scholarly journals Granulomatous Gastritis: A Clinicopathologic Analysis of 39 Biopsy Cases

2018 ◽  
Vol 1 (2) ◽  
pp. 10-15
Author(s):  
Jouini Raja ◽  
Meriam Sabbah ◽  
Naija Meriam ◽  
Fatma Khanchel ◽  
Wafa Koubaa ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Laboratory Data ◽  
Final Diagnosis ◽  
Morphological Findings ◽  
Granulomatous Gastritis ◽  
Associated Lesions ◽  
Gastric Tuberculosis ◽  
Hematoxylin And Eosin ◽  
H Pylori

Introduction: Granulomas in gastric biopsy specimens are extremely rare. The final diagnosis of granulomatous gastritis is based on morphological findings, clinical and laboratory data. The aim of our study is to evaluate the clinical fields and to determine the etiology of gastric granulomatosis in our experience Patients and Methods: Thirty nine patients were reviewed retrospectively in the department of pathology of Habib Thameur between 2000 and 2018. Slides from all cases were stained by hematoxylin and eosin. The clinic-pathologic findings and the associated lesions were analyzed and the final etiology of the gastric granulomatosis was noted. Results: Biopsies from the 39 patients diagnosed as having granulomatous gastritis were reviewed. Mean age was 49 years (24 – 96) and sex ratio was 0,25 (M/F=8/31). Indication of endoscopy was gastric pain in 12 cases, chronic diarrhea in 6 cases, anemia in 2 cases, vomiting in 4 cases. Other symptoms were rare. Upper endoscopy was normal in 8 cases, showed antral gastropathy in 20 cases (erythematous in 6 cases, nodular in 8 cases and ulcerated in 6 cases). In four cases, fundic lesions were observed. Granuloma was unique in 14 cases and multiple in 25 cases. Localisation of granuloma was the antrum in 25 cases, the fundus in 7 cases, and both of them in 7 cases. An associated chronic gastritis was noted in 25 cases. Concerning the etiology, 10 of our patients had Crohn's disease while 6 of them had gastric tuberculosis. In five cases, H Pylori was the retained cause of gastric granulomatosis. In the other patients, the final diagnosis was sarcoidosis (n=3), foreign body reaction (n=1), yersiniosis (n=1). In our series, thirteen cases were unclassifiable. Conclusion: Although many cases remain unclassified, in most cases of granulomatous gastritis, a diagnosis of Crohn's disease or tuberculosis could be established. If this cases are excluded, an association between H. pylori and granulomatous gastritis cannot be ruled out. The others causes are extremely rare.

scholarly journals Endoscopic and Histopathological Findings of the Esophagus, Stomach, and Duodenum in Patients with Crohn’s Disease from a Reference Center in Bahia, Brazil

2021 ◽  
Vol 11 (2) ◽  
pp. 374-385
Author(s):  
Andrea Maia Pimentel ◽  
Luiz Antônio Rodrigues de Freitas ◽  
Rita de Cássia Reis Cruz ◽  
Isaac Neri de Novais Silva ◽  
Laíla Damasceno Andrade ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Mononuclear Cells ◽  
Erosive Esophagitis ◽  
Gastric Body ◽  
Polymorphonuclear Cells ◽  
Cross Sectional ◽  
Histopathological Findings ◽  
Focally Enhanced Gastritis ◽  
H Pylori

(1) The aim of the present study was to describe the endoscopic and histopathological findings in the esophagus, stomach, and duodenum in patients with Crohn’s disease. (2) Methods: This was a cross-sectional study that included patients receiving treatment from the inflammatory bowel disease outpatient clinic. Esophagogastroduodenoscopies with biopsies of the stomach and proximal duodenum were performed. Presence of Helicobacter pylori bacteria was assessed by Giemsa staining. (3) Results: We included 58 patients. Erosive esophagitis was identified in 25 patients (43.1%), gastritis was diagnosed in 32 patients (55.2%) and erosive duodenitis was found in eight (13.8%). The most frequent histopathological finding in the H. pylori-positive group was increased inflammatory activity in the gastric body and antrum, with a predominance of mononuclear and polymorphonuclear cells. In turn, the most frequent finding in the H. pylori-negative group was chronic inflammation with predominance of mononuclear cells. Focally enhanced gastritis was identified in four patients (6.9%), all of whom were negative for H. pylori. Granulomas were not observed. H. pylori infection was present in 19 patients (32.8%). (4) Conclusions: Nonspecific endoscopic and histological findings were frequent in patients with Crohn’s disease. Focally enhanced gastritis was uncommon and observed only in H. pylori-negative patients. The time from the diagnosis, patient age, and therapy in use may have influenced the nondetection of epithelioid granuloma.

