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Query: UMLS:C0021831 (enteropathy)
 4,403 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The records of a series of 700 patients with inflammatory bowel disease, 498 with Crohn's disease and 202 with ulcerative colitis, have been analyzed to determine the relative incidence and characteristic features of their extra-intestinal manifestations. The group with Crohn's disease included 62 with colitis, 223 with ileocolitis, and 213 with regional enteritis. A consideration of the clinical patterns and an understanding of their pathophysiology suggested a subdivision into two main groups: one "colitis related" and one related to the pathophysiology of the small nonspecific third group. Group A, colitis related, comprises joint, skin, mouth, and eye disease. The complications might be immunologically determined, were closely associated with active inflammation, and often responded to medical or surgical treatment of the underlying bowel disease. They occurred in 36% of the entire series of patients: joints were involved in 23%, skin in 15%, and mouth and eye each in 4%. Pyoderma gangrenosum was observed most often in ulcerative colitis and erythema nodosum most often in granulomatous colitis. The incidence of Group A complications was higher in disease involving the colon (42%) than in disease restricted exclusively to the small bowel (23%). There were interrelationships among the various members of Group A, with multiple manifestations occurring in a third of affected patients. Group B, related to small bowel pathophysiology, includes malabsorption, gallstones, kidney stones, and non-calculous hydronephrosis and hydroureter. Disorders in this group were generally related to the severity of the disease in the small bowel and tended to persist even in the absence of active inflammation. In contrast to Group A, this group occurred most frequently in small bowel disease, and least in colonic disease. Malabsorption was virtually confined to the patients with small bowel disease (10% incidence), while gallstones and renal stones were also both more frequent in Crohn's disease (11% and 9% respectively), the latter usually in association with small bowel resection or ileostomy. Group C, found in a small percentage of patients, consists of nonspecific complications, including osteoporosis (3%), liver disease (5%), peptic ulcer (10%), and amyloidosis (1%).
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PMID:The extra-intestinal complications of Crohn's disease and ulcerative colitis: a study of 700 patients. 95 99

We describe a patient with a highly unusual appearance of pyoderma gangrenosum. The pyoderma was located on the auricular region and preceded other manifestations of inflammatory bowel disease by 11 years. There was no correlation between the course of the pyoderma and the clinical activity of the associated bowel disease. Mycotic superinfections masked and delayed the diagnosis in our patient for several years. Only when typical pyoderma gangrenosum lesions developed on the legs at the site of trauma and responded dramatically to systemic corticosteroids was the correct diagnosis established. Pyoderma gangrenosum with secondary fungal infection was thus distinguished from deep ulcerated skin fungal infection simulating pyoderma.
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PMID:Atypical auricular pyoderma gangrenosum simulating fungal infection. 279 34

This review focuses on the behavior and pathogenesis of selected dermatologic and rheumatologic manifestations of inflammatory bowel disease. Erythema nodosum, the most common skin lesion, correlates with activity of the bowel disease but not with its duration or extent. Resolution occurs with therapy of inflammatory bowel disease. Pyoderma gangrenosum, the most severe skin lesion, bears little relationship to the activity or extent of the colitis. Therapy is usually supportive, but dapsone and steroids appear promising. Immune and vasculitic mechanisms have been postulated for both skin lesions. Peripheral arthritis usually has its onset with or after the development of colitic symptoms. It worsens with exacerbation of bowel inflammation and responds to treatment of the bowel disease. Immune mechanisms are likely. Spondyloarthropathy usually occurs before the onset of overt intestinal disease. Its course is unrelated to the bowel inflammation, it does not respond to treatment of bowel disease, and it is associated with HLA B27.
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PMID:Selected rheumatologic and dermatologic manifestations of inflammatory bowel disease. 327 91

