Interventions for the management of abdominal pain in Crohn's disease and inflammatory bowel disease

AbstractFor many years, there has been a concern that inflammatory bowel disease carries an increased lymphoma risk. At the same time, patients with intestinal lymphomas are occasionally misdiag-nosed as having Crohn’s disease. We report a case of T-cell lymphoma of the bowel misdiag-nosed as Crohn’s disease, which illustrates the diagnostic challenges posed by peripheral extranodal lymphomas. A 68-year old female presented with clinical symptoms (diarrhoea, abdominal pain, poor appetite and significant weight loss), and colonoscopic and initial histological findings that were similar to inflammatory bowel disease. She was diagnosed with Crohn’s disease and received treatment with sulfasalazine with subsequent improvement of symptoms. Eight months after the initial diagnosis the patient experienced sudden abdominal pain. Laparotomy revealed necrosis in the small and large intestine and ileostomy was performed. On day 10 of a complicated postoperative period the patient died. Post-mortem histopathological examination of small and large intestine revealed highly malignant peripheral T-cell lymphoma, not otherwise specified. Differentiation of intestinal T-cell lymphoma from Crohn’s disease continues to be a challenge, because clinical, colonoscopic, radiological and histopathological findings can mimic Crohn’s disease. Careful multi-disciplinary assessment and knowledge of this rare disorder is crucial for timely diagnosis.

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Crohn’s disease

InnovAiT Education and inspiration for general practice ◽

10.1177/1755738018772321 ◽

2018 ◽

Vol 11 (8) ◽

pp. 435-442

Author(s):

James Franklin

Keyword(s):

Inflammatory Bowel Disease ◽

Weight Loss ◽

Crohn’S Disease ◽

Abdominal Pain ◽

Gastrointestinal Tract ◽

Crohn's Disease ◽

Terminal Ileum ◽

Bowel Disease ◽

Rare Condition ◽

Inflammatory Bowel

Crohn’s disease is a chronic relapsing gastrointestinal condition. It is an inflammatory bowel disease that can affect any part of the gastrointestinal tract from mouth to anus, but most commonly affects the terminal ileum and colon. Individuals can present with a wide variety of symptoms, but diarrhoea, abdominal pain and weight loss are the most common. It is a rare condition, but GPs play an important role in recognising Crohn’s disease and supporting patients through their lifelong treatment.

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P200 Celiac disease (CD) and CHRONIC INFLAMMATORY BOWEL DISEASE (IBD) association

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.326 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S264-S265

Author(s):

S Hmimass ◽

I Benelbarhdadi ◽

N Lagdali ◽

M Borahma ◽

F Z Ajana

Keyword(s):

Inflammatory Bowel Disease ◽

Crohn’S Disease ◽

Abdominal Pain ◽

Celiac Disease ◽

Crohn's Disease ◽

Bowel Disease ◽

The Other ◽

Chronic Inflammatory Bowel Disease ◽

Inflammatory Bowel ◽

Chronic Inflammatory Bowel

Abstract Background Association Celiac disease (CD) and CHRONIC INFLAMMATORY BOWEL DISEASE (IBD) is rare. the aim of the study is to determine the frequency as well as the anatomical and evolutionary characteristics of this association. Methods This is a retrospective descriptive and analytical study of 10 patients between 2005 and 2020. The diagnosis of CD was established after careful clinical examination and questioning, on the determination of specific auto antibodies against transglutaminase type Ig A and endomysium and on the histological study of duodenal biopsies showing a IEL> 30%. And that of IBD was based on a range of clinical, endoscopic, histological and radiological arguments Results 10 cases of association CD and IBD were diagnosed in a cohort of 267 CD, 960 Crohn’s disease and 520 Haemorrhagic rectocolitis. The frequency of association was 3.7% in the cohort of CD, 0.9% In the Crohn’s disease cohort and 0.2% in the cohort of Haemorrhagic rectocolitis. Predominantly female, 80% female and 20% male. The diagnosis of CD preceded that of Crohn’s disease in 80% (n=8), with an average delay of 32 months (12–72 months). All patients were put on a gluten-free diet (GFD). Despite good therapeutic compliance for at least 18 months, the evolution was marked by the persistence of anaemic syndrome and dysenteric syndrome in six cases (60%), diarrhoea and colic-type abdominal pain in four cases (40%). And an occurrence of rectorragie, anaemic syndrome and dysenteric syndrome in two cases (20%). In front of the persistence of symptoms, we first eliminated a resistance to GFD. Then an upper and lower digestive, radiological and histological endoscopic assessment concluded that there was an isolated colonic crohn’s disease in five (50%) of the patients; gastric and colonic in three (30%). 60% (n=6) of the patients had luminal and stenotic involvement in two patients. The diagnosis of IBD preceded that of celiac disease in 20% (n=2), one patient had luminal colonic Crohn’s disease and one patient had left Haemorrhagic rectocolitis. The diagnosis of CD was clinically retained by the appearance of an associated anemic syndrome in one case with atypical abdominal pain, and with dysenteric syndrome in the other case. Serologically, one was positive for anti transglutaminase type Ig A and the other was seronegative. Histologically, both patients had a IEL >30% with subtotal atrophy. The evolution was favourable on the GFD, which was always followed up alongside the treatment of IBD, with good clinical and endoscopic improvement Conclusion The association between CD and IBD is possible, albeit rare. It is necessary to think about the search for it whenever there is a persistence or appearance of other evocative symptoms despite good therapeutic compliance.

