scholarly journals Pyloric stenosis as a manifestation of isolated gastric Crohn’s disease responding to intralesional steroid injection and balloon dilation: a case report

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
K. Balendran ◽  
S. Udumalagala ◽  
N. M. M. Nawaraththne
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Pyloric Stenosis ◽  
Steroid Injection ◽  
Balloon Dilation ◽  
Symptom Improvement ◽  
Pyloric Obstruction ◽  
Chronic Inflammatory Condition ◽  
Intralesional Steroid ◽  
Intralesional Steroid Injection

Abstract Background Crohn’s disease is a chronic inflammatory condition that can affect the gut from mouth to anus. Gastroduodenal involvement is seen in less than 5% of all patients with Crohn’s disease. Among those cases, isolated gastric Crohn’s disease is even rarer. Although most patients with isolated gastric involvement have nonspecific complaints, very few of them do develop features of pyloric obstruction. There is a paucity of data on specific management of gastric Crohn’s disease owing to its rarity and its frequent coexistence with colonic or ileal disease. We report a case of a patient who had pyloric stenosis as a manifestation of isolated gastric Crohn’s disease responding to intralesional steroid injection and balloon dilation. Case presentation A previously healthy woman presented with recurrent postprandial vomiting, epigastric discomfort, and unintentional weight loss over 6 months. She had no diarrhea or extraintestinal manifestations. Clinically, she was pale and dehydrated. Examination of systems was unremarkable except for mild epigastric tenderness. Her initial laboratory findings were normocytic normochromic anemia, high inflammatory markers, and hypokalemia. Esophagogastroduodenoscopy revealed an inflamed pyloric mucosa with features of pyloric obstruction. Furthermore, magnetic resonance enterography confirmed the pyloric stenosis. Histopathological examination of a biopsy from the pylorus revealed noncaseating granuloma with superficial ulceration. Tuberculosis and sarcoidosis were excluded by appropriate investigations, and a diagnosis of gastric Crohn’s disease was made. Following the initial resuscitation, intralesional steroid injection and controlled radial expansion balloon dilation of the pylorus were carried out. The patient was commenced on azathioprine as a maintenance treatment, which led to a successful dilation and remarkable symptom improvement. Conclusion Symptoms of pyloric obstruction as a manifestation of isolated gastric Crohn’s disease are extremely unusual in clinical practice, awareness of which would facilitate early appropriate investigations and treatment.

DOZ047.68: Intralesional steroid injection therapy for the treatment of esophageal anastomotic stricture in a pediatric esophageal atresia population

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
P D Ngo ◽  
A Kamran ◽  
S J Clark ◽  
R W Jennings ◽  
T E Hamilton ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Esophageal Atresia ◽  
Steroid Injection ◽  
Anastomotic Stricture ◽  
Balloon Dilation ◽  
Injection Therapy ◽  
Efficacy And Safety ◽  
Intralesional Steroid ◽  
Intralesional Steroid Injection

Abstract Background and Aims The role of intralesional steroid injection (ISI) in the treatment of anastomotic stricture in esophageal atresia (EA) patients remains unclear. The aim of this study is to evaluate the efficacy and safety of ISI in a large pediatric EA population. Methods One-hundred fifty eight EA patients who had undergone at least one ISI for the treatment of esophageal anastomotic stricture between 2010 and 2017 were identified. The change in stricture diameter (ΔD) was compared between procedures with balloon dilation alone (ISI-) and balloon dilation with steroid injection (ISI+). Assessment for change in efficacy with increasing numbers of ISI interventions was performed. Results A total of 1055 balloon dilations were performed (452 ISI+). The median ΔD was significantly greater in the group of steroid injection procedures: 1 mm (IQR 0, 3) versus 0 mm (IQR -1, 1.5) (P < 0.0001). The ISI+ group had greater percentage of improved stricture diameter (P < 0.0001) and lesser percentages of unchanged and decreased stricture diameters at subsequent endoscopy (P = 0.0009, P = 0.003). The ΔD for each of an anastomosis’ first 3 ISI+ procedures was greater than the ΔD for its subsequent ISI+ procedures: 1 mm (IQR 0, 3) versus 0.5 mm (IQR -1.25, 2) (P = 0.001). Multivariable logistic regression confirmed the significance of ISI on increasing the likelihood of improved stricture diameter. Conclusions This study demonstrates that intralesional steroid injection with dilation was well tolerated and improved anastomotic stricture diameter more than dilation alone. The benefit of ISI over dilation alone was limited to the first three ISI procedures.