Pyoderma gangrenosum is a cutaneous disorder associated with systemic diseases such as ulcerative colitis, Crohn's disease, rheumatoid arthritis, and blood dyscrasias. We are reporting two cases of pustular pyoderma gangrenosum associated with ulcerative colitis. One patient had inactive bowel disease when she developed her third episode of pustules, erosions, and nodules on the left leg. The other patient exhibited a widespread painful vesiculopustular eruption that coincided with the onset of her colitis. Both patients presented with pustules as the primary manifestation of their pyoderma gangrenosum. Histologic examination of skin from both patients revealed an acute perifollicular inflammation. Pyoderma gangrenosum should be considered in the differential diagnosis of pustular disorders in children with underlying conditions such as ulcerative colitis.
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PMID:Pustular pyoderma gangrenosum associated with ulcerative colitis in childhood. Report of two cases and review of the literature. 377 39

The authors examined 1132 patients with chronic ulcerative colitis (CUC) seen at the Cleveland Clinic to clarify the relationship between the clinical features of colitis and the incidence and severity of erythema nodosum (EN) and pyoderma gangrenosum (PG). There were 21 patients (2%) with EN and 21 (2%) with PG, both of which affected those with active and extensive colitis. CUC was inactive in only 10% of the EN group and 20% of the PG group; it was left-sided in 20% of the EN group and 15% of the PG group. The mean duration of CUC before the appearance of EN and PG was 5 and 10 years, respectively. Three patients had consulted a dermatologist for PG before a clinical diagnosis of CUC was made. EN and PG recurred in 20 and 33% of cases, respectively. EN appeared almost exclusively on the legs, while PG appeared on various areas of the skin, including the site of ileostomy in one patient. EN was controlled with adequate medical or surgical treatment of CUC, but PG was relatively refractory, requiring specific treatment of its own in 30% of patients. In one case each, EN and PG recurred after subtotal colectomy but had resolved completely after proctectomy. In one patient, PG developed for the first time 1 year after total colectomy. Less than half of EN patients and two-thirds of PG patients ultimately had to undergo colectomy because of bowel disease. No patient required colectomy because of skin lesions.
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PMID:Clinical course and evolution of erythema nodosum and pyoderma gangrenosum in chronic ulcerative colitis: a study of 42 patients. 402 77

A review of our records disclosed eight children with pyoderma gangrenosum. All had associated inflammatory bowel disease, and four had arthritis. In three patients the bowel disease was severe and required resection of portions of the affected bowel. The cutaneous lesions had a chronic course (average duration, 2 1/2 years), and systemic therapy was required in seven cases. Previously reported cases of pyoderma gangrenosum in children are reviewed, and the management of this skin disorder in childhood is discussed.
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PMID:Pyoderma gangrenosum in childhood. 672 42

Pyoderma gangrenosum is most commonly associated with inflammatory bowel disease and rheumatoid arthritis, but it has been associated with various haematological malignancies. A 54-year-old man with no history of bowel disease or arthritis presented with a leg ulcer, which healed after treatment. Results of bone marrow aspiration were compatible with primary thrombocythaemia. Seven weeks later there were pronounced recurrence of the ulceration and pyoderma gangrenosum was diagnosed. The appearance of pyoderma gangrenosum associated with blood disorders may differ from that associated with bowel and joint disease.
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PMID:Pyoderma gangrenosum associated with primary thrombocythaemia. 681 Oct 33

A retrospective study of nine patients with active pyoderma gangrenosum at the time of operation for inflammatory bowel disease showed two patterns of postoperative skin healing: 1) prompt healing within 2 months, occurred in five patients with moderate to severe inflammatory bowel disease. 2) skin disease persisted in four others, healing only after a year. Three of these patients had mild ulcerative colitis, and in them, the operation was carried out in the hope of curing crippling pyoderma gangrenosum. The fourth patient had only an intestinal bypass for ileitis. Our observations suggest that prompt skin healing may occur after surgery in patients with severe inflammatory bowel disease, but not necessarily in those with milder bowel disease or in those in whom some bowel disease persists.
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PMID:Does intestinal resection heal the pyoderma gangrenosum of inflammatory bowel disease? 686 78