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Localization and Activity of Inflammatory Bowel Disease Using 111ln Leukocyte Imaging

Nuklearmedizin ◽

10.1055/s-0038-1629438 ◽

1988 ◽

Vol 27 (03) ◽

pp. 83-86 ◽

Cited By ~ 3

Author(s):

B. Briele ◽

F. Wolf ◽

H. J. Biersack ◽

F. F. Knapp ◽

A. Hotze

Keyword(s):

Inflammatory Bowel Disease ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Disease Activity ◽

Bowel Disease ◽

Cell Uptake ◽

Disease Extent ◽

Bowel Diseases ◽

Inflammatory Bowel ◽

Leukocyte Imaging

A prospective study was initiated to compare the clinically proven results concerning localization/extent and activity of inflammatory bowel diseases with those of 111ln-oxine leukocyte imaging. All patients studied were completely examined with barium enema x-ray, clinical and laboratory investigations, and endoscopy with histopathology. A total of 31 leukocyte scans were performed in 15 patients (12 with Crohn’s disease, 3 with ulcerative colitis). The scans were graded by comparing the cell uptake of a lesion (when present) and a bone marrow area providing a count ratio (CR). The inflammatory lesions were correctly localized on 26 leukocyte scans, and in 21 scans the scintigraphically estimated extent of disease was identical to endoscopy. In 5 cases the disease extent was underestimated, 4 scans in patients with relapse of Crohn’s disease were falsely negative, and in one patient with remission truly negative. The scintigraphically assessed disease activity was also in a good agreement with clinical disease activity based on histopathology in all cases. We conclude that leukocyte imaging provides valuable information about localization and activity of inflammatory bowel disease.

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CLINCAL EFFECTIVENESS OF GOLIMUMAB IN CROHN’S DISEASE – AN OBSERVATIONAL STUDY BASED ON THE SWEDISH NATIONAL QUALITY REGISTRY FOR INFLAMMATORY BOWEL DISEASE

10.26226/morressier.59a6b348d462b80290b54e3d ◽

2017 ◽

Author(s):

Sara Rundquist

Keyword(s):

Inflammatory Bowel Disease ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Observational Study ◽

Bowel Disease ◽

Quality Registry ◽

National Quality ◽

Inflammatory Bowel ◽

National Quality Registry

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Prebiotics and Probiotics in Inflammatory Bowel Disease: Where are we now and where are we going?

Current Clinical Pharmacology ◽

10.2174/1574884715666200312100237 ◽

2020 ◽

Vol 15 (3) ◽

pp. 216-233 ◽

Cited By ~ 1

Author(s):

Maliha Naseer ◽

Shiva Poola ◽

Syed Ali ◽

Sami Samiullah ◽

Veysel Tahan

Keyword(s):

Ulcerative Colitis ◽

Inflammatory Bowel Disease ◽

Clinical Trials ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Adverse Effects ◽