Outcomes of Passable and Non-passable Strictures in Clinical Trials of Crohn’s Disease: A Post-hoc Analysis

2021 ◽  
Author(s):  
Neeraj Narula ◽  
Emily C L Wong ◽  
Parambir S Dulai ◽  
John K Marshall ◽  
Jean-Frederic Colombel ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Activity Index ◽  
Disease Activity Index ◽  
Symptom Improvement ◽  
Logistic Regression Models ◽  
Post Hoc Analysis ◽  
Endoscopic Remission ◽  
Post Hoc ◽  
The Impact

Abstract Background and Aims There is paucity of evidence on the reversibility of Crohn’s disease [CD]-related strictures treated with therapies. We aimed to describe the clinical and endoscopic outcomes of CD patients with non-passable strictures. Methods This was a post-hoc analysis of three large CD clinical trial programmes examining outcomes with infliximab, ustekinumab, and azathioprine, which included data on 576 patients including 105 with non-passable strictures and 45 with passable strictures, as measured using the Simple Endoscopic Score for Crohn’s Disease [SES-CD]. The impact of non-passable strictures on achieving clinical remission [CR] and endoscopic remission [ER] was assessed using multivariate logistic regression models. CR was defined as a Crohn’s Disease Activity Index [CDAI] &lt;150, clinical response as a CDAI reduction of ≥100 points, and ER as SES-CD score &lt;3. Results After 1 year of treatment, patients with non-passable strictures demonstrated the ability to achieve passable or no strictures in 62.5% of cases, with 52.4% and 37.5% attaining CR and ER, respectively. However, patients with non-passable strictures at baseline were less likely to demonstrate symptom improvement compared with those with passable or no strictures, with reduced odds of 1-year CR (adjusted odds ratio [aOR] 0.17, 95% CI 0.03–0.99, p = 0.048). No significant differences were observed between patients with non-passable strictures at baseline and those with passable or no strictures in rates of ER [aOR 0.82, 95% CI 0.23–2.85, p = 0.751] at 1 year. Conclusions Patients with non-passable strictures can achieve symptomatic and endoscopic remission when receiving therapies used to treat CD, although they are less likely to obtain CR compared with patients without non-passable strictures. These findings support the importance of balancing the presence of non-passable strictures in trial arms.

The Efficacy of Skin Cooling for Pain Relief during Intralesional Steroid Injection for Keloid Treatment: A Randomized Cross-Over Study

2021 ◽  
Vol 104 (11) ◽  
pp. 1752-1757
Keyword(s):  
Treatment Group ◽  
Rating Scale ◽  
Steroid Injection ◽  
Pairwise Comparison ◽  
Random Order ◽  
Repeated Measure ◽  
Skin Cooling ◽  
Intralesional Steroid ◽  
Intralesional Steroid Injection ◽  
Pre Treatment

Objective: To evaluate if pre-treatment skin cooling can reduce the pain during steroid injection. Materials and Methods: A randomized cross-over study was conducted between September 2015 and October 2016. This study received ethical approval ID035904 No. MURA2016/152. Forty-four subjects with keloid that needed intralesional steroid injection were divided into three pretreatment groups, no treatment, skin cooling with ice pack, and skin applying with a mixture of lidocaine 2.5% and prilocaine 2.5% (EMLA®), in random order. Pain intensity was measured by using 100-mm visual analogue scale (VAS). The satisfaction levels were assessed with orderly interval rating scale from 1 to 5. Repeated-measure analysis of variance (ANOVA) and Bonferroni pairwise comparison were used for data analyses. Results: The mean VAS score at the time of needle puncturing into the skin and during steroid infiltration was statistically significant lower in skin cooling compared to no treatment group (p<0.001) and EMLA group (p<0.05). The satisfaction level was also statistically significant higher in skin cooling compared to no treatment group (p<0.001) and EMLA group (p<0.001). Thirty-seven patients (84%) selected skin cooling method as the most favorable pre-anesthetic method for intralesional steroid injection. Conclusion: Skin cooling with ice before intralesional steroid injection of keloid effectively reduces pain and patients are also satisfied. Keyword: Keloid, Corticosteroid, Pre-treatment, pain, skin cooling

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