If one reviews the literature with zeal, it is increasingly apparent that few organs escape recruitment when IBD is chronic or progressive. Insights into mucosal pathophysiology have helped with understanding the more frequent extraintestinal manifestations, but the mechanisms attendant to the development of less common events (e.g. acute pancreatitis, concurrent gluten sensitive enteropathy, or active pulmonary disease) remain either poorly studied or obscure. It is particularly interesting, however, to read reports of abnormal pulmonary function, generally of the obstructive type, correlated to measurements of abnormal intestinal permeability in patients with either active pulmonary sarcoid or pulmonary involvement in Crohn's disease. It has been further speculated that similarities in the mucosal immune system of the lung and intestine are responsible for evidence of bronchial hyperreactivity in patients with active IBD. Finally, it is important to recognize that extensions of the inflammatory process are not restricted to the development of organ-based events but may be responsible for some of the most frequent systemic abnormalities detected in IBD patients. It is now also well confirmed that the cytokine environment in IBD can support activated coagulation and, in some clinical situations, overt vascular thrombosis. The cerebrovascular complications of IBD are well recognized and range from peripheral venous thrombosis to central stroke syndromes and pseudotumor cerebri. Reports of focal white matter lesions in the brains of patients with IBD or an increased incidence of polyneuropathy may be other clinical examples of regional microvascular clotting. Microvascular injury appears to be more ubiquitously present, with reports ranging from a speculated primary causative role (e.g., granulomatous vasculitis in the mesenteric circulation) to the utility of nailbed vasospasm, in Crohn's disease, as a clinical marker for disease activity. It is also reported that IL-6 suppression of erythropoietin production is a major feature of the chronic anemia seen in active IBD. Moreover, the capacity of peripheral monocytes from active IBD patients to secrete TNF and IL-8 is reported predictive for the degree of therapeutic response from recombinant erythropoietin. These collected observations constitute another excellent example of the symmetry between basic science and clinical utility. It is from the context of applied basic science that many future therapies will arise. Empiricism will lose much of its appeal as clinical observations will be increasingly translated into cellular language. Already in animal models, elemental diets diminish IL-6-related acute inflammatory injury, and reductions in dietary lipid alter the antigenicity of bacteria. Provocatively, in humans, unconfirmed reports have even associated diet therapy with the resolution of uveitis and pyoderma gangrenosum. It is likely that efforts will also be made to induce oral tolerance if specific triggering proteins are discovered or to alter bowel flora if such an arcane area of investigation becomes resurgent.
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PMID:Extraintestinal considerations in inflammatory bowel disease. 880 40

Pyoderma gangrenosum (PG) is an ulcerating noninfectious disease of the skin seen in 1 to 5% of patients with inflammatory bowel disease. The pathogenesis of PG has yet to be determined but may be related to abnormal T cell responses and the production of TNF-alpha, a powerful proinflammatory cytokine. Infliximab, a chimeric monoclonal antibody to TNF-alpha, has been approved for the treatment of Crohn's disease. We present four patients with PG treated with Infliximab for fistulizing Crohn's in whom complete healing of PG was achieved. Four patients with active fistulizing Crohn's disease and PG were treated. All patients were females ranging in age from 48 to 60 years, with a mean age of 54 years. Three of four patients had PG lesions located on the lower extremities; one patient had peristomal disease. All patients had at least colonic involvement of their Crohn's. The patients received either a single infusion or a series of three 5 mg/kg Infliximab infusions. All four patients demonstrated rapid healing of PG within 4 weeks of the first infusion of Infliximab. PG healing followed improvement in bowel disease. Complete resolution without recurrence was noted in all patients. Rapid resolution of PG was noted in four female patients with fistulizing Crohn's disease treated with Infliximab. Healing was complete, without recurrence. The anti-TNF-alpha properties of Infliximab suggest that healing may be mediated by the drug's effect on cytokine pathways, perhaps by blunted T cell activation early in the inflammatory cascade. We suggest an independent effect of Infliximab on PG.
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PMID:Treatment of pyoderma gangrenosum with infliximab in Crohn's disease. 1548 18


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