Bowel Disease ◽

Relapse Prevention ◽

Remission Induction ◽

Inflammatory Bowel

The incidence, prevalence, and cost of care associated with diagnosis and management of inflammatory bowel disease are on the rise. The role of gut microbiota in the causation of Crohn's disease and ulcerative colitis has not been established yet. Nevertheless, several animal models and human studies point towards the association. Targeting intestinal dysbiosis for remission induction, maintenance, and relapse prevention is an attractive treatment approach with minimal adverse effects. However, the data is still conflicting. The purpose of this article is to provide the most comprehensive and updated review on the utility of prebiotics and probiotics in the management of active Crohn’s disease and ulcerative colitis/pouchitis and their role in the remission induction, maintenance, and relapse prevention. A thorough literature review was performed on PubMed, Ovid Medline, and EMBASE using the terms “prebiotics AND ulcerative colitis”, “probiotics AND ulcerative colitis”, “prebiotics AND Crohn's disease”, “probiotics AND Crohn's disease”, “probiotics AND acute pouchitis”, “probiotics AND chronic pouchitis” and “prebiotics AND pouchitis”. Observational studies and clinical trials conducted on humans and published in the English language were included. A total of 71 clinical trials evaluating the utility of prebiotics and probiotics in the management of inflammatory bowel disease were reviewed and the findings were summarized. Most of these studies on probiotics evaluated lactobacillus, De Simone Formulation or Escherichia coli Nissle 1917 and there is some evidence supporting these agents for induction and maintenance of remission in ulcerative colitis and prevention of pouchitis relapse with minimal adverse effects. The efficacy of prebiotics such as fructooligosaccharides and Plantago ovata seeds in ulcerative colitis are inconclusive and the data regarding the utility of prebiotics in pouchitis is limited. The results of the clinical trials for remission induction and maintenance in active Crohn's disease or post-operative relapse with probiotics and prebiotics are inadequate and not very convincing. Prebiotics and probiotics are safe, effective and have great therapeutic potential. However, better designed clinical trials in the multicenter setting with a large sample and long duration of intervention are needed to identify the specific strain or combination of probiotics and prebiotics which will be more beneficial and effective in patients with inflammatory bowel disease.

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The Changing Prognosis of Ulcerative Colitis and Crohn’s Disease by Decades

Crohn's & Colitis 360 ◽

10.1093/crocol/otab008 ◽

2021 ◽

Author(s):

Burton I Korelitz ◽

Judy Schneider

Keyword(s):

Ulcerative Colitis ◽

Inflammatory Bowel Disease ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Medical Therapy ◽

Bowel Disease ◽

Surgical Intervention ◽

Inflammatory Bowel

Abstract We present a bird’s eye view of the prognosis for both ulcerative colitis and Crohn’s disease as contained in the database of an Inflammatory Bowel Disease gastroenterologist covering the period from 1950 until the present utilizing the variables of medical therapy, surgical intervention, complications and deaths by decades.

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Leucine-rich alpha-2 glycoprotein is a potential biomarker to monitor disease activity in inflammatory bowel disease receiving adalimumab: PLANET study

Journal of Gastroenterology ◽

10.1007/s00535-021-01793-0 ◽

2021 ◽

Author(s):

Shinichiro Shinzaki ◽

Katsuyoshi Matsuoka ◽

Hiroki Tanaka ◽

Fuminao Takeshima ◽

Shingo Kato ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Disease Activity ◽

Bowel Disease ◽

Fecal Calprotectin ◽

Potential Biomarker ◽

Adalimumab Therapy ◽

Adalimumab Treatment ◽

Inflammatory Bowel

Abstract Background This multicenter prospective study (UMIN000019958) aimed to evaluate the usefulness of serum leucin-rich alpha-2 glycoprotein (LRG) levels in monitoring disease activity in inflammatory bowel disease (IBD). Methods Patients with moderate-to-severe IBD initiated on adalimumab therapy were enrolled herein. Serum LRG, C-reactive protein (CRP), and fecal calprotectin (fCal) levels were measured at week 0, 12, 24, and 52. Colonoscopy was performed at week 0, 12, and 52 for ulcerative colitis (UC), and at week 0, 24, and 52 for Crohn’s disease (CD). Endoscopic activity was assessed using the Simple Endoscopic Score for Crohn’s Disease (SES-CD) for CD and the Mayo endoscopic subscore (MES) for UC. Results A total of 81 patients was enrolled. Serum LRG levels decreased along with improvements in clinical and endoscopic outcomes upon adalimumab treatment (27.4 ± 12.6 μg/ml at week 0, 15.5 ± 7.7 μg/ml at week 12, 15.7 ± 9.6 μg/ml at week 24, and 14.5 ± 6.8 μg/ml at week 52), being correlated with endoscopic activity at each time point (SES-CD: r = 0.391 at week 0, r = 0.563 at week 24, r = 0.697 at week 52; MES: r = 0.534 at week 0, r = 0.429 at week 12, r = 0.335 at week 52). Endoscopic activity better correlated with LRG compared to CRP and fCal on pooled analysis at all time points (SES-CD: LRG: r = 0.636, CRP: r = 0.402, fCal: r = 0.435; MES: LRG: r = 0.568, CRP: 0.389, fCal: r = 0.426). Conclusions Serum LRG is a useful biomarker of endoscopic activity both in CD and UC during the adalimumab treatment.

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