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Query: UMLS:C0010346 (Crohn's disease)
 21,615 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The radiological investigations relevant to chronic IBD are described briefly with emphasis placed on compression techniques in small bowel studies. A classification for reporting small bowel Crohn's disease is proposed, where the disease is staged as early, advanced or complicated, and the extent of involvement measured directly from the film. The terminal ileum may be normal in 20% of children with proximal Crohn's disease, so that ileoscopy should not be used to exclude small bowel disease. Radiological assessment of the small bowel is important in management. Surgical referral was based on the radiological changes in 6% of patients, and in 24% the presence of extensive uncomplicated small bowel Crohn's disease led to treatment with elemental diet. The use of some specialized examinations, such as the instant and ileostomy enema, are discussed.
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PMID:Radiological investigation of chronic inflammatory bowel disease in childhood. 800 38

Flexible endoscopy, performed after oral bowel preparation and under moderate intravenous sedation, proves to be well tolerated, safe and highly effective in the diagnosis and management of children with IBD. At St Bartholomew's Hospital it is performed as the investigation of first choice, on the basis that it supplies colour documentation, histopathological and (where relevant) bacteriological evidence, which achieves certain confirmation or exclusion in almost every case and in the shortest possible time. Biopsies must always be taken, as mucosa of normal appearance can show either microscopic ulcerative colitis or Crohn's disease. When there are the characteristic 'aphthoid' ulcers, visual diagnosis of Crohn's disease is reasonably certain, particularly in early-stage disease, although amoebic and other infective causes of colitis can give misleadingly similar appearances. The endoscopist can usually inspect (and almost always biopsy) the terminal ileum, and can expect many children to show the prominent 'nodular lymphoid hyperplasia' which is essentially a normal finding-though sometimes misdiagnosed radiologically as being Crohn's deformity. However, it is important that radiological assessment by barium follow-through complements colonoscopy in view of the not infrequent cases of intestinal Crohn's disease in children where the proximal small intestine is involved, even if the colon and terminal ileum are spared.
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PMID:Endoscopic features of chronic inflammatory bowel disease in childhood. 800 39

Inflammatory bowel diseases are uncommon in the Chinese, but the incidence is rising. Their differentiation from infective colitis is often not clear-cut and diagnosing inflammatory bowel diseases can be difficult in Asia. We have studied Chinese patients with ulcerative colitis (N = 19) and Crohn's disease (N = 12) for anti-neutrophil cytoplasmic antibodies (ANCA) by indirect immunofluorescence (IIF) and enzyme-linked immunosorbent assays (ELISA). Patients with enteric fever (N = 29) and irritable bowel syndrome (N = 24) were recruited as controls. Seventy-three percent of ulcerative colitis patients exhibited either p-ANCA (31%) or c-ANCA (42%) by IIF. Twenty-five percent of Crohn's disease patients were found to be p-ANCA positive. However, these ANCA were nonreactive to anti-alpha granule, antiproteinase 3, antimyeloperoxidase, or antilactoferrin. All positive patients had extensive colitis. Sera collected from patients suffering from enteric fever and irritable bowel syndrome were negative for ANCA by IIF and ELISA. We concluded that the detection of ANCA is helpful in diagnosing inflammatory bowel diseases. Further attempts to characterize these autoantibodies are needed.
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PMID:Anti-neutrophil cytoplasmic antibodies (ANCA) and inflammatory bowel diseases in Chinese. 814 55

Advances in investigative techniques have led to increasing reports of Crohn's disease in CF patients. A retrospective review of the literature on IBD in CF showed findings characterized by ileocolitis with fistula formation; 83% required surgery. A prospective survey of 11,321 CF patients attending 49 CF centers revealed 28 with IBD (25 Crohn's, three ulcerative colitis), ages 4-20 years, mean 15.6 years. The prevalence rate of IBD (247/10(5)) was 7x controls and was accounted for by Crohn's disease (221/10(5)) which was 17x controls. The mechanisms that predispose CF patients to Crohn's disease are discussed.
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PMID:Crohn's disease and cystic fibrosis. 814 54

This study examined whether life event stress under general or more specific conditions (fear of separation, feeling of being under pressure, feeling of being caught between two quarreling parties, separation experiences) contribute to the aggravation of inflammatory bowel disease. Firstly, 51 patients with ulcerative colitis, 57 patients with Crohn's disease, and 60 controls were compared in terms of these variables. In addition, the IBD patients filled out questionnaires regarding life events, the specific psychological conditions mentioned above, and their symptoms several times in the three years after the first measurement. By means of group comparisons and intraindividual correlations between relapse precipitating life events and illness activity, only feelings of being under pressure showed a modest correlation to the disease activity. We conclude that the variables in question have little influence on the beginning of the relapse.
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PMID:[The significance of recurrence-inducing events for patients with chronic inflammatory bowel diseases. Results of a prospective longitudinal study over three years]. 817 35

