Radiographic appearances and course of discrete mucosal ulcers in Crohn's disease of the colon

Although the radiographic manifestations of Crohn's disease of the colon have been extensively reviewed, few reports specifically illustrate the evolution of discrete mucosal ulcers in this disease. There is, moreover, some controversy concerning the nature and significance of small or so-called aphthous ulcers in the pathogenesis of Crohn's colitis. In this study, results from sequential primary double-contrast barium enemas performed over a 5-year period in 21 patients with proven Crohn's colitis were reviewed. A localized segment of colon showing discrete mucosal ulcers was selected for analysis and comparison in serial examinations. The radiographic appearances and course of these discrete mucosal ulcers are described and illustrated.     

24例克隆病的内镜诊断

文章研究了分析１９８０年１－１９９６年６月间我院经手术及病理证实的２４例克隆病的内镜特征。结果显示该组有典型克隆病内镜特征的患者仅占４０％，肠道狭窄为该组克隆病的最常见的内镜表现。在排除恶性肿瘤后，节段性肠道狭窄支持克隆病的诊断。     

Analysis of colonoscopic findings in the differential diagnosis between intestinal tuberculosis and Crohn's disease

BACKGROUND AND STUDY AIMS: Intestinal tuberculosis and Crohn's disease are chronic inflammatory bowel disorders that are difficult to differentiate from one another. This study aimed to evaluate the diagnostic value of various colonoscopic findings in the differential diagnosis between intestinal tuberculosis and Crohn's disease. PATIENTS AND METHODS: Colonoscopic findings on initial work-up were prospectively recorded in patients with an initial diagnosis of either intestinal tuberculosis or Crohn's disease. These findings were analyzed after a final diagnosis of intestinal tuberculosis (n = 44) or Crohn's disease (n = 44) had been made after follow-up. RESULTS: Four parameters (anorectal lesions, longitudinal ulcers, aphthous ulcers, and cobblestone appearance) were significantly more common in patients with Crohn's disease than in patients with intestinal tuberculosis. Four other parameters (involvement of fewer than four segments, a patulous ileocecal valve, transverse ulcers, and scars or pseudopolyps) were observed more frequently in patients with intestinal tuberculosis than in patients with Crohn's disease. We hypothesized that a diagnosis of Crohn's disease could be made when the number of parameters characteristic of Crohn's disease was higher than the number of parameters characteristic of intestinal tuberculosis, and vice versa. Making these assumptions, we calculated that the diagnosis of either intestinal tuberculosis or Crohn's disease would have been made made correctly in 77 of our 88 patients (87.5 %), incorrectly in seven patients (8.0 %), and would not have been made in four patients (4.5 %). CONCLUSIONS: A systematic analysis of colonoscopic findings is very useful in the differential diagnosis between intestinal tuberculosis and Crohn's disease.     

Medication-induced esophagitis

Clinical, radiographic, and endoscopic features of medication-induced esophagitis (MIE) in 4 patients are described. When the clinical history and symptoms raise a high index of suspicion for MIE, a double-contrast esophagram or endoscopic examination should be performed. The proximal esophagus, particularly the aortic segment, and occasionally the distal esophagus are the sites most commonly affected by MIE. Superficial mucosal erosions, shallow ulcers, and subtle mucosal alterations can be demonstrated by double-contrast esophagrams if careful attention is paid during performance and interpretation of these studies in an appropriate clinical setting.     

Mucosal healing of esophageal involvement of Crohn's disease with granulocyte/monocyte adsorption

We report a case of a 16-year-old male who suffered from Crohn's disease (CD) with esophageal involvement, showing remarkable improvement with granulocyte/monocyte adsorption (GMA). The patient had been diagnosed as ileocolic CD and was treated with 5-aminosalicylate. He was admitted to our hospital with symptoms of fever, diarrhea, and odynophagia. Endoscopic examinations revealed that the exacerbation of ileocolic ulcers, and advent of ulcers in esophagus. Because of the patient's refusal to receive corticosteroids, immunomodulators, or biologics, he underwent GMA twice a week. After 10 sessions of GMA, he entered remission with significant decrease in clinical activity. In addition, endoscopic examinations showed remarkable improvement of ileocolic ulcers and disappearance of esophageal lesions. No adverse events were observed. GMA could be effective for manifestations of CD in gastrointestinal tract other than ileum or colon.     

Esophageal manifestations of Crohn's disease

Two patients with concurrent esophagitis and ileocolitis due to Crohn's disease are presented. The initial feature of esophageal involvement was dysphagia caused by severe inflammation of the distal esophagus with mucosal ulcerations and polypoid folds. Long-term observation of both cases revealed a gradually progressive course leading to development of rigid esophageal stricture, intramural sinus tract, and esophagobronchial or esophagogastric fistulas. The clinical and radiographic manifestations of Crohn's esophagitis in these 2 patients and in 18 previously reported cases are reviewed.     

