Crohn's disease and ulcerative colitis

This column discusses the prevalence, symptoms, and treatment of Crohn's disease and ulcerative colitis and the role nurses play for these patients.     

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.     

Atopic disease in ulcerative colitis and Crohn's disease.

Three hundred patients with ulcerative colitis, 200 with Crohn's disease and matched control subjects completed questionnaires about atopic disease. They were asked whether they had ever suffered from asthma, hay fever, allergic rhinitis or eczema; in ulcerative colitis all of these features occurred with twice the frequency, but in Crohn's disease only eczema was more common than in controls.     

Non-specific ulcerative colitis and Crohn's disease]

The paper is concerned with current status of nonspecific ulcerative colitis and Crohn's disease. Clinical, diagnostic and therapeutic aspects are considered. Crohn's disease was studied in its variants. Hyperbaric oxygenation introduced in combined treatment of the two diseases is evaluated.     

Treatment of ulcerative colitis and Crohn's disease with monoclonal antibody

Ulcerative colitis and Crohn's disease are nonspecific inflammatory diseases of unknown etiology. Recent immunological studies have shown that proinflammatory cytokines and adhesion molecules play an important role in the pathogenesis of ulcerative colitis and Crohn's disease. Therefore, monoclonal antibodies to proinflammatory cytokines and adhesion molecules are used to suppress the mucosal inflammatory response in experimental colitis and ulcerative colitis and Crohn's disease. Anti-TNF alpha antibody and anti-alpha 4 beta 7 integrin antibody are well-tolerated and effective for treatment of patients with Crohn's disease. This review described clinical features and immunopathophysiology of ulcerative colitis and Crohn's disease, proinflammatory cytokines and immunosuppressive cytokines and adhesion molecules involved in the pathogenesis of both disease, and treatment of both diseases with monoclonal antibodies.     

New biologic therapeutics for ulcerative colitis and Crohn's disease

Introduction: Some inflammatory bowel disease (IBD) patients especially those with refractory Crohn's disease (CD) or relapsing ulcerative colitis (UC) do not respond to current therapies. The newly introduced biological drugs have got some interest due to their specificity and selectivity in modulation of inflammatory elements.

Areas covered: In 46 included randomized, placebo-controlled clinical trials, the efficacy and safety of different biologic drugs have been evaluated in moderately to severely active CD or UC patients. Current investigated drugs include new anti-TNF drugs (adalimumab, certolizumab pegol, etanercept, onercept and golimumab), anti-CD20 (rituximab), T-cell inhibitors (abatacept) and anti-α4 integrins (natalizumab and vedolizumab). Adalimumab, certolizumab, and golimumab showed significant efficacy in induction of remission and maintenance in CD and UC patients with a rate of adverse events similar to placebo in the major trials. Natalizumab and vedolizumab were effective in the treatment of moderately to severely active CD and UC patients. However, vedolizumab caused less adverse effects than natalizumab. onercept, etanercept, rituximab and abatacept were all well tolerated but were not effective in CD or UC patients.

Expert opinion: Anti-TNF drugs, except for onercept and etanercept, and anti-α4 integrins exhibit beneficial therapeutic effects. Although they were all well tolerated, the incidence of progressive multifocal leukoencephalopathy associated with natalizumab should not be missed.     

Value of virtual computed tomographic colonography for Crohn's colitis: comparison with endoscopy and barium enema

Background: Crohns colitis, frequently accompanied by stenosis or narrowing, can be difficult to assess through conventional methods. We evaluated the usefulness of virtual computed tomographic colonography (CTC) for the detection of colonic lesions due to Crohns disease. Methods: Forty-two lesions in 33 patients with Crohns disease were examined by CTC and barium enema (BE). Twenty-two patients also were examined by colonoscopy (CS). The visualization ability of CTC was compared with those of the other two methods. Results: In the visualization of elevated lesions, there was no significant difference between CTC and BE (18 of 20, p = 0.487) or between CTC and CS (15 of 16, p = 0.99); however, ulcerative lesions were less often visualized by CTC. However, CTC enabled identification of serious lesions in the colon proximal to the stenosis in nine patients and was superior to BE and CS in terms of its ability to visualize the proximal site of the stenosis (p = 0.003). Conclusion: CTC is clinically useful for the evaluation of Crohns colitis, especially those with stenotic lesions.     

