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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 United Kingdom and Ireland Register of Home Parenteral Nutrition (HPN) contains details on 237 cases treated between 1977 and 1987. One hundred courses of HPN were given to 89 patients for complications of Crohn's disease. Six registering centers provided 87 percent of the courses of treatment. The short-bowel syndrome was a factor in 60 patients, fistulas in 29 patients, and exacerbation of the disease in 41 patients. Thirty patients had more than one complication. The age distribution of patients with Crohn's disease was the same as for all HPN patients. Nine patients have died and eight have ceased HPN because of complications from the treatment. Fifty two percent of the patients had no complications. Patients with Crohn's disease on HPN had a significantly better lifestyle than the group as a whole (P less than .05) and had lower sepsis and complication rates (P less than .01 and 0.001, respectively). The 60 Crohn's patients with short-bowel syndrome spent a significantly longer time on HPN than Crohn's patients overall (P less than .05). Only 15 of these have been able to cease treatment and resume enteral feeding, compared with 23 of the other 40 patients who were able to resume enteral nutrition after a median of three months. Analysis of the authors' group of 35 patients included in the 100 showed that the only nutritional parameters of use in monitoring the patients' well-being were weight and serum albumin. Eighty percent of the patients with Crohn's disease who were treated by HPN have either successfully resumed enteral feeding or are successfully managing their own HPN. HPN is a safe and effective treatment for patients with acute or chronic intestinal failure from Crohn's disease.
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PMID:How do patients with Crohn's disease fare on home parenteral nutrition? 313 56

We prospectively studied 169 patients with Crohn's disease to determine if postoperative infectious complications could be related to perioperative blood transfusions. Postoperative septic complications developed in 18 of the 69 patients who received more than 1 unit of blood (26 percent) compared with 8 of the 100 patients (8 percent) who received 1 unit of blood or no blood (p = 0.0014). Previous operation, low body weight, and having an ostomy were also related to septic complications. Patients receiving more than 1 unit of blood were significantly more likely to have low preoperative serum albumin levels, to have undergone abdominoperineal or small bowel resection, and to have an ostomy. Postoperative septic complications were significantly related to perioperative blood transfusions after controlling for these potential confounding factors independently by subgrouping and simultaneously by using multiple logistic regression. Blood transfusion may be a more significant factor in postoperative immune suppression and susceptibility to infection than previously recognized.
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PMID:Relationship of postoperative septic complications and blood transfusions in patients with Crohn's disease. 334 37

Although dilatation of the jejunum is a well-recognized feature of Crohn's disease there has been no systematic inquiry as to whether this is related simply to distal intestinal obstruction or to other factors such as hypoalbuminemia and mucosal disease. Barium follow-up examinations of 21 patients with Crohn's disease who had serum albumin concentrations of 2.1-4.4 g/dl were reviewed. Fourteen of these patients (67%) had increased mean jejunal width. All patients with direct radiologic evidence of a stricture (six patients) had increased jejunal caliber, but this only accounted for 43% of patients with this abnormality. Of the remaining eight patients, six had hypoalbuminemia, three of whom had serum albumin concentrations less than or around 2.7 g/dl, the previously determined "albumin threshold" for jejunal dilatation. We conclude that increased jejunal caliber in Crohn's disease not only occurs in association with distal intestinal stenosis but also with severe hypoalbuminemia in the absence of obstruction. We were unable to define a cause of jejunal dilatation in 36% of these patients, but propose that functional obstruction due to distal nonstenosing inflammatory disease may be a factor.
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PMID:Jejunal dilatation in Crohn's disease. Intestinal obstruction or intestinal edema? 341 92