Gastrointestinal manifestations of essential mixed cryoglobulinemia

A patient with essential mixed cryoglobulinemia (EMC) presented initially with gastric ulcers and, six months later, with a lesion of the ileum, mild stricture of the transverse colon, and stricture of the sigmoid colon with deep ulceration. The initial diagnosis was Crohn's disease, but pathologic examination of the resected sigmoid lesion showed vasculitis secondary to EMC. Patients with EMC can present with gastrointestinal manifestations mimicking Crohn's disease. A review and classification of the gastrointestinal manifestations of EMC are presented.     

Crohn's disease involving the proximal stomach

We report an unusual case of Crohn's disease of the esophagus and stomach. Unlike previously described cases, the disease in this patient affected the fundus and body while sparing the antrum of the stomach, and produced a mass effect simulating malignancy.     

Radiology of colonic interposition and its associated complications

A retrospective review of the medical records, pathology reports, and radiographic studies of 81 patients who had undergone colonic interposition was undertaken, with special attention to postoperative complications. Both early (within 30 days postoperatively, 81 patients) and late (later than 30 days postoperatively, 57 patients) complications were reviewed. Early findings included anastomotic narrowing (18 patients), anastomotic leak (13), aspiration (11), and ischemic necrosis of the colon (3). Late findings included aspiration (9 patients), anastomotic strictures (8), gastric stasis (6), redundancy and tortuosity of the colon (5), anastomotic ulcers (4), gastrocolic reflux (3), and gastroesophageal reflux into the residual esophagus (2).     

Idiopathic esophageal ulceration in the acquired immunodeficiency syndrome: Radiologic reappraisal in 10 patients

Idiopathic esophageal ulceration in patients with AIDS has previously been described. Establishing this diagnosis is important because of the excellent response of these ulcers to corticosteroid therapy. We studied 10 such patients with esophagography and endoscopy. HIV was isolated from the ulcer base in six of the 10 patients utilizing various techniques including in situ hybridization. No other organisms were found. All of the ulcers were in the distal half of the esophagus and were solitary in eight of the 10 patients. The solitary ulcers were large (2.5×2.0 cm to 12×9 cm) and deep (>0.5 cm) with undermined margins. In three patients, fistulae arose from the distal esophagus and crossed the gastroesophageal junction. In one patient, a huge idiopathic ulcer perforated into the mediastinum. These latter findings are not seen in the more common ulcerating AIDS esophagitides due to herpes simplex and cytomegalovirus.     

Diagnostic significance of endoscopic biopsy in Crohn's disease

We investigated the diagnostic value of biopsies taken from Crohn's lesions such as ulcers, aphthoid lesions, cobble-stone epithelium and "pseudopolyps". One hundred and forty-six colonoscopies performed in 141 patients with Crohn's disease (CD) were analyzed. Biopsies were taken during colonoscopy from different gross lesions. Histologic confirmation of CD by granulomas and microgranulomas was obtained in 36 cases from 146 colonoscopies (24.7%). In 80 investigations (54.8%) the histologic findings were consistent with, but not diagnostic of, CD, in 30 cases (20.5%) histology was non-diagnostic. The lesions most likely to contain granulomas were ulcers and we therefore conclude that biopsies taken from ulcer are diagnostically superior to those taken from other lesions seen in CD.     

Crohn's disease in the esophagus--report of a case

A case of esophageal Crohn's disease is described. Crohn's lesion was observed in the lower esophagus, and sarcoid-like granulomas were found in the biopsied specimen. A clinical consideration of this phenomenon is presented.     

Upper gastrointestinal tract endoscopy in inflammatory bowel disease

Upper gastrointestinal endoscopy is used to evaluate upper gastrointestinal symptoms in patients with inflammatory bowel disease. This article discusses the procedure, which may allow for the diagnosis of Crohn's disease of the esophagus, stomach, and/or duodenum. Biopsies of normal gastric mucosa in patients with indeterminate colitis may be helpful in making a diagnosis of Crohn's colitis. Upper gastrointestinal endoscopy may allow for therapeutic intervention in terms of bleeding and stricturing disease.     

Capsule endoscopy in patients with suspected Crohn's disease and negative endoscopy

BACKGROUND AND STUDY AIMS: The aim of the present study was to assess the value of capsule endoscopy in the diagnostic work-up of patients in whom there is a clinical suspicion of small bowel Crohn's disease that cannot be confirmed using traditional techniques. PATIENTS AND METHODS: A total of 21 patients (14 men, seven women; mean age 43 +/- 8 years) with a clinical and biochemical suspicion of Crohn's disease were included in the study. Conventional imaging work-up, including upper and lower endoscopy, as well as a small-bowel follow-through, was carried out in all of the patients. RESULTS: Pathological findings were not observed in 12 of the 21 patients (57 %). In the other nine patients (43 %), lesions supporting the diagnosis of Crohn's disease were seen. The most frequent findings were located in the distal ileum and included aphthae, lineal and serpiginous ulcers, and fissures. Four patients had lesions in the jejunum. One patient showed erosions in the distal duodenum, jejunum, and ileum. No adverse effects of the technique were observed in any of the patients. CONCLUSIONS: Capsule endoscopy is a valuable diagnostic tool in patients with suspected Crohn's disease that has not been confirmed using standard imaging techniques.     

