Management of inflammatory bowel disease

Ulcerative colitis and Crohn's disease result from an interaction between genetic and environmental factors. Only one gene, NOD2/CARD15, has been clearly identified; a minority of people with alteration of this gene develop Crohn's disease. The NOD2/CARD15 protein is thought to be involved in defence against intracellular bacteria. This supports the idea that Crohn's disease and ulcerative colitis result from altered immunological responses to the normal intestinal flora. Life expectancy is normal in ulcerative colitis and nearly so in Crohn's disease, but both conditions cause considerable morbidity. Approximately 80% of patients with Crohn's disease eventually require surgery, and about 25% of patients with ulcerative colitis require colectomy. Treatment of ulcerative colitis is generally by corticosteroids for acute disease and mesalazine for maintenance, but the range of therapies for Crohn's disease is expanding. Alternative therapies include immunosuppressives, enteral nutrition, antibiotics, anti-TNF antibody (infliximab), corticosteroids, and surgery. High dosages of corticosteroids may provide symptomatic relief in Crohn's disease but do not affect the long term natural history of the disease, and management strategies should avoid using steroids whenever possible.     

Crohn's disease of the appendix

Granulomatous inflammation typifying Crohn's disease was centred within or confined to appendices in six patients, two of whom developed lesions attributable to Crohn's disease elsewhere in the gut. The remaining four patients have remained symptom-free for periods varying from two to six years. Histological evidence of Crohn's disease was also present in five of 46 appendices available for re-examination in a survey of 63 cases of Crohn's enterocolitis. It is adduced that appendiceal involvement in Crohn's disease is not uncommon.     

Axillary artery occlusion as a presenting feature of Crohn's disease

A 20 year old Caucasian woman with Crohn's disease is described in whom axillary artery occlusion due to arteritis dominated the clinical picture. This case demonstrates that isolated large vessel arteritis can be an unusual feature of Crohn's disease. Crohn's disease should be considered in any patient presenting with a large vessel arteritis.     

Perforation in Crohn's disease of the small bowel

During a five-year period, three patients with general peritonitis, secondary to perforation of the small bowel in Crohn's disease, were successfully treated by resection and primary anastomosis. During this period, 30 patients presented with small bowel or ileocaecal Crohn's disease. The possibility of perforation should be considered when evaluating the need for surgery in patients with Crohn's disease with symptoms of obstruction.     

张苏闽治疗克罗恩病肛瘘临证经验

张苏闽秉承脾胃为后天之本、气血生化之源之理论,认为治疗克罗恩病肛瘘以调脾为重中之重。多角度联合明确诊断,内外结合、中西医治疗克罗恩病肛瘘。张教授将中医传统"挂线"疗法与克罗恩病特殊病理相结合,首创"丝挂逐剪"引流法,并对克罗恩病肛瘘手术挂线的材质、拆线时机均给予了详细的阐述。针对克罗恩病肛瘘,提倡应用外科局部微创疗法,在国内首先尝试应用自体脂肪干细胞移植治疗克罗恩病肛瘘,并取得良好临床疗效。重视病因病机,辨证选药,传统与现代疗法相结合,自成一套中西医结合诊疗克罗恩病肛瘘方法。     

Sweet's syndrome in association with Crohn's disease

A case of Sweet's syndrome in association with Crohn's disease in a young woman is reported. Sweet's syndrome is a rare extraintestinal manifestation of Crohn's disease and ulcerative colitis.     

