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.     

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.     

Circulating platelet–leukocyte aggregates in patients with inflammatory bowel disease

BackgroundInflammatory bowel diseases (IBDs), Crohn's disease, and ulcerative colitis are considered to be chronic inflammatory disorders implicated with recurrent tissue damage to the intestine. There is a positive correlation between platelet–leukocyte aggregates and ischemic vascular risk. There are limited data about the relationship between platelet–leukocyte aggregates and IBD. This study was designed to determine whether platelet–leukocyte aggregates increase in IBD, and whether a relationship exists between the elevation of platelet–leukocyte aggregates and disease activity.MethodsA total of 20 patients with IBD (16 with ulcerative colitis and 4 with Crohn's disease) and 20 healthy controls participated in our study. Nine patients were in active-phase IBD, whereas 11 patients were in inactive phase. To show the presence of thrombocyte aggregates, the monoclonal antibodies such as Isotype IgG1 mouse antihuman CD42b-PE (phycoerythrin) (Beckman Coulter IMI417), Isotype IgG1 mouse antihuman CD45-FITC (fluorescein isothiocyanate) (Beckman Coulter IM0782), and Isotype IgG2a mouse antihuman CD45RO-FITC (Beckman Coulter IMI247) were used. Additionally, the values of platelet–neutrophil aggregates were measured in peripheral blood samples using flow cytometry techniques.ResultsThe levels of platelet–leukocyte aggregates in blood samples were found to be significantly higher during both the active and inactive phases in patients with IBD. There were no statistically significant differences between active-phase and inactive-phase patients.ConclusionWe determined that the patient group had significantly higher platelet–leukocyte aggregate levels compared with the control group. This finding suggests that platelet–leukocyte aggregates may play a role in the development of IBD.     

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.     

Nutritional disturbances in Crohn's disease.

A wide range of nutritional disturbances may be found in patients with Crohn''s disease. As more sophisticated tests become available to measure vitamin and trace element deficiencies, so these are being recognized as complications of Crohn''s disease. It is important to recognize nutritional deficiencies at an early stage and initiate appropriate treatment. Otherwise many patients, experiencing what can be a chronic and debilitating illness, may suffer unnecessarily from the consequences of deprivation of vital nutrients.     

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。     

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.     

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:     

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.     

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.     

Development of an Inflammatory Bowel Disease registry

Inflammatory Bowel Disease is characterized by two major entities, Crohn's Disease and Ulcerative Colitis. These bowel diseases have associated problems involving the eyes, joints, skin, kidneys, immunological system, hepatobiliary system, and psychiatric disturbances. A regional IBD registry encompassing 18 hospitals and IBD specialists in east/northeast Pennsylvania was established to promote awareness of the clinical and epidemiological aspects of the disease. Results of this data collection effort will be shared with patients and physicians through the use of newsletters and symposia. A Basic History (HX) form, an Operative Data (OR) form, and an Annual Follow-up (FU) form was used to collect relevant data. Participation is voluntary and all information is confidential.     

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.     

炎症性肠病肾损害的临床病理分析

目的 了解炎症性肠病肾脏损害的临床及病理特点。方法 对2010 年5 月～2018 年12 月在我院诊断为炎症性肠病肾损害的21 例患者的临床资料进行分析、总结,对其中行肾穿刺活检的13 例患者的活检病理特点进行描述。结果 21 例炎症性肠病肾损害患者中,男7 例,女14 例,溃疡性结肠炎患者16 例,克罗恩病患者5 例。其中13 例患者行肾穿刺活检,病理类型包括IgA 肾病6 例,膜性肾病3 例,间质性肾炎3 例,新月体肾炎1 例。结论 IBD 患者可以出现不同类型的病理损害,其中以IgA 肾病、间质性肾炎以及膜性肾病最为常见。     

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.     

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.     

张伯礼教授治疗克罗恩病验案一例

克罗恩病是一种以慢性肠道炎症为主要表现的全身性疾病,具有难治愈,易复发的特点,目前尚缺乏根治的方法。中医具有辨证论治特色,且不良反应较小,治疗克罗恩病具有控制病情进展,改善症状的优势。张伯礼教授临证具有较丰富的临床经验,现将张教授治疗克罗恩病验案一则进行整理报告,希冀体悟张教授临床辨证思维及遣方用药经验。     

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.     

Distal adenomatous polyps are rare in patients with inflammatory bowel disease

Objective

There is an increased risk of colorectal cancer in patients with inflammatory bowel disease (IBD). The aim of this study was to compare the prevalence of left sided adenomas in patients with IBD aged 55–64 years with a local age matched control population.

Method

A review of clinical notes. The prevalence of adenomas in patients with IBD attending for either sigmoidoscopy or colonoscopy was compared with local age matched controls that participated in the national screening trial for colorectal cancer with flexible sigmoidoscopy.

Results

Of 106 patients (61 male, 45 female, mean age of 59 years), 80 suffered from ulcerative colitis, 20 from Crohn''s disease, and six from indeterminate colitis. All patients had undergone at least one flexible sigmoidoscopy and 75 had a colonoscopy. Distal adenomas were found in three patients with ulcerative colitis compared with 67 of 749 controls (2.8% v 8.9%, χ² = 4.6, p = 0.03).

Conclusions

The results suggest that distal adenomatous polyps are rare in patients aged 55–64 years with IBD compared with a control population. This supports the hypothesis that lesions other than polyps are important for the development of colorectal cancer in patients with IBD.     

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.


     

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.