Unusual presentation of Crohn’s disease

2021 ◽  
Vol 14 (6) ◽  
pp. e242703
Author(s):  
Kate Edwards ◽  
Karen Yearsley
Keyword(s):  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Wedge Resection ◽  
Rare Condition ◽  
Unusual Presentation ◽  
Protein Losing Enteropathy ◽  
Inflammatory Bowel ◽  
Alpha 1 Antitrypsin ◽  
Underlying Pathophysiology

A previously well 37-year-old woman attended the emergency assessment unit with symptoms of lethargy, breathlessness and peripheral oedema, whereby initial basic investigations revealed an iron deficiency anaemia and serum hypoalbuminaemia. The patient subsequently had multiple admissions to secondary care over a 2-year period due to worsening peripheral and central oedema. Investigations ruled out non-gastrointestinal causes of serum hypoalbuminaemia, such as renal, cardiac and hepatic failures. Gastrointestinal investigations later revealed raised faecal alpha-1 antitrypsin and small bowel ulceration on capsule endoscopy, with a histological diagnosis of Crohn’s disease made after a small bowel wedge resection. This case describes the unusual presentation of Crohn’s disease displaying symptoms primarily of protein-losing enteropathy, an uncommon and under-recognised consequence of inflammatory bowel disease. A review of current literature and the underlying pathophysiology for this rare condition are discussed, particularly in relation to Crohn’s disease.

P108 TEDUGLUTIDE USE IN CROHN’S DISEASE: A CASE SERIES

2020 ◽  
Vol 26 (Supplement_1) ◽  
pp. S23-S23
Author(s):  
Adeeti Chiplunker ◽  
Christina Ha ◽  
Shirley Paski
Keyword(s):  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Median Duration ◽  
Dose Adjustment ◽  
Medical Center ◽  
Case Series ◽  
Dose Interval ◽  
Retrospective Case ◽  
Inflammatory Bowel

Abstract Background Teduglutide is a glucagon-like peptide-2 (GLP-2) analogue with trophic effects on the intestinal mucosa to increase the absorptive surface area and enhance nutrient and fluid absorption of the small bowel (SB).1 It has been shown to reduce parenteral nutrition (PN) and intravenous fluid (IVF) requirements and is an important adjunct in the medical management of short bowel syndrome (SBS).1–2 Crohn’s disease (CD) is an important etiology of SBS but use of teduglutide in this population can be challenging. Aim The aim of this case series was to describe the use of teduglutide in CD patients. Methods A retrospective case series of all CD patients with SBS who used teduglutide at the Inflammatory Bowel Disease Center at Cedars-Sinai Medical Center. Age, duration of SBS, length of remaining SB and colonic continuity status were recorded. BMI, average daily PN kilocalories (kcal), and IVF requirements were recorded at the time of teduglutide initiation. The duration of teduglutide use was calculated. Teduglutide dose, dose adjustment history, reason for dose adjustment, and therapy complications were noted. Results 9 patients were included (5 male/4 female). Median age was 57 years (IQR 32). Median length of remaining small bowel was 60cm (IQR 27.5) and median duration of SBS was 8 years (IQR 9.83). Median BMI at teduglutide initiation was 18.66 (IQR 4.29) with a median duration of PN of 4.5 years (IQR 9.42) and median PN kcal/day of 971.43 (IQR 518). The median duration of teduglutide was 1.1 years (IQR 3.4). 4 patients (44%) had a teduglutide dose change. 2 patients had dose interval extended from daily to every other day to reduce injection burden. 1 patient developed obstructive symptoms on daily dosing, which resolved when the dose interval was extended to every other day. 1 patient had to stop therapy due to a small bowel obstruction requiring hospitalization. 8 patients (88%) were able to wean or stop PN/IVF with addition of teduglutide. 1 patient had to restart PN despite teduglutide therapy. Table 1. Discussion Teduglutide is effective in Crohn’s disease patients and facilitates weaning of PN and IVF requirements. Most patients tolerate the recommended dose with daily injections, but the dose interval can be extended to every other day to reduce obstructive symptoms or reduce the injection burden without affecting ability to wean PN/IVF. References

Crohn’s disease

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.

scholarly journals P410 Which patients with established Crohn’s disease benefit most from the use of the Patency capsule test prior to small bowel capsule endoscopy?