Crohn病致肛瘘的治疗

目的探讨Crohn病致肛瘘的治疗方法。方法分析手术治疗的37例Crohn病致肛瘘患者的临床资料,随访术后复发及肛门自制功能障碍的发生情况。结果37例患者术后复发13例(35.1%),术后肛门失禁5例(13.5%)。11例存在直肠炎者7例复发(63.6%),显著高于非直肠炎者(23.1%)(P=0.028);存在直肠炎者肛门失禁发生率36.4%,亦显著高于非直肠炎者(3.8%)(P=0.021)。低位肛瘘患者术后肛门失禁发生率显著低于高位肛瘘患者(4.2%vs30.8%,P=0.042)。高位肛瘘病例中,挂线疗法患者术后肛门失禁发生率显著高于非切断括约肌术式患者(66.7%vs0.0%,P=0.021)。结论Crohn病致肛瘘患者治疗较为困难,应首先行规范的药物治疗争取非手术治愈,药物治疗无效者行手术治疗。术前须控制直肠炎。低位肛瘘宜行瘘管切开术,高位肛瘘应采用非切断括约肌的手术。     

Erythema nodosum progressing to pyoderma gangrenosum as a complication of Crohn's disease

Erythema nodosum occurs more frequently than pyoderma gangrenosum in Crohn's disease. We report the occurrence of both lesions in a woman with Crohn's disease and the transformation of one to the other. Pyoderma gangrenosum has been described at the site of previous trauma in Crohn's disease and at the site of other skin conditions in other circumstances, but, to the best of our knowledge, actual progression from erythema nodosum to pyoderma gangrenosum has been reported on only one previous occasion in Crohn's disease.     

克罗恩病急诊的临床分析(附23例报告)

目的：分析探讨克罗恩病（CD）急诊的临床特点，诊断和治疗；方法：调查了1988年－2002年30例CD患者，其中23例（76．6％）发生急诊，对本病临床情况，诊断和治疗方法及疗效进行了回顾，结果：本组CD急诊误诊率为10例（43％），手术治疗17例，内科治疗6例，22例患者症状改善，病情缓解，一例死于并发的恶性肿瘤；结论：CD临床特点是急诊发生率高，误诊与其临床表现多样，缺乏对CD认识有关；诊断需用结肠镜，X线，腹部B超，DSA，CT等检查综合评价，及时手术和积极内科治疗对本病的预后有重要的意义。     

克罗恩病临床生物学行为及其治疗方法研究

目的结合Montreal分型分析克罗恩病（Crohn’s disease,CD）患者生物学行为,并比较近14年来治疗策略的变迁。方法收集1997年1月-2011月1月我院确诊为CD患者的临床资料,结合Montreal标准对患者的一般资料、临床特点和生物学行为进行分析。并按照年限将患者分为两组（A组=1997年-2004年,B组=2004年-2011年）,比较两组药物治疗方法及手术情况。结果共有197位确诊患者入组,发病率以男性患者居多（61.4%）,平均年龄为32±7岁。诊断时病变部位多位于回结肠（41.6%）,生物学行为以非狭窄非穿透型为主（44.7%）。与A组比较,B组激素及免疫抑制使用有增多趋势（P〈0.05）,手术治疗比例降低（P〈0.05）。结论本研究中CD患者的病变部位多位于回结肠,以非狭窄非穿透型为主,近7年激素及免疫抑制剂使用有增多趋势,手术比例有降低趋势。     

Detection of inflammatory bowel disease in adults and children: evaluation of a new isotopic technique

The distribution of radioactivity after the oral administration of sucralfate labelled with technetium-99m was studied in 33 patients with Crohn's disease (13 adults, 20 children), 10 with ulcerative colitis (four adults), and 29 controls (23 with upper intestinal disease, four irritable bowel, one hypolactasia, and one malrotation of the gut). Positive scans were obtained in all patients with ulcerative colitis and 29 of 31 with active Crohn's disease. The scans of two patients with inactive Crohn's disease were negative. There were two false negative scans in patients with Crohn's colitis and one false positive scan. Overall, sensitivity was 95% and specificity 97%. Comparison with radiology in 39 patients showed similar distribution of disease in 24 and more extensive disease in 12. The scan was inexpensive, simple to perform, well tolerated, allowed small and large bowel to be visualised simultaneously, and used a lower dose of radiation than barium studies. It may prove useful as a screening test for inflammatory bowel disease and in the serial assessment of disease activity.     

