Free perforation of the small bowel in Crohn's disease.

A rare case of free double ileal perforation in previously asymptomatic and undiagnosed Crohn''s disease of the terminal ileum is described. At operation, a primary resection and anastomosis of the diseased bowel was performed. The management of free perforation in Crohn''s disease is discussed, together with a review of the literature. It is suggested that the absence of steroids in a previously undiagnosed case may favour primary resection and anastomosis.     

Occult small bowel adenocarcinoma complicating Crohn's disease: a report of three cases.

Three patients with Crohn''s disease are described who were treated by ileal resection for intestinal obstruction. Histological examination of the resected specimen in each case established the diagnosis of adenocarcinoma of the small intestine complicating Crohn''s disease. This diagnosis should be considered in patients with longstanding macroscopic Crohn''s disease who present with severe or recurrent symptoms. The diagnosis may not be apparent on routine radiological examination or even macroscopically at laparotomy.     

Isolated gastroduodenal Crohn's disease in a ten-year-old girl.

The first case of a child with gastroduodenal Crohn''s disease and no other intestinal lesions is described. She presented with persistent anaemia and failure to thrive. There was megaloblastosis due to B12 deficiency secondary to absent intrinsic factor. The diagnosis was delayed for nearly 3 years andthen treatment with steroids and azathioprine resulted in rapid clinical improvement. The diagnostic possibility of Crohn''s disease in unusual sites should be considered in any child with unexplained failure to thrive.     

Unusual extra-intestinal manifestations in inflammatory bowel disease (IBD)

The extra-intestinal complications of inflammatory bowel disease (IBD) usually appear in patients with long standing active intestinal disease. A patient with Crohn''s colitis is described, in whom extra-intestinal symptoms, some of which were unusual, preceded the definitive diagnosis by 9 years.     

Primary antibody deficiency and Crohn's disease

Five patients with primary antibody deficiency were investigated because of intermittent but persistent diarrhoea of several years duration despite immunoglobulin replacement therapy. We found no evidence of Giardia lambia or other intestinal pathogens to explain their gastrointestinal symptoms. All five had definite radiological evidence of small bowel Crohn''s disease and three had histological specimens available with abnormalities consistent with Crohn''s disease. One patient had a non-caseating granuloma in an oral ulcer. A second patient with stricturing disease in the small bowel had a mucosal inflammatory infiltrate with non-caseating granulomas. A third had transmural inflammation but no granulomas. All five patents were diagnosed as having Crohn''s disease and have responded symptomatically to steroid therapy.


     

多层螺旋CT小肠造影对克罗恩病的诊断价值

目的探讨多层螺旋CT小肠造影(multi-slice CT enterography,MSCTE)对肠管克罗恩病(Crohn’s diease,CD)的诊断价值。方法对48例临床疑似CD患者进行MSCTE检查,对照肠镜、病理结果,计算其诊断敏感性、特异性,并分析CD的影像学表现,包括发生部位、肠壁增厚程度、强化程度及增强特点、肠腔狭窄程度、并发症及周围脏器受累情况。结果 MSCTE诊断CD的敏感性为89.2%,特异性为36.4%。CD最常见发生部分为末端回肠(81.1%)。影像学表现为:肠壁环形增厚(89.2%),黏膜明显强化(97.3%),黏膜面毛糙,肠壁分层状强化(88.9%),肠腔节段性中-重度狭窄(86.7%)。并发症包括肠梗阻、肠系膜淋巴结增生、梳征(肠系膜血管增粗)、肠瘘。结论 MSCTE是CD的重要影像学检查方法,在CD的诊断、活动性判断及肠外并发症的显示中具有重要意义,结合肠镜、病理结果,有助于提高诊断准确性。     

Scurvy and vitamin C deficiency in Crohn's disease.

A case of scurvy presenting in a patient with Crohn''s disease is reported. A normal response to replacement therapy is seen. Vitamin C (ascorbic acid) deficiency was found in 7 out of 10 patients with clinically quiescent Crohn''s disease, 4 of whom had an adequate oral intake of vitamin C. There was no significant difference in oral intake between patients with Crohn''s disease and matched controls but there was a significant difference (P less than 0.001) in leucocyte ascorbic acid levels. It is recommended that patients with Crohn''s disease be screened for vitamin C deficiency and receive prophylactic vitamin C supplements daily.     

MDCTE评分评价克罗恩病活度的临床应用

收集临床确诊并行CT小肠检查的活动期克罗恩病患者50例.回顾性分析患者的CT表现,将患者的CT所见赋予一定的分值并进行综合评分,根据活动度指数将患者分为轻度活动期、中度活动期和明显活动期,比较CT评分与患者的活动度指数之间的相关性,结果显示CT评分与患者活动度明显相关(r=0.825,P＜0.001).表明多排CT小肠成像评分可以用于临床评估克罗恩病患者的活动度..     

