Coexisting Crohn's disease and ulcerative colitis

This case report describes a patient initially presenting with Crohn's disease of the ileum who subsequently developed ulcerative proctocolitis. Reports of patients with both inflammatory bowel disease confirmed by histopathologic examination are rare.     

溃疡性结肠炎及克罗恩病的内镜活检病理特点分析

目的 总结溃疡性结肠炎（UC）及克罗恩病（CD）的病理形态学特点,为其诊断提供借鉴.方法 收集临床首次诊断并经病理科证实的UC患者180例、CD患者106例,资料包括年龄、性别及病变累及肠道的部位,并选用病理组织学标准对病变的黏膜结构改变、黏膜慢性炎症细胞浸润、黏膜急性炎症改变、黏膜上皮改变进行评价,比较两类患者间的差异.结果 和CD病例比较,UC病例出现黏膜结构紊乱的比例较高（P＜0.05）,出现局灶间断性炎症的比例较低（P＜0.05）,隐窝炎、隐窝脓肿及固有膜内中性粒细胞浸润发生率较高（P＜0.05）,表面上皮变扁或糜烂、黏液细胞减少的发生率较高.肉芽肿样小结、假幽门腺化生及裂隙状溃疡改变仅出现在CD病例.180例UC病例中90%（162例）病例病变部位局限于结肠.106例CD病例中28%（30例）病变部位局限于回盲部,56%（59例）病变累及到2个及以上不同部位.结论 肠镜活检病理诊断UC及CD是一个综合分析的过程.若病变局限于回盲部或胃肠道多部位累及,黏膜出现肉芽肿样小结、局灶间断性炎细胞浸润、假幽门腺化生等改变则倾向于CD诊断;若病变局限于结肠,黏膜出现弥漫一致性炎或明显的黏膜结构改变、黏膜上皮改变则倾向于UC诊断.     

Endotoxin-induced microclots in ulcerative colitis and Crohn's disease

Radially oriented fibrin microclots were observed when blood from patients with active lesions of Crohn's disease and ulcerative colitis was kept in capillary tubes for 24 h. Addition of bacterial extract or endotoxins increased the fibrin formation. The phenomenon is not seen in healthy subjects or patients who have healed after colectomy. The data are consistent with our findings in patients with vasculitis and support the view that patients with Crohn's disease and ulcerative colitis have circulatory endotoxins.     

Esophageal lesions in Crohn's disease and ulcerative colitis

This article reviews the literature about esophageal involvement of Crohn's disease and ulcerative colitis. The review highlights the incidence of IBD, clinical features and difficulties of diagnosis and treatment of patients with esophageal involvement of IBD.     

Pericarditis associated with ulcerative colitis and Crohn's disease

Extracolonic manifestations of inflammatory bowel disease are common and diverse. However, cardiac complications are unusual and we therefore wish to report two cases in which pericarditis occurred. The first was a patient with Crohn's disease of the colon, in whom the pericarditis developed postoperatively. In the second case an acute pericarditis came on simultaneously with the initial presentation of ulcerative colitis.     

Clq metabolism in ulcerative colitis and Crohn's disease

The metabolism of pure radioiodine labelled Clq has been observed in five patients with ulcerative colitis, five patients with Crohn's disease, and in five control subjects. Both the fractional catabolic rate and the synthesis rate of Clq were increased in the five patients with Crohn's disease and in four of the five patients with ulcerative colitis. The fifth patient was in remission and had a normal synthesis rate. These results support the hypothesis that complement activation plays a role in the pathogenesis of these disease states and that the increased complement activation is primarily via the classical pathway.     