Classic treatment of high anal fistulas by the laying open technique requires total or subtotal section of the sphincter muscles and results in anal incontinence. This study assesses the efficacy of the flap advancement technique in these cases. It entails the resection of the crypt at the origin of the fistula, the area being covered by a mucomuscular flap of the rectal wall. From 1977 to early 1992, 18 patients (13 female and 5 male patients; mean age: 40 years) presenting with a deep anal fistula underwent such an operation. There were 16 suprasphincteric and 2 high transsphincteric tracts. Associated IBD was noted in 7 cases (5 Crohn's colitis, 2 UC). Five fistulas were of obstetrical origin. In 8 cases, patients had undergone previous surgical treatments without success. All patients had a flap advancement. In 2 cases, a colostomy had been previously carried out. Two more diverting stomies were performed (combined abdominal procedures). No mortality or morbidity was encountered. Mean postoperative stay was 8 days. Current status could be established in all patients. Three immediate failures were observed (1 case of Crohn's disease, two recurring cases). All the other patients did well with persistent healing of the fistula after a mean follow-up of 61 months (range, 6-150). Three stomies were closed; one patient delayed the procedure. Functional results were excellent. In the "success" group, all the evaluable patients (14/15) had normal fecal continence. Two female patients are still complaining of mild flatus incontinence. In the failure group, the preoperative anorectal function was maintained.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Treatment of deep anal fistulas using a flap from the rectal wall]. 819 10

Tablets of mesalazine covered with a pH-dependent coating (Pentacol), labeled by an original technique with technetium-99m, were administered to 12 patients, 9 with Crohn's disease, 3 of which recurrent, 1 with ulcerative colitis, and 2 with irritable bowel syndrome, with the aim of verifying in vivo the intestinal site of disintegration and how the contents spread throughout the intestine. In all cases the tablet was broken down in the distal ileum at extremely variable intervals, from 5 to 27 h, and the contents spread into the nearby loops and into the colon. The notable differences in the residence time of the whole tablet in the ileum can be explained by differences in adhesion to the inflamed mucosa and by a lower pH in the part of the ileum affected by the disease.
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PMID:Scintigraphic study of gastrointestinal transit and disintegration sites of mesalazine tablets labeled with technetium-99m. 823 33

Despite multiple invasive diagnostic procedures including exploratory laparotomy and surgical resection, our patient's diagnosis remained an enigma. However, given the clinical scenario and the documented PG, a trial of steroids was warranted. The patient has fared well since her treatment, with resolution of all her symptoms. We feel confident that her disease process is most consistent with, and is most likely, Crohn's disease. There are several lessons to be learned from this case: 1) Inflammatory bowel disease can present at any age and belongs in a clinician's differential diagnosis of fever and diarrhea. 2) Failure to consider IBD in an elderly patient may lead to significant delay in diagnosis, and may expose the patient to unnecessary and sometimes dangerous intervention. 3) IBD in the elderly generally follows the same clinical patterns seen in younger patients. 4) Appropriate therapy can lead to prompt control or even resolution of the signs and symptoms of IBD.
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PMID:Atypical presentation of inflammatory bowel disease in the elderly. 824 80

Increased intestinal permeability in patients with Crohn's disease and their first degree relatives has been proposed as an aetiological factor. The nine hour overnight urinary excretion of polyethyleneglycol-400 (PEG-400) and three inert sugars (lactulose, l-rhamnose, and mannitol) was used to test the permeation in 47 patients with Crohn's disease of whom 18 had at least one first degree relative with inflammatory bowel disease (2BD) and 52 patients with ulcerative colitis of whom 16 had at least one first degree relative with IBD. A total of 17 first degree relatives with IBD and 56 healthy first degree relatives were included. Thirty one healthy subjects not related to patients with IBD served as controls. No significant differences in PEG-400 permeation were found between the groups of patients, relatives, and controls, or between diseased and healthy relatives. The permeability to lactulose, rhamnose, and mannitol similarly did not differ between the three groups. This study challenges the previously reported findings of increased PEG-400 permeation in patients with Crohn's disease and in their healthy and diseased first degree relatives. There was no increase in permeability in a similar group of ulcerative colitis patients and their families.
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PMID:Intestinal permeability in patients with Crohn's disease and ulcerative colitis and their first degree relatives. 782 99

In conclusion, it seems there has been a definite change in the epidemiology and course of IBD since earlier this century. Several points are worth emphasising: The diseases are relatively common, and there has been a general increase in their incidence, more so in some regions than others. The largest group affected is young adults, who will have their disease over several decades. This could potentially impact markedly on the workforce and on health care services. There is clearly a range of severity of this disease, and a greater number of mild cases have probably been diagnosed recently. This also helps to explain the differences in severity, need for surgery, and survival noted between community based studies and referral centre groups. Treatment has improved, particularly surgery (which usually takes place earlier on less critically ill patients), better operations, including continence surgery for most patients with UC and gut sparing procedures in Crohn's disease such as stricturoplasty. Medical management of acute disease has also improved which, in particular, has reduced mortality in elderly patients. Except for a subset of patients, life expectancy is close to normal, and time lost from the workforce, when considered in perspective over a working lifetime, is negligible. We can therefore be justifiably optimistic about the current long term outcome of IBD, and encourage our patients, their families and their employers to share in this outlook. With the promise of newer medical therapies on the horizon, prognosis may be further improved. Corticosteroids with little or no systemic side effects are currently in clinical trials and new anti-inflammatory agents are being examined for their efficacy through prostaglandin, leukotriene, or oxygen free-radical inhibition. Now that mortality from IBD is largely a thing of the past, we need to concentrate our attention more closely on the associated morbidity. It is to be hoped that future long term studies attempt the difficult clinical measurements of morbidity and quality of life.
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PMID:Inflammatory bowel disease--its history, current status and outlook. 830 96


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