Capsule endoscopy in small bowel Crohn’s disease and Tuberculosis

2017 ◽  
Vol 47 (2) ◽  
pp. 113-118 ◽  
Author(s):  
Surinder Singh Rana ◽  
Vishal Sharma ◽  
Ravi Sharma ◽  
Ritambhra Nada ◽  
Rajesh Gupta ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Gastrointestinal Tract ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Capsule Endoscopy ◽  
Ileocecal Valve ◽  
Final Diagnosis ◽  
Diagnostic Challenge ◽  
Large N ◽  
Aphthous Ulcers

Differentiation of small bowel tuberculosis (SBTB) from Crohn’s disease (CD) is a diagnostic challenge. We studied 52 patients with suspected SBTB or CD with terminal ileal involvement, who were prospectively enrolled. After confirming patency of the gastrointestinal tract, 26 patients underwent capsule endoscopy (CE). A final diagnosis of CD was found in 18 patients and SBTB in eight patients. All SBTB patients had involvment of the ileocecal valve (ICV) with large (n = 6) and aphthous (n = 2) ulcers in the ileal segment. In CD, ICV involvement was seen in five (33%) patients. Large and aphthous ulcers were observed in seven (47%) and 15 (100%) patients, respectively. On comparison with CD, patients with SBTB had increased frequency of ICV involvement ( P = 0.002) and lesser frequency of aphthous ulcers ( P = 0.007). CE can help in differentiating CD from SBTB by the position of its involvement and the type of ulcers present.

scholarly journals Predictors of Ustekinumab Failure in Crohn’s Disease After Dose Intensification

2020 ◽  
Author(s):  
Rahul S Dalal ◽  
Cheikh Njie ◽  
Jenna Marcus ◽  
Sanchit Gupta ◽  
Jessica R Allegretti
Keyword(s):  
Logistic Regression ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Cox Regression ◽  
Laboratory Data ◽  
Perianal Disease ◽  
Secondary Outcome ◽  
Opioid Use ◽  
Dose Intensification ◽  
Multivariable Logistic Regression

Abstract Background Many patients with Crohn’s disease (CD) who lose response to the standard ustekinumab dose interval of every 8 weeks (q8w) undergo dose intensification to q4w or q6w. However, baseline factors that predict success or failure after dose intensification are unknown. We sought to identify predictors of failure of ustekinumab after dose intensification for patients with CD. Methods This was a retrospective cohort study of adult CD patients undergoing ustekinumab dose intensification at a tertiary referral center between January 1, 2016, and January 31, 2019. Electronic health records were reviewed to obtain patient demographics, CD history, and laboratory data. The primary outcome was failure to achieve corticosteroid-free remission (Harvey-Bradshaw Index <5) within 12 months after intensification. The secondary outcome assessed was time to new biologic therapy after dose intensification. We used multivariable logistic regression and Cox regression to identify predictors of these outcomes. Results We included 123 patients who underwent ustekinumab dose intensification to q4w (n = 64), q5w (n = 1), q6w (n = 55), or q7w (n = 3). Multivariable logistic regression demonstrated that perianal disease, Harvey-Bradshaw Index, and opioid use at time of intensification were associated with failure to achieve remission. Cox regression demonstrated that perianal disease and corticosteroid use at time of intensification were associated with shorter time to a new biologic. Conclusion Perianal disease, Harvey-Bradshaw Index, current opioid use, and current corticosteroid use are associated with ustekinumab failure after dose intensification in CD. Larger, prospective studies are needed to corroborate these findings and guide therapeutic strategies for patients who lose response to standard ustekinumab dosing.

scholarly journals Primary Gastric Tuberculosis Presenting as Non-Healing Ulcer and Mimicking Crohn's Disease

2011 ◽  
Vol 50 (5) ◽  
pp. 439-442 ◽  
Author(s):  
Naoki Ishii ◽  
Keiichi Furukawa ◽  
Toshiyuki Itoh ◽  
Yoshiyuki Fujita
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Healing Ulcer ◽  
Gastric Tuberculosis

scholarly journals Organizing Pneumonia in a Patient with Quiescent Crohn’s Disease

2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Satoshi Tanida ◽  
Masaya Takemura ◽  
Tsutomu Mizoshita ◽  
Keiji Ozeki ◽  
Takahito Katano ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Maintenance Therapy ◽  
Rare Complication ◽  
Final Diagnosis ◽  
Pathological Examination ◽  
Organizing Pneumonia ◽  
Moderate Risk ◽  
Sustained Improvement

A 64-year-old man with Crohn’s disease (CD) was admitted to our hospital due to moderate risk of pneumonia while receiving scheduled adalimumab maintenance therapy. Symptoms remained virtually unchanged following administration of antibiotics. A final diagnosis of organizing pneumonia (OP) was made based on findings of intra-alveolar buds of granulation tissue and fibrous thickening of the alveolar walls on pathological examination and patchy consolidations and ground glass opacities on computed tomography. Immediate administration of prednisolone provided rapid, sustained improvement. Although a rare complication, OP is a pulmonary manifestation that requires attention in CD patients.