Colonic inflammatory bowel disease. Medical therapies for colonic Crohn's disease and ulcerative colitis

Advances in the treatment of inflammatory bowel disease (IBD) in the past decade include 5-aminosalicylic preparations with fewer adverse effects; new, rapidly metabolized corticosteroids; and new agents targeted at refractory or complicated IBD. Dr Tung and Dr Warner discuss the use of these and more traditional drugs in patients with colonic Crohn's disease and ulcerative colitis, stressing the need for individualized treatment.     

Autonomic cardiovascular regulation in quiescent ulcerative colitis and Crohn's disease

BACKGROUND: In inflammatory bowel diseases, changes in autonomic enteric regulation may also affect neural cardiovascular control. However, while cardiac autonomic modulation has been shown to be impaired in active ulcerative colitis, the occurrence of cardiovascular autonomic alterations, also in the quiescent phase of inflammatory bowel diseases, is still a matter of debate. The aim of our study was thus to explore the features of cardiovascular autonomic regulation in ulcerative colitis and Crohn's disease during their remission phase. MATERIALS AND METHODS: Autonomic cardiovascular control was evaluated by time- and frequency-domain indexes of spontaneous heart rate and blood pressure variability and by assessing the baroreflex heart rate control (sequence technique) in 26 patients with ulcerative colitis, in 26 patients with Crohn's disease and in 23 healthy controls. RESULTS: The groups were matched for age, gender and body mass index. They had similar blood pressure mean levels and variability. By contrast, mean heart rate, its overall variability (standard deviation), and baroreflex sensitivity were lower in ulcerative colitis patients than in controls. Moreover, all indexes related to cardiac vagal control were significantly lower in ulcerative colitis patients with respect not only to controls but also to Crohn's disease patients. CONCLUSIONS: Cardiac vagal control is impaired in quiescent ulcerative colitis only, and not in Crohn's disease, while in both bowel diseases vascular control appears preserved. Since cardiovagal modulation seems related to anti-inflammatory mechanisms, the reduced parasympathetic cardiac regulation in apparently quiescent ulcerative colitis suggests that such systemic derangement is accompanied by local subclinical inflammations, even in the absence of clinically active inflammatory processes.     

The value of double-contrast barium enema in amebic colitis

We report here our findings on the double-contrast barium enema given to 8 patients with amebic colitis and a comparison is made with endoscopic features. A definite diagnosis of amebic colitis was made by fecal examination or by endoscopic biopsy. Radiologic findings included fine marginal serration, aphthoid ulcers, minute barium flecks, marginal defects, loss of haustration, and deformities of the bowel. Aphthoid ulcers and marginal defects are both characteristic of amebic colitis. The double-contrast barium enema is most useful for differentiating amebiasis from other forms of colitis.     

Permeability of intestinal barrier fo macromolecules in patients with Crohn's disease and ulcerative colitis

Ovalbumin loading enzyme immunoassay was made in 44 patients with ulcerative colitis (UC) and 8 patients with Crohn's disease (CD). Enhanced intestinal permeability for macromolecules was found in 87.5 and 65.9% of patients with CD and UC, respectively. Blood serum of UC patients suffering from combination of food intolerance with dysbacteriosis contained ovalbumin in amounts exceeding those in patients without the above disorders 3.4 times (p < 0.05). No significant relationship existed between UC patients' high intestinal permeability and such indices as age, duration of the disease, intestinal lesion extension, administration of corticosteroids. It was found desirable to include ovalbumin intestinal permeability test in examination of UC and CD patients to differentiate treatment policy.     

Differentiating Crohn's colitis from ulcerative colitis. A rundown of likenesses and dissimilarities

Crohn's colitis and ulcerative colitis are two distinct clinical entities with differing clinical, pathologic, endoscopic, and radiographic findings. Because of distinct differences in their response to surgical and, in some instances, medical management, clinical separation of these two unique disease states is important. Although at times diagnostic confusion may persist, thorough clinical evaluation, including the judicious use of mucosal biopsy, yields the correct diagnosis in the majority of patients.