We compared conventional measures of disease activity with 24-h fecal alpha 1-antitrypsin clearance in 59 children and adolescents with Crohn's disease and 30 with ulcerative colitis. Among the Crohn's patients clearance was increased significantly in those with abnormal erythrocyte sedimentation rates (ESR) (greater than 15 mm/h, p less than 0.005) and diminished serum albumin (less than 35 g/L, p less than 0.005), but not in those with an abnormal Crohn's disease activity index (CDAI less than 150). Correlation between alpha 1-antitrypsin clearance and ESR was poor (r = 0.17) as with CDAI (r = 0.09). We conclude that severity of enteric protein loss is not closely related to the degree of abnormality of commonly used measures of disease activity in young patients with Crohn's disease. In contrast, in patients with ulcerative colitis, alpha 1-antitrypsin clearance correlated more consistently with clinical assessment of inflammatory activity (p less than 0.001).
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PMID:Enteric protein loss measured by fecal alpha 1-antitrypsin clearance in the assessment of Crohn's disease activity: a study of children and adolescents. 349 90

Leucocyte elastase is a neutral proteinase which plays an important role in the pathogenesis of inflammatory disorders. Infiltration of bowel mucosa by neutrophil and eosinophilic granulocytes is a characteristic feature of chronic inflammatory bowel diseases. We studied plasma elastase in 44 patients suffering from Crohn's disease or ulcerative colitis. Plasma levels were significantly higher in these patients compared to 7 patients with non-inflammatory bowel diseases or 53 healthy controls. Elevated plasma levels were more often found in patients with active inflammation than in those with inactive disease. Elastase did neither correlate with leucocyte counts, serum albumin, ESR, alpha 1-proteinase inhibitor and orosomucoid nor with clinical indices or the faecal excretion of 111In-labelled granulocytes. In serial studies of 15 patients, elastase did not always run parallel to the disease activity. We conclude that plasma elastase does not reliably indicate the inflammatory activity in chronic inflammatory bowel diseases.
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PMID:Leucocyte elastase in chronic inflammatory bowel diseases: a marker of inflammatory activity? 365 Jan 81

The charts of 64 patients with Crohn's ileitis were reviewed to determine what characteristics at the time of first observation at a specialized center were predictive of surgery for irreversible obstruction, using Cox's proportional hazard model. Individual variables which proved significant (P less than 0.01) included age at presentation to the clinic, serum albumin, sedimentation rate, and the presence of radiologic strictures. Patients eventually requiring surgery were older than the rest because of a later date of symptom onset; furthermore, patients with strictures on initial x-rays had not been ill for a longer period of time than those who did not have strictures. These data suggest that fibrosis and stenosis are characteristic of a subgroup of Crohn's patients, rather than being inevitable phases of disease evolution. Multivariate analysis revealed that patients with low serum albumin, high sedimentation rate, and roentgenologic stenosis at first observation were ten times as likely to require surgery for obstruction at 10 years than those without any of these three unfavorable parameters.
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PMID:Prediction of surgery for obstruction in Crohn's ileitis. A study of 64 patients. 369 Dec 76

Serum antibodies of immunoglobulin G, immunoglobulin M, and immunoglobulin A isotypes to five major proteins of cow's milk, casein, bovine serum albumin, alpha-lactalbumin, beta-lactoglobulin A, and beta-lactoglobulin B, were measured using enzyme-linked immunosorbent assay in 51 patients with ulcerative colitis, 49 with Crohn's disease, and 20 age-matched controls. Immunoglobulin G and immunoglobulin M antibodies to cow's milk proteins were significantly elevated in patients with inflammatory bowel disease as compared to controls. In contrast, no significant increase in immunoglobulin A antibodies to 3 of 5 proteins was noted. The increased titers of antibodies to milk proteins seem to be specific and not due to a polyclonal immunoglobulin activation, as naturally occurring blood group antibodies were not elevated in patients with ulcerative colitis and Crohn's disease. A good correlation of disease activity, as measured by serum alpha 1-acid glycoprotein concentrations, and immunoglobulin G and immunoglobulin A antibody titers against certain cow's milk proteins could be demonstrated in Crohn's disease, but not ulcerative colitis. These findings suggest that production of antibodies to cow's milk proteins reflects specific immunization with these antigens. The study of antibody isotypes and correlation with disease activity may provide better insight into the immune response to dietary antigens and its possible role in the pathogenesis of inflammatory bowel diseases.
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PMID:Serum antibodies to cow's milk proteins in ulcerative colitis and Crohn's disease. 379 84