scholarly journals Efficacy and Safety of Biosimilar Infliximab in Bio-naïve Patients With Crohn’s Disease

2021 ◽  
Author(s):  
Tsubasa Oike ◽  
Naoki Akizue ◽  
Yuki Ohta ◽  
Hirotaka Koseki ◽  
Masaya Saito ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Remission Rate ◽  
Laboratory Data ◽  
Mucosal Healing ◽  
Efficacy And Safety ◽  
Laboratory Findings ◽  
Factor Α ◽  
Necrosis Factor ◽  
Retrospective Multicenter Study

Abstract The infliximab biosimilar CT-P13 was the first biosimilar drug targeting tumor necrosis factor-α. However, its efficacy and safety in real-world clinical situations have remained insufficient. Therefore, we aimed to verify the efficacy and safety of CT-P13 in bio-naïve patients with Crohn’s disease. This retrospective multicenter study compared the remission rate at week 54 between patients with Crohn’s disease treated with originator infliximab or CT-P13. Endoscopic and laboratory findings were assessed in both groups. A total of 184 (156 originator and 28 CT-P13) patients were analyzed. Of these, 138 originator users and 19 biosimilar users completed 54-week administration. The clinical remission rates in patients taking originator infliximab of CT-P13 at week 54 were 92.5% and 100%, respectively. The endoscopic scores of each group significantly decreased from baseline at week 54 in both groups, and the mucosal healing rate at week 54 was 53% and 64%, respectively. Laboratory data significantly improved from baseline to week 14 and 54 in both groups. Adverse events were observed more frequently in the CT-P13 group ( 25% vs. 4.5%, p = 0.0015). The efficacy of CT-P13 were comparable with those of originator infliximab in bio-naïve patients with Crohn’s disease evaluated by clinical, endoscopic, and laboratory findings.

scholarly journals The gastric microbiota in patients with Crohn’s disease; a preliminary study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jerzy Ostrowski ◽  
Maria Kulecka ◽  
Iwona Zawada ◽  
Natalia Żeber-Lubecka ◽  
Agnieszka Paziewska ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Pairwise Comparison ◽  
16S Rrna Gene Sequencing ◽  
Rrna Gene ◽  
Bacterial Phyla ◽  
Abundant Otus ◽  
Significant Difference ◽  
H Pylori ◽  
Gastric Microbiota

AbstractThe gastric microbiota in Crohn’s disease (CD) has not been studied. The purpose of the study was to evaluate differences of stomach microbiota between CD patients and controls. DNA was extracted from gastric mucosal and fluid samples, from 24 CD patients and 19 controls. 16S rRNA gene sequencing identified 1511 operational taxonomic units (OTUs), of which 239 passed the low abundance and low variance filters. All but one CD patients were HP negative. Fifteen bacterial phyla were identified in at least one mucosal or fluid site. Of these, Bacteroidota and Firmicutes accounted for 70% of all phyla. Proteobacteria, Actinobacteriota, and Fusobacteriota combined accounted for 27%. There was significant difference in the relative abundance of Bacteroidota, Proteobacteria, Fusobacteriota, and Campilobacterota between CD patients and controls only in gastric corpus samples. In gastric liquid, there was a significant difference only in Actinobacteriota. Pairwise comparison identified 67 differentially abundant OTUs in at least one site. Of these, 13 were present in more than one comparison, and four differentiating OTUs (Neisseriaceae, Neisseria, Absconditabacteriales, and Microbacteriaceae) were identified at all tested sites. The results reveal significant changes in gastric microbial profiles (beta diversity, phylum, and individual taxa levels) between H. pylori-negative CD patients and controls.

scholarly journals P074 Histopathologic evaluation and lymphocyte subpopulations of the upper digestive tract of Crohn’s disease

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S172-S173
Author(s):  
A Martin Cardona ◽  
A Carrasco García ◽  
E Tristán Lopez ◽  
Y Zabana Abdo ◽  
M Aceituno Quintanilla ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Celiac Disease ◽  
Crohn's Disease ◽  
Digestive Tract ◽  
Activity Index ◽  
Lymphocyte Subpopulations ◽  
Histopathological Study ◽  
Clinical Parameters ◽  
Upper Digestive Tract ◽  
H Pylori