英夫利昔治疗瘘管性克罗恩病二例

目的探讨瘘管性克罗恩病的治疗方法。方法对二例瘘管性克罗恩病患者的诊治经过进行回顾分析并复习文献。结果二例患者经英夫利昔诱导缓解治疗后,瘘管完全愈合。结论对于瘘管性克罗恩病患者,英夫利昔具有诱导和维持缓解的良好疗效及使用的安全性。     

Crohn's disease--is there a long latent period?

Four cases of Crohn's disease developing in adult females, who had been in close contact during their teens, are described. It is suggested that this could indicate an infective causation for Crohn's disease with a long latency.     

Colonic Crohn's disease and use of oral contraception

The prevalence of use of oral contraception before the onset of disease was established in 100 consecutive women attending follow up clinics for inflammatory bowel disease. A significant excess of women with Crohn's disease confined to the colon had taken oral contraceptives in the year before developing symptoms (10/16 (63%] compared with women with small-intestinal Crohn's disease (12/49 (24%); p less than 0.02) and women with ulcerative colitis (3/35 (9%); p less than 0.0005). When the patient groups were matched for age and year of onset of disease usage of oral contraception before the onset of disease was still more common among women with isolated colonic Crohn's disease (9/12, 75%) than among those with ulcerative colitis (2/12 (17%); p less than 0.02) and was also more common than would be expected from reported figures for oral contraception in England and Wales (31.4% of women aged under 41; p less than 0.005). A survey of current patient records showed that isolated colonic disease was at least twice as common among women with Crohn's disease (63/218, 29%) compared with men (25/181, 14%; p less than 0.001). These data support the suggestion made previously that oral contraceptives may predispose to a colitis that resembles colonic Crohn's disease.     

Arterial thrombosis in Crohn's disease

Four cases of arterial thrombosis in persons with Crohn's disease without other known, predisposing causes for vascular disease are described. Various types of vascular disease that are associated with inflammatory bowel disease are discussed and the risk factors for thrombotic complications in patients with active Crohn's disease are assessed.     

Crohn's disease in monozygotic twins

A pair of monozygotic twins with Crohn's disease is described. Both have ileocaecal disease and suffered their first symptoms after living apart for 6 years. The pathogenic role of hereditary and environmental factors is discussed in the light of this and previous reports of twins with Crohn's disease.     

Relative incidence of Crohn's disease and ulcerative colitis in six Melbourne hospitals

Information on the relative incidence of Crohn's disease and ulcerative colitis was obtained by a prospective investigation at six Melbourne teaching hospitals. One hundred and eleven patients who presented with chronic inflammatory bowel diseases between 1980-1981 were admitted to the study. Forty (36%) patients were diagnosed as having Crohn's disease and 63 (57%) patients as having ulcerative colitis. The type of chronic inflammatory bowel disease could not be determined in eight (7%) patients. These findings suggest that the relative frequency of Crohn's disease and ulcerative colitis in Melbourne hospitals is within the range that is reported for northern Europe and the United States.     

Coexistent ulcerative colitis and Crohn's disease

This case report describes a patient with chronic ulcerative colitis and epithelial dysplasia of 17 y duration ultimately complicated by colonic carcinoma. At laparotomy, clinically unsuspected but typical Crohn's disease of the terminal ileum was also found. The macroscopic and histological features of the resected terminal ileum were characteristic of Crohn's disease.     

Rectal biopsy in patients with Crohn's disease. Normal mucosa on sigmoidoscopic examination

Of 99 patients with Crohn's disease whose rectal segment appeared normal on sigmoidoscopy, there was histologic inflammation in 45% and features characteristic of Crohn's disease in 30% of rectal biopsy specimens. Granulomas were found in 18% of patients, including 13% of those with ileitis, 13% of those with ileocolitis, and 37% of those with colitis. Eleven of the 17 granulomas were small undermarcated microgranulomas. Rectal biopsy specimens are of value to confirm the diagnosis in Crohn's disease and to determine the state of clinical activity even when the sigmoidoscopic appearance is normal.