuberculosis signal in CD has been previously reported, a cause and effect relationship has not been established. In part, this is due to conflicting data from studies with empirical antimycobacterial therapy. We conclude that clinical trials with anti-M. paratuberculosis therapy are indicated in patients with CD who have been stratified into the aggressive (perforating) and contained (nonperforating) forms.
Autoradiography↗
Multiple doses of intravenous interleukin 10 in steroid-refractory Crohn's disease. Crohn's Disease Study Group.
BACKGROUND & AIMS: Interleukin 10 (IL-10) is a cytokine with immunosuppressive and anti-inflammatory activities. Gene-targeted IL-10-deficient mice develop a chronic intestinal inflammatory disease that is reminiscent of Crohn's disease. The present double-blind randomized multicenter trial was designed to evaluate the safety, tolerance, and pharmacokinetics of IL-10 in Crohn's disease. METHODS: Forty-six patients with active steroid-resistant Crohn's disease were treated with one of five doses of recombinant human IL-10 (0.5, 1, 5, 10, or 25 micrograms/kg) or placebo administered once daily by intravenous bolus injection over 7 consecutive days. RESULTS: Treatment was safe and well tolerated, and no evidence for IL-10 accumulation was observed at the end of the treatment period. At the end of the study, Crohn's disease activity scores were 179 in IL-10-treated patients and 226 in patients receiving placebo. The proportion of patients that experienced a complete remission at any time in the 3-week follow-up period was 50% in the IL-10 group and 23% in placebo-treated patients. CONCLUSIONS: These results indicate that IL-10 administered as a daily bolus injection over 1 week is safe and well tolerated and may be clinically efficacious.
Adult↗
Early presentation of carcinoma of the small bowel in Crohn's disease ("Crohn's carcinoma"). Case reports and review of the literature.
We report here 3 cases of adenocarcinoma of the small bowel complicating Crohn's disease ("Crohn's carcinoma"). In 2 cases, the adenocarcinoma was discovered in the first attack of enteritis. In only one other case in the literature, a similar presentation was described. A review of 59 reported cases of adenocarcinoma of small bowel in Crohn's disease, together with these 3 cases reveals that: (a) the cancer develops at a younger age than in carcinoma de novo; (b) there is no difference in incidence of carcinoma in the first, second, and third decades after the onset of symptoms of Crohn's disease; (c) in 73% of cases, the neoplasm rose in the ileum; (d) in all but 1 case it developed in inflamed segments of bowel; (e) in 31% of cases the cancer developed in a bypassed segment of bowel. This analysis clearly demonstrates that "Crohn's carcinoma" is a complication in Crohn's disease and not a chance coexistence of two diseases in the same patient.
Adenocarcinoma↗
[Isolated jejunal Crohn disease].
Crohn Disease (CD) is a chronic granulomatous inflammatory disorder of not well known etiology. It may affect the whole digestive tract, segmentally, from the mouth to the anus although the rectum is usually not involved. Digestive symptoms of CD depend on the location and extension of the disease, its fistulating or stenosing evolution as well as the presence of local or systemic complications. 40% of the patients affected with CD have simultaneous terminal ileal and colonic involvement, 30% have terminal ileitis and 25% have granulomatous colitis. Isolated esophageal, gastroduodenal and perianal affection reach no more than 5% of the patients. We describe a case of a patient affected with CD with isolated jejunal involvement who was admitted to the hospital because of iron deficiency anemia and bowel subocclusion as an atypical clinical manifestation of the disease. After surgical resection of the affected segment of the bowel, the patient became asymptomatic up to now.
Anemia, Hypochromic↗
Association analysis of SLC22A4, SLC22A5 and DLG5 in Japanese patients with Crohn disease.
Crohn disease (CD) is an inflammatory bowel disease characterized by chronic transmural, segmental, and typically granulomatous inflammation of the gut. Recently, two novel candidate gene loci associated with CD, SLC22A4 and SLC22A5 on chromosome 5 known as IBD5 and DLG5 on chromosome 10, were identified through association analysis of Caucasian CD patients. We validated these candidate genes in Japanese patients with CD and found a weak but possible association with both SLC22A4 (P=0.028) and DLG5 (P=0.023). However, the reported genetic variants that were indicated to be causative in the Caucasian population were completely absent in or were not associated with Japanese CD patients. These findings imply significant differences in genetic background with CD susceptibility among different ethnic groups and further indicate some difficulty of population-based studies.
Case-Control Studies↗