克隆病及其异型增生与癌变的临床病理学分析

探讨克隆病（ｃｒｏｈｎ’ｓ ｄｉｓｅａｓｅ，ＣＤ）肠粘膜上皮增生，异型增生，癌变的临床病理特点及意义。方法收集５到ＣＤ患者的临床病理资料，光镜观察肠粘膜活检及手术肠切除的病理组织学特点，应用国际炎性肠 的分标准对上皮增生进行分类，部分切片行ＣＥＡ、ＰＣＮＡ免疫组化染色。结果３例肠为膜活检未发现特异性为。５例手术标本均可见非干酪样坏死肉芽肿或巨细胞；３例有典型裂隙状溃疡形成。４例次上皮有局灶未定型异     

Thalidomide use in pediatric patients

OBJECTIVE: To provide a detailed overview of thalidomide use in pediatric patients. DATA SOURCES: English-language articles were identified through a MEDLINE search (1966-February 2001); key terms included thalidomide, child, graft-versus-host disease, cancer, HIV, Crohn's disease, Beh?et's disease, and lupus erythematosus. References cited in those articles were also evaluated. DATA SYNTHESIS: Thalidomide appears to be effective in patients with chronic, not acute, graft-versus-host disease (GVHD) and in healing aphthous ulcers in patients with HIV infection. Limited case reports suggest efficacy of thalidomide in the treatment of cutaneous manifestations of Beh?et's disease, Crohn's disease, and lupus in children; however, the recurrence of disease is almost universal on drug discontinuation. CONCLUSIONS: Thalidomide should be used as a last resort when all other therapies fail, preferably in male or prepubescent female patients.     

Mast Cells and Headache in Crohn's Disease

SYNOPSIS
Four patients with vascular headaches of remarkable severity and chronicity not responding to usual therapies brought attention to their families in which at least two members each also have Crohn's disease. Hitherto an association of Crohn's disease with vascular headache of the migrainous type has not been recognized.One patient suffered bouts of extreme constipation at age four years. When eight years old he developed "screaming, pounding headaches". During headaches, intermittent crampy periumbilical pain and diarrhea appeared. Subsequent radiologic and surgical evidence resulted in a diagnosis of Crohn's disease. His 11-year-old brother was seen for headaches which were intractable over a period of at least six months, but bowel symptoms has not appeared as yet. Their father has Crohn's disease.A 19-year-old woman with Crohn's disease presented with headaches of the migrainous type of eight months duration, resistent to all therapies. Her mother has Crohn's disease and migraine and a sister has peptic ulcers, "gaseous colon" and migraine.Resected bowel of three of these patients showed large numbers of mast cells. We suggest that vasoactive substances, including histamine released from mast cells, could cause headache. Moreover, impaired sulfate conjugation of monamines, or decreased monoamine oxidase in diseased bowel could facilitate the absorption and increase the circulation of vasoactive substances causing headache.     

111Indium leukocyte scanning in small-bowel Crohn's disease

Twelve patients with Crohn's disease of the small bowel were evaluated by¹¹¹indium leukocyte scanning of the abdomen. There was localization of the labelled cells in the areas of active Crohn's disease and the findings were in complete agreement with the extent of abnormalities demonstrated on barium examination of the small intestine. The value of this technique in the assessment of Crohn's disease and as an adjunct to the conventional small bowel series is discussed.     

Association of Meckel's diverticulum and Crohn's disease

A significant association between Meckel's diverticulum and Crohn's disease has been suggested in the clinical literature. Ten patients with both entities demonstrated radiographically as well as cases reported in the literature were analyzed to determine the relevance of this association to radiologic evaluation. The Meckel's diverticulum in most cases was an incidental finding whereas the Crohn's disease usually accounted for the patient's clinical symptoms. Recognition of this association should prevent unnecessary laparotomy for an incidental Meckel's diverticulum and improve the radiographic diagnosis of coexistent Crohn's disease.     

Barrett's esophagus in scleroderma: Increased prevalence and radiographic findings

Ten of 27 patients (37%) with scleroderma who underwent endoscopy at our hospital between 1980 and 1984 for symptoms of reflux esophagitis had biopsy-proven Barrett's esophagus. Two of those 10 patients had esophageal adenocarcinomas. In a blinded review of esophagrams (all but 2 using double-contrast technique) from 16 of the 27 patients, only 1 patient was thought to be at high risk for Barrett's esophagus due to a high esophageal stricture with an adjacent reticular pattern of the mucosa. The latter patient had biopsy-proven Barrett's mucosa. Eight patients were thought to be at moderate risk for Barrett's esophagus due to reflux esophagitis and/or distal strictures in 6 and polypoid intraluminal masses in 2. Three of the 6 patients with esophagitis and/or strictures had Barrett's esophagus, and both patients with masses had adenocarcinomas arising in Barrett's mucosa. Finally, 7 patients who had no esophagitis or strictures were thought to be at low risk for Barrett's esophagus. None of those 7 had histologic evidence of Barrett's mucosa. Thus, the major value of double-contrast esophagography is its ability to classify patients into high-, moderate-, and low-risk for Barrett's esophagus to determine the relative need for endoscopy and biopsy in these patients.