Abstract Background The histology of the duodenum of Crohn’s disease (CD) has been scarcely explored. Lymphocytic enteritis (LE) and duodenal atrophy were described in CD but the prevalence is unknown and in some cases it raises the differential diagnosis with celiac disease. It is unknown if there is a cytometric-specific pattern of lymphocyte subpopulations of CD as it occurs in celiac disease (increased TCRγδ+ and decreased CD3− lymphocytes) (Fernández-Bañares F. PLoS One 2014). Objectives: Duodenal evaluation of CD: (1) histopathology, (2) lymphocyte subpopulations and (3) association of histopathological abnormalities with clinical parameters. Methods A total of 134 patients (82 CD, 52 celiac) and 13 controls were prospectively included. Endoscopic, histopathological and clinical parameters were recorded: calprotectin, Harvey–Bradshaw activity index, Montreal classification, treatment regimen, celiac disease work-up, H. pylori and stool parasites. Lymphocyte subpopulations [CD4+, CD8+, DP(CD4+CD8+), DN(CD4-CD8−), TCRγδ and CD3−] were evaluated by flow cytometry. Kruskal–Wallis and U of Mann–Whitney were used as statistical method. Results Twenty-five CD patients (30.5%) showed macroscopic involvement of the upper digestive tract (L4). The histopathological study was normal in 46 (56.1%) and showed abnormalities in 36 [7.3% chronic inflammatory infiltrate (of these one granulomas and three LE); 36% isolated LE]. In 20 cases, LE was considered to be due to CD (62.5%), while in 12 (37.5%) it was due to H. pylori (n = 8), NSAIDs (n = 2) and parasites (n = 2). The gastric and oesophageal mucosa showed abnormalities in 64.2% (chronic gastritis) and 15.4%, respectively. No relationship was found between histopathological abnormalities, activity, treatment and the outcome of CD. CD4+ and CD8+ subpopulations did not differ from controls and CD at diagnosis, but they have an increased ‘helper’ response (CD4+) and a reduced suppressor response (CD8+) in previously diagnosed CD (p < 0.0001). There were no differences in DP(CD4+CD8+), whereas DN(CD4−CD8−) were increased in both early and late CD (p = 0.008 vs. controls). Celiac disease presented much more marked changes than CD with decreased ‘helper’ CD4+, suppressors CD8+ and DP(CD4+CD8+) (p < 0.0001 vs. controls and CD), whereas DN(CD4−CD8−) were much more increased than in CD (p < 0.0001). The characteristic celiac cytometric pattern was not detected in CD. Conclusion LE (not atrophy) is a frequent finding in the duodenum of CD. Despite being indistinguishable from celiac LE, the immune response is completely different and could be used for diagnostic purposes. The increase in ‘atypical’ DN lymphocytes from the early CD suggests that it is an intrinsic immune alteration that deserves further characterisation by using multiparametric cytometry.

scholarly journals The Anti-Saccharomyces Cerevisiae Antibody Assay in a Province-Wide Practice: Accurate in Identifying Cases of Crohn’s Disease and Predicting Inflammatory Disease

2005 ◽  
Vol 19 (12) ◽  
pp. 717-721 ◽  
Author(s):  
Brinderjit Kaila ◽  
Kenneth Orr ◽  
Charles N Bernstein
Keyword(s):  
Saccharomyces Cerevisiae ◽  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Celiac Disease ◽  
Crohn's Disease ◽  
Inflammatory Disease ◽  
Gastrointestinal Symptoms ◽  
Final Diagnosis ◽  
Elisa Test ◽  
Indeterminate Colitis

OBJECTIVE: To determine the utility of the anti-Saccharomyces cerevisiae antibody (ASCA) ELISA test developed in Manitoba in 2001 in a population-wide sample referred from physicians across Manitoba in their investigation of patients with gastrointestinal symptoms.METHODS: Patients whose serum was referred for ASCA testing in 2001 and 2002 were eligible for the present study. ELISA was performed by a technologist, blind to patient diagnoses. A single investigator contacted physicians to facilitate chart review. Data collected included demographics, final diagnoses and tests used to substantiate the final diagnosis.RESULTS: Of 482 subjects identified, 410 charts were available for review and 29 of those were unavailable for follow-up or had incomplete charts. The present study population included Crohn's disease (CD, n=114), ulcerative colitis (n=74), indeterminate colitis (n=31), celiac disease (n=9), irritable bowel syndrome (n=75), other diagnoses (n=33) and no disease (n=45). ASCA had a sensitivity of 37% (95% CI 27.8 to 46.8) and specificity of 97% (95% CI 93.8 to 98.6) for diagnosing CD and an odds ratio for a diagnosis of CD of 18.4 (95% CI 8.2 to 41.3). The 47 ASCA-positive patients included the following diagnoses: CD=39, ulcerative colitis=3, indeterminate colitis=1, celiac disease=3 and no disease=1. The likelihood of having an inflammatory disease if ASCA is positive was nearly 40-fold.CONCLUSION: A positive ASCA test using this assay nearly clinches a diagnosis of some form of inflammatory intestinal disease, which is highly likely to be CD. In symptomatic patients, a positive ASCA test should encourage the clinician to pursue further investigations

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