Consumption of refined carbohydrate by patients with Crohn's disease in Tel-Aviv-Yafo.

In 27 patients with Crohn''s disease living in Israel the current intake of refined carbohydrate (total sugars) and added sugar is significantly greater than in healthy controls. The dietary survey was retrospective and showed that patients with Crohn''s disease ate 269 g of monosaccharides and disaccharides each day compared with 192 g by matched controls. Similar differences were also found at the onset of the symptoms, 314 g compared with 207 g. These findings were independent of the country of origin or cultural grouping. Several factors are discussed which suggest a secondary rather than causal relationship between sugar consumption and Crohn''s disease.     

探讨国内抗酿酒酵母抗体（ASCA）鉴别诊断克罗恩病的截断点（cutoff值）的相关研究

目的检测抗酿酒酵母抗体IgG、IgA在克罗恩病患者中的表达水平,探讨其鉴别诊断克罗恩病的cutoff值。方法纳入2018年10月～2019年4月期间诊断为克罗恩病的患者109例,溃疡性结肠炎30例,内镜检查无异常者25例。间接酶联免疫检测法测定患者血清中抗酿酒酵母抗体IgG、IgA表达水平,计算其cutoff值、灵敏度、特异度等指标。结果抗酿酒酵母抗体的阳性率为47.71%,抗酿酒酵母抗体IgG的cutoff值为10.5,灵敏度为71.56%,特异度为61.82%;抗酿酒酵母抗体IgA的cutoff值为0.415,灵敏度为66.06%,特异度为78.18%;两者任一阳性的灵敏度为85.32%,两者均阳性的特异度为80.00%。结论抗酿酒酵母抗体IgG、IgA在中国人群克罗恩病患者中的表达水平不高,需制定相应的cutoff值,两者联合检测可提高克罗恩病患者检出率。     

Guillain-Barr�� syndrome as an extraintestinal manifestation of Crohn's disease.

A variety of extraintestinal manifestations, probably immune-mediated, may appear during relapses of Crohn''s disease. We report the clinical observation of a 34-year-old woman who developed a Guillain-Barré syndrome, aphthous stomatitis and oligoarthritis during a relapse of Crohn''s ileocolitis. This case suggests that the Guillain-Barré syndrome may be another extraintestinal manifestation of Crohn''s disease.     

The Kveim test in Crohn's disease

Kveim tests were done in forty-eight patients with Crohn''s disease. Of forty-five with definite or probable Crohn''s disease, twenty-three had a positive Kveim test. This finding could be explained:     

Crohn's disease in Bangladeshis and Europeans in Britain: an epidemiological comparison in Tower Hamlets.

The incidence of Crohn''s disease in a defined Bangladeshi community was assessed in a retrospective, epidemiological study in the London Borough of Tower Hamlets from 1972 to 1989. The borough population of 164,000 includes over 28,000 Bangladeshis. Potential cases were identified from hospital pathology and medical records. There were 99 cases of Crohn''s disease during the study period, of which five were Bangladeshi. The mean standardized incidence in Bangladeshis was 1.2/10(5)/year in the 1970s and 2.3/10(5)/year in the 1980s compared with 3.8/10(5)/year and 4.1/10(5)/year in Europeans, and 4.6/10(5)/year and 5.4/10(5)/year in West Indians, respectively. None of the changes with time was statistically significant. There were no cases amongst Hindus. The relative risk to Europeans, compared to Bangladeshis, was 2.5 during the 1970s and 2.0 in the 1980s. The difference between European incidence and that of other ethnic groups was not statistically significant; however, the number of Bangladeshi cases was small (five), and diminishes the power of the study. The apparent similarity of the incidences of Crohn''s disease in Bangladeshis and Europeans contrasts with findings in other South Asians. Further investigations of the differences in incidence of Crohn''s disease in South Asians is needed.     

Retinal vasculitis associated with Crohn's disease.

Although systemic vasculitis can be a complication of inflammatory bowel disease at several locations (skin, eyes, brain, mesentery, and lung) the association of retinal vasculitis with Crohn''s disease is rare. We studied a 26-year-old woman with biopsy-demonstrated Crohn''s disease who developed a severe bilateral retinal arteritis and phlebitis, with acute loss of vision.     

Pellagra complicating Crohn's disease.