The role of parenteral nutrition with complete bowel rest in the management of active Crohn's disease was evaluated retrospectively in 100 patients who were otherwise refractory to conventional medical management. Ninety patients received complete nutrient replacement and 10 received protein-sparing therapy. In 77 patients, a clinical remission was achieved. Analysis of subgroups revealed that the remission rate was equivalent in patients with subacute bowel obstruction (76%), inflammatory mass (82%), and otherwise uncomplicated severe active disease (89%). However, those patients with fistulae responded less well (63%). The location of the intestinal involvement with the disease did not influence the remission rate (73% in those with small bowel disease only and 78% in those with combined small and large bowel disease). All six patients with only large bowel involvement achieved a remission. In 81% of those patients with a remission, no corticosteroids were given, or the dose prior to TPN was maintained. The serum albumin improved significantly (p less than 0.001) from 3.2 +/- 0.1 to 3.6 +/- 0.1 g/dl with total parenteral nutrition, but there was no significant effect on the hematocrit (p greater than 0.5). The percentage of patients still in remission after 3 months and 1 yr of follow-up was 75 to 79 and 58 to 61%, respectively, in the three nonfistulous groups, and 46 and 36%, respectively, in those with fistulous disease. Thus total parenteral nutrition with complete bowel rest appears to be an effective therapeutic modality in the primary management of complicated Crohn's disease.
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PMID:Total parenteral nutrition and complete bowel rest in the management of Crohn's disease. 392 72

A screening study was conducted to identify malnutrition in gastroenterology outpatients and to ascertain whether poor food intake is a contributing factor. A 48-hour recall method was used to collect dietary data from 154 patients (87 women and 67 men). Fourteen (16%) of the women and 8 (12%) of the men were classified as having protein-energy malnutrition (PEM) on the basis of abnormal anthropometric measurements or low serum albumin concentration. PEM was found in several diagnostic groups, but 9 of the 14 malnourished women had Crohn's disease. Protein undernutrition was more evident in women; calorie undernutrition was more evident in men. More women than men had low serum albumin levels. Low hemoglobin levels were particularly prevalent among patients with Crohn's disease. Many of the patients, especially women, had "inadequate" and "marginal" intakes of folate, vitamin A, thiamin, and calcium according to Nutrition Canada interpretive standards. The intake of iron was particularly poor among women: 59% of the intakes of female patients were classified as inadequate (less than 10 mg/day). Ten of the 14 female patients with PEM had inadequate iron intakes. Serum folates of less than 5 ng/ml were present in 72% of the women and 77% of the men. The data suggest that gastrointestinal outpatients are at high risk of malnutrition and that one of the factors contributing to the problem is inadequate food intake.
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PMID:Protein-energy malnutrition in gastroenterology outpatients: increased risk in Crohn's disease. 393 1

The value of the Crohn's disease activity index (CDAI) in defining clinical remission in Crohn's disease has been assessed in 71 studies using a new method to quantitate gut inflammatory activity: faecal 111In-labelled granulocyte excretion. The range of faecal 111In granulocyte excretion in the irritable bowel syndrome was found to be 0.2-1.9% (mean +/- SD 0.98 +/- 0.55%) of injected dose. 63 (89%) of studies with a CDAI less than 150 and 88% of studies with a serum albumin greater than 35 g/l had faecal 111In granulocyte excretion above the upper limit found in the irritable bowel syndrome ranging from 2.4% to 40%. This study shows that the majority of patients with Crohn's disease in clinical remission have significant gut inflammatory activity. Whether treatment of this activity will alter the natural history of the disease needs prospective evaluation.
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PMID:Clinical remission in Crohn's disease--assessment using faecal 111In granulocyte excretion. 394 92


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