Macrophage turnover in Crohn's disease and ulcerative colitis

Monocytopoietic proliferation activity was determined in 8 patients during severe attacks of Crohn's disease and in 6 patients with ulcerative colitis. Similar results were obtained in both groups of patients. A moderate but significant hyperproliferation of monocytopoiesis was found to be present in about half of the patients, and with some of the remainder of cases, part of the criteria for hyperproliferation were also fulfilled. This indicates that Crohn's disease as well as ulcerative colitis are frequently associated with moderate overproduction of monocytes which may be assumed to be induced by macrophage demand of the affected tissues. In comparison with other diseases involving inflammations, the monocytopoietic hyperproliferation was moderate. Therefore, the inflammation in Crohn's disease and ulcerative colitis seems to be characterized by a relatively low macrophage turnover induced by pathogenetic mechanisms of moderate macrophage toxicity.     

Sabin-Feldman dye test in ulcerative colitis and Crohn's disease

The prevalence of Toxoplasma infection among patients with inflammatory bowel disease was studied. The Sabin-Feldman dye test was performed on 35 patients with Crohn's disease, 44 patients with ulcerative colitis, and 140 control patients. A higher incidence of positive reactions was found in Crohn's disease patients over the age of 40 (P<0.05). All other factors showed no significant differences among the three groups of patients. These factors include age younger than 40 years, sex, duration of disease, extent of disease, and type of treatment. It is concluded that there is no correlation between inflammatory bowel diseases and toxoplasmosis. Toxoplasma infection, however, should be considered in patients with Crohn's disease who are over 40 years old, and who present with nonspecific signs of intercurrent infection.     

Serum lysozyme in Crohn's disease and ulcerative colitis.

Serum lysozyme (muramidase) was determined in 72 patients with Crohn's disease or ulcerative colitis. Serum lysozyme was elevated in both disease groups. The mean enzyme level was significantly higher in Crohn's disease than in ulcerative colitis, but there was a considerable overlapping between the groups, which makes serum lysozyme determination of dubious value in the differential diagnosis between Crohn's disease and ulcerative colitis. No correlation was found between the serum lysozyme concentration and the activity of the diseases.     

Human leucocyte antigens in Crohn's disease and ulcerative colitis

The frequency of occurrence of 15 of the commoner human leucocyte antigens was determined in 18 patients with Crohn's disease and in 16 patients with ulcerative colitis, using an in-vitro lymphocyte cytotoxicity test (Harris, Wentzel, Cocking, Dodsworth, and Ukaejiofo, 1970). The overall results showed that, with the exception of human leucocyte antigen 3 in patients with Crohn's disease, in neither disease was there any major difference in any of the other antigen frequencies compared with a panel of 50 healthy controls. Nor was there an excess frequency of any particular antigen occurring in both Crohn's disease and colitis.     

Mechanisms of disease: pathogenesis of Crohn's disease and ulcerative colitis

Crohn's disease and ulcerative colitis are idiopathic, chronic, relapsing, inflammatory conditions that are immunologically mediated. Although their exact etiologies remain uncertain, results from research in animal models, human genetics, basic science and clinical trials have provided important new insights into the pathogenesis of chronic, immune-mediated, intestinal inflammation. These studies indicate that Crohn's disease and ulcerative colitis are heterogeneous diseases characterized by various genetic abnormalities that lead to overly aggressive T-cell responses to a subset of commensal enteric bacteria. The onset and reactivation of disease are triggered by environmental factors that transiently break the mucosal barrier, stimulate immune responses or alter the balance between beneficial and pathogenic enteric bacteria. Different genetic abnormalities can lead to similar disease phenotypes; these genetic changes can be broadly characterized as causing defects in mucosal barrier function, immunoregulation or bacterial clearance. These new insights will help develop better diagnostic approaches that identify clinically important subsets of patients for whom the natural history of disease and response to treatment are predictable.     

Cutaneous delayed hypersensitivity in Crohn's disease and ulcerative colitis

In this study the Multi-Test was applied in 48 patients with inflammatory bowel disease and in 25 normal controls. A significant difference between normal controls and patients with Crohn's disease but not between normal controls and patients with ulcerative colitis was found with regard to anergic status, frequency of positive skin reactions, and size of skin infiltration. The authors conclude that in patients with Crohn's disease a defect exists in the cellular immunity.