We report a 53-year-old patient with clinical features of pellagra as a complication of Crohn''s disease. His symptoms improved rapidly on taking oral nicotinic acid and vitamin B complex. We suggest the paucity of reported cases of pellagra in Crohn''s disease is a reflection of poor recognition of this complication.     

胶囊内镜对回肠末端溃疡的诊断价值

目的探讨胶囊内镜对回肠末端溃疡患者的诊断价值。方法对34例回肠末端溃疡患者行胶囊内镜检查,回顾性分析其镜下表现。结果 34例患者肠道准备条件均比较满意,胶囊内镜排出时间约24~72 h;33例患者顺利完成检查,1例患者电池耗尽未进入结肠,共检出慢性非特异性炎症20例,克罗恩病11例,白塞氏病、嗜酸细胞性胃肠炎各1例。患者在整个检查中无不适反应。结论胶囊内镜对回肠末端溃疡患者具有较高的诊断价值,安全性高,不良反应少,易被患者接受,值得推广。     

Is Asacol as effective as sulphasalazine in maintaining remission of Crohn's disease and ulcerative colitis?

To compare the efficacy of Asacol (mesalazine coated with Eudraget-S) as a maintenance therapy with that of sulphasalazine, relapse rates of patients with ulcerative colitis and Crohn''s disease, treated with sulphasalazine or Asacol were assessed in a retrospective study. A total of 164 patients were investigated, 127 on sulphasalazine and 37 on Asacol. None of the patients on Asacol was changed from sulphasalazine because of lack of efficacy to sulphasalazine. Relapse rates were measured over a 4 year period. In ulcerative colitis these were sulphasalazine 10/77 (13.0%), Asacol 5/20 (25.0%), NS; in all Crohn''s disease patients, sulphasalazine 12/50 (24.0%), Asacol 11/17 (64.7%); P less than 0.0025. In patients with Crohn''s disease with ileal involvement, relapse rates were sulphasalazine 9/28 (32.1%), Asacol 9/11 (81.6%), P less than 0.0125; without ileal involvement, sulphasalazine 3/22 (13.6%), Asacol 2/6 (33.4%), NS. This study suggests that Asacol is as effective as sulphasalazine in maintaining remission in ulcerative colitis and in patients with Crohn''s disease without ileal involvement. Sulphasalazine seems to be more effective than Asacol in maintaining remission in patients with Crohn''s disease with terminal ileal involvement.     

Bilateral foot drop, weight loss and rectal bleeding as an acute presentation of Crohn's disease.

We report a 71 year old lady who presented with weight loss, rectal bleeding and bilateral foot drop having been previously fit and well. Clinical examination, laboratory investigation and postmortem examination confirmed the diagnosis of active Crohn''s disease and acute peripheral neuropathy. The clinical course of this patient suggests that the peripheral neuropathy might have resulted from the common pathogenesis for Crohn''s disease.     

Prognosis and management of Crohn's disease in the over-55 age group.

The course, prognosis and management of 62 patients with Crohn''s disease aged 55 years or over at diagnosis has been reviewed. The distal ileus was the commonest site of disease in the older patient, where the characteristic presentation was acute after initially mild symptoms. Early local resection was often required, particularly where there was diagnostic doubt or suspicion of caecal malignancy. Recurrence rates were much lower in the older patient than after resection in younger patients. Medical treatment played a minor role in the management of patients with distal ileal disease, in part because stricture formation was present at diagnosis and the acute nature of symptoms at presentation led to early surgical treatment. Colonic Crohn''s disease was usually confined to the distal or left side of the colon and initially could be difficult to distinguish from diverticular disease. Extensive colonic Crohn''s disease was rare. The apparently limited disease was not necessarily associated with a good prognosis, since disease at this site sometimes progressed rapidly, necessitating urgent surgical resection. Medical treatment (corticosteriod therapy, with or without azathioprine) was usually effective initially for treatment of symptomatic colonic Crohn''s disease, but sustained remission was rare. Those patients with persistent symptoms were restored to good health with surgical treatment but at a price, in that nearly half eventually required a permanent stoma.     

Endoscopic balloon dilatation of duodenal strictures in Crohn's disease.

Endoscopic balloon dilatation of oesophageal and colonic strictures is now widely performed. Duodenal strictures due to Crohn''s disease represent a difficult clinical problem as surgical intervention is a major undertaking and recurrences are common. We describe endoscopic balloon dilatation in three patients with obstructive symptoms from duodenal strictures due to Crohn''s disease. The procedure appeared safe, was well tolerated and resulted in an excellent symptomatic response. This method is particularly suitable for short duodenal strictures and avoids the need for surgical intervention in this difficult group of patients.