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S417-S418
Author(s):  
A Elosua Gonzalez ◽  
M Rullan Iriarte ◽  
S Rubio Iturria ◽  
C Rodríguez Gutiérrez ◽  
M Vicuña Arregui ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Capsule Endoscopy ◽  
Bowel Disease ◽  
Inflammatory Markers ◽  
Postoperative Recurrence ◽  
Mucosal Healing ◽  
Routine Clinical Setting ◽  
Inflammatory Bowel

Abstract Background An important factor that limits a wider utilization of small bowel capsule endoscopy (SBCE) in Crohn’s Disease (CD) is the potential risk of retention. The Patency® capsule (PC) lowers the risk of SBCE retention by assessing pre-procedure intestinal patency. Our aims were to evaluate the use of PC in patients with established CD in routine clinical practice and to identify predictive factors of intestinal patency in CD patients. Methods We included all patients with CD followed in the Inflammatory Bowel Disease Unit of the Complejo Hospitalario de Navarra in which a SBCE was performed from 01/01/2008 to 31/12/2019. An intact PC excreted in its original shape within 30 hours after swallowing was considered a positive patency test. Results A total of 465 SBCE were indicated in 333 patients. In 61.9% a previous patency test with PC was performed, with significant differences in its use according to the age at diagnosis according to the Montreal classification (A1 75.9%, A2 64.8%, A3 46.1%) and behaviour (B2 81.3%, B3 80%, B1 54.2%), the indication (postoperative recurrence monitoring 87.2%, flare 65.5%, staging small bowel disease 52.4%, assessing mucosal healing 44.8%) and the presence of previous CD surgery (68.6% vs. 55.6%). In 33 cases (7%) SBCE was contraindicated due to negative patency test. Eleven SBCE were retained of the 432 procedures finally performed (incidence 2.5%; 95% CI 1.06%-4.02%). Retention occurred in 5.6% of procedures without prior PC compared to 0.4% with previous PC (p<0.001). Stricturing disease (OR 2.94; 1.31-6.58), penetrating disease (OR 3.85; 1.59-9.31) and presence of elevated inflammatory markers (OR 3.73; 1.85-7.50) were identified as independent factors associated with retention (negative PC test or SBCE retention) in the multivariate analysis. Conclusion A patency test prior to SBCE was performed in 61.9% of patients with known CD. The use of PC is associated with a lower risk of SBCE retention in a routine clinical setting. Patients with stricturing or penetrating disease or elevation of inflammatory markers have significantly higher risk of retention and would therefore benefit from a pre-SBCE PC.

scholarly journals Reduced expression of COVID-19 host receptor, ACE2 is associated with small bowel inflammation, more severe disease, and response to anti-TNF therapy in Crohn’s disease

2020 ◽  
Author(s):  
Alka A. Potdar ◽  
Shishir Dube ◽  
Takeo Naito ◽  
Gregory Botwin ◽  
Talin Haritunians ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Severe Disease ◽  
Angiotensin Converting Enzyme 2 ◽  
Transcriptomic Data ◽  
Inflammatory Bowel ◽  
Poor Outcomes ◽  
Ileal Tissue ◽  
Worse Prognosis

AbstractAngiotensin-Converting Enzyme 2 (ACE2) has been identified as the host receptor for SARS-coronavirus 2 (SARS-CoV-2) which has infected millions world-wide and likely caused hundreds of thousands of deaths. Utilizing transcriptomic data from four cohorts taken from Crohn’s disease (CD) and non-inflammatory bowel disease (IBD) subjects, we observed evidence of increased ACE2 mRNA in ileum with demographic features that have been associated with poor outcomes in COVID-19 including age and raised BMI. ACE2 was downregulated in CD compared to controls in independent cohorts. Within CD, ACE2 expression was reduced in inflamed ileal tissue and also remarkably, from un-involved tissue in patients with a worse prognosis in both adult and pediatric cohorts. In active CD, small bowel ACE2 expression was restored by anti-TNF therapy particularly in anti-TNF responders. Collectively our data suggest that ACE2 downregulation is associated with inflammation and worse outcomes in CD.

scholarly journals Small Bowel Volvulus as Delayed Presentation of Undiagnosed Crohn’s Disease: A Case Report

2021 ◽  
Vol 5 (4) ◽  
pp. 455-458
Author(s):  
Minh Thu Nguyen ◽  
Amir Ali ◽  
Ryan Bodkin
Keyword(s):  
Crohn’S Disease ◽  
Case Report ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Exploratory Laparotomy ◽  
Hemodynamic Instability ◽  
Delayed Presentation ◽  
Aged Woman ◽  
Middle Aged Woman ◽  
Inflammatory Bowel

Introduction: Emergency department (ED) visits related to flare-ups of inflammatory bowel disease (IBD) are becoming more prevalent. There are many potentially dangerous complications and sequelae of uncontrolled IBD. Case Report: We report a case of a middle-aged woman who presented with a few hours of severe abdominal pain, nausea, and vomiting. Given her hemodynamic instability, she was sent urgently for computed tomography, which showed an incomplete small bowel malrotation, mesenteric volvulus, and high-grade small bowel obstruction with evolving ischemia. The patient underwent exploratory laparotomy to resect most of her small intestines. Biopsies later revealed active Crohn’s disease. Conclusion: Patients with flare-ups of IBD are common in the ED, but very few present with a midgut volvulus later in life. Our case is unique and adds to the literature due to the dramatic consequences of undiagnosed Crohn’s disease in a patient with intermittent symptoms and extensive workup spanning over two decades.

scholarly journals Surgical management of complex ileocolonic Crohn’s disease: a survey of IBD colorectal surgeons to assess variability in operative strategy

2021 ◽  
Author(s):  
E Garofalo ◽  
F Selvaggi ◽  
A Spinelli ◽  
G Pellino ◽  
K Flashman ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Surgical Management ◽  
Significant Heterogeneity ◽  
Operative Strategy ◽  
Clinical Scenarios ◽  
Colorectal Surgeons ◽  
Inflammatory Bowel ◽  
Multifocal Disease

Abstract Introduction To explore the reported variability in the surgical management of ileocolonic Crohn’ s disease and identify areas of standard practice, we present this study which aims to assess how different colorectal surgeons with a subspecialty interest in inflammatory bowel disease (IBD) surgery may act in different clinical scenarios of ileocolonic Crohn’s disease. Methods Anonymous videos demonstrating the small bowel walkthrough and anonymised patients’ clinical data, imaging and pathological findings were distributed to the surgeons using an electronic tool. Surgeons answered on operative strategy, bowel resections, management of small bowel mesentery, type of anastomosis and use of stomas. Results Eight small bowel walkthrough videos were registered and 12 assessors completed the survey with a questionnaire completion rate of 87.5%. There was 87.7% agreement in the need to perform an ileocolonic resection. However, the agreement for the need to perform associated surgical procedures such as strictureplasties or further bowel resections was only 57.4%. When an anastomosis was fashioned, the side to side configuration was the most commonly used. The preferred management of the mesentery was dissection close to the bowel. Conclusions The decision on the main procedure to be performed had a high agreement amongst the different assessors, but the treatment of multifocal disease was highly controversial, with low agreement on the need for associated procedures to treat internal fistulae and the use of strictureplasties. At the same time, there was significant heterogeneity in the decision on when to anastomose and when to fashion an ileostomy.

scholarly journals Adherence to the Porto Criteria Based on the Hungarian Nationwide Pediatric Inflammatory Bowel Registry (HUPIR)

2021 ◽  
Vol 9 ◽  
Author(s):  
Katalin E. Müller ◽  
Antal Dezsőfi ◽  
Áron Cseh ◽  
Dániel Szűcs ◽  
Noémi Vass ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Diagnostic Yield ◽  
Diagnostic Workup ◽  
Multiple Biopsy ◽  
Inflammatory Bowel ◽  
Diagnostic Work ◽  
Bowel Imaging ◽  
Small Bowel Imaging

Objectives: According to the Porto criteria, upper endoscopy and ileocolonoscopy with histology for patients with pediatric inflammatory bowel disease (pIBD) are recommended with small bowel imaging (SBI). We aimed to evaluate the adherence to the Porto criteria and biopsy sampling practice and to evaluate the diagnostic yield of magnetic resonance enterography (MRE) first time in a nationwide pIBD inception cohort.Methods: Newly diagnosed pIBD cases (ages 0–18 years) are registered in the prospective, nationwide Hungarian Paediatric IBD Registry (HUPIR). We analyzed the diagnostic workup of patients recorded between the 1st of January 2007 and the 31st of December 2016.Results: Data for diagnostic workup was available in 1,523 cases. Forty percent of the cases had complied with the Porto criteria. Adherence to the Porto criteria increased significantly from 20 to 57% (p < 0.0001) between 2007 and 2016. The most frequent reason for the incomplete diagnostic work-up was the lack of small bowel imaging (59%). In 2007, 8% of cases had a biopsy from all segments, and this rate reached 51% by 2016 (p < 0.0001). We analyzed the diagnostic yield of MRE in 113 patients (10.1%), who did not have any characteristic lesion for Crohn's disease. The MRE was positive for the small bowel in 44 cases (39%).Conclusions: Adherence to the Porto criteria increased significantly during the 10-year period. This is the first study that reports multiple biopsy sampling as the less accepted recommendation. The diagnostic yield of MRE in patients without characteristic lesion for Crohn